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Trunk Exercises Improve Gait Symmetry in Parkinson Disease

A Blind Phase II Randomized Controlled Trial

Hubble, Ryan P., PhD; Naughton, Geraldine, PhD; Silburn, Peter A., PhD, FRACP; Cole, Michael H., PhD

American Journal of Physical Medicine & Rehabilitation: March 2018 - Volume 97 - Issue 3 - p 151–159
doi: 10.1097/PHM.0000000000000858
Original Research Articles CME Article . 2018 Series . Number 3

Objective Deficits in step-to-step symmetry and trunk muscle activations have been linked to falls in Parkinson disease. Given such symptoms are poorly managed with anti-parkinsonian medications, alternate therapies are needed. This blind phase II randomized controlled trial sought to establish whether exercise can improve step-to-step symmetry in Parkinson disease.

Design Twenty-four Parkinson disease patients with a falls history completed baseline assessments of symptom severity, balance confidence, mobility, and quality of life. Step-to-step symmetry was assessed by deriving harmonic ratios from three-dimensional accelerations collected for the head and trunk. Patients were randomly assigned to either 12 wks of exercise and falls prevention education or falls prevention education only. Both groups repeated the baseline tests 12 and 24 wks after the initial assessment. The Australian and New Zealand Clinical Trials Registry number is ACTRN12613001175763.

Results At 12 wks, the exercise group had statistically significant and clinically relevant improvements in anterior-posterior step-to-step trunk symmetry. In contrast, the education group recorded statistically significant and clinically meaningful reductions in medial-lateral and vertical step-to-step trunk symmetry at 12 wks.

Conclusions Given that step-to-step symmetry improved for the exercise group and declined for the education group after intervention, active interventions seem more suited to increasing independence and quality of life for people with Parkinson disease.

To Claim CME Credits Complete the self-assessment activity and evaluation online at

CME Objectives Upon completion of this article, the reader should be able to do the following: (1) Describe the effect deficits in trunk muscle function have on gait in individuals with Parkinson disease; (2) Identify the benefits of targeted trunk exercises on step-to-step symmetry; and (3) Discuss the benefits of improving step-to-step symmetry in individuals with Parkinson disease.

Level Advanced

Accreditation The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

From the Australian Catholic University, School of Exercise Science, Banyo, Queensland, Australia (RPH, MHC); Australian Catholic University, School of Exercise Science, Fitzroy, Victoria, Australia (GN); and Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia (PAS).

All correspondence should be addressed to: Ryan P. Hubble, PhD, Department of Kinesiology, Wesley College, 120 N State St, Dover, DE 19901; Michael H. Cole, PhD, School of Exercise Science, Australian Catholic University, PO Box 456, Virginia, Queensland, 4014 Australia.

RPH was supported by an international PhD scholarship provided by the Australian Catholic University. MHC received research support from the Australian National Health and Medical Research Council (NHMRC) and the Australian Catholic University.

This project was supported by research funding provided by the Australian Catholic University. MHC was supported by an Australian National Health and Medical Research Council (NHMRC) Early Career Researcher Fellowship (Project #GNT1016481) and research funding provided by the Australian Catholic University (Project #2013000570). The funding bodies did not contribute to data collection or data analysis and played no part in the decision to prepare and publish this article.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

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