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Factors Associated With Responsiveness to Gait and Balance Training in People With Parkinson Disease

Löfgren, Niklas, RPT, PhD; Conradsson, David, RPT, PhD; Joseph, Conran, RPT, PhD; Leavy, Breiffni, RPT, PhD; Hagströmer, Maria, RPT, PhD; Franzén, Erika, RPT, PhD

Journal of Neurologic Physical Therapy: January 2019 - Volume 43 - Issue 1 - p 42–49
doi: 10.1097/NPT.0000000000000246
Research Articles

Background and Purpose: Although increasing evidence supports the benefit- of exercise among people with Parkinson disease (PwPD), it is unclear whether a given exercise modality suits all PwPD, given the heterogeneity of the disease. The purpose of this study was to explore factors associated with responsiveness to a highly challenging training intervention that incorporated dual-task exercises.

Methods: Forty-seven PwPD (mean age: 73 years; 19 females, Hoehn and Yahr stages 2-3) who had participated in 10 weeks of highly challenging gait and balance training were included. Baseline demographics, disease-related factors, physical and cognitive ability, and perceived health were used for the prediction of percent change in balance performance (the Mini-BESTest) and comfortable gait speed between the pre- and postassessments, using multiple linear regression analyses.

Results: Thirty-five percent of the variance of change in balance performance was explained by General Health Perceptions (β = −0.36), the Timed Up and Go test (β = −0.33), and the single-task performance of a cognitive task (β = −0.24). Forty-nine percent of change in gait speed was explained by gait speed while performing a dual task (β = −0.46), dual-task interference while walking (β = 0.43), time to complete the Timed Up and Go test (β = −0.29), and percent error on a cognitive task (β = −0.25).

Discussion and Conclusions: The results may suggest that the PwPD with overall lower perceived health, functional mobility, and cognitive functions are the ones most likely to benefit from highly challenging and attention-demanding gait and balance training.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at:

Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden (N.L., D.C., C.J., B.L., M.H., E.F.); Function Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden (N.L., D.C., B.L., M.H., E.F.); Community Health Sciences Faculty, Physiotherapy Department, University of the Western Cape, Bellville, South Africa (C.J.); and Stockholms Sjukhem, R&D Unit, Stockholm, Sweden (E.F., B.L.).

Correspondence: Niklas Löfgren, RPT, PhD, Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Alfred Nobels Allé 23, Huddinge, Stockholm 141 83, Sweden ( or

This work represents a preplanned secondary analysis from a randomized clinical trial that has previously been published. However, the specific contents of this manuscript have never been published elsewhere, nor presented at any scientific meeting.

This study was funded by the Swedish Research Council, Karolinska Institutet, Neuro Sweden, the Swedish Parkinson Association, FORTE, and the Vårdal foundation.

Trial registration number: NCT01417598.

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (

© 2019 Academy of Neurologic Physical Therapy, APTA