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Trunk Exercises Improve Balance in Parkinson Disease

A Phase II Randomized Controlled Trial

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

Journal of Neurologic Physical Therapy: April 2019 - Volume 43 - Issue 2 - p 96–105
doi: 10.1097/NPT.0000000000000258
Research Articles

Background and Purpose: Trunk control is important for maintaining balance; hence, deficient trunk control may contribute to balance problems in people with Parkinson disease (PD). Unfortunately, this deficit is poorly managed with pharmacological therapies, emphasizing the need for alternative therapies for these patients. This randomized controlled trial sought to examine the effects of a 12-week trunk-specific exercise-based intervention on balance in people with PD.

Methods: Twenty-four people with PD and with a history of falls completed assessments of motor symptom severity, balance confidence, mobility, quality of life, and quiet-standing balance. Participants were then randomized to receive either 12 weeks of exercise or education and reassessed after 12 and 24 weeks.

Results: Linear mixed-models analyses showed no significant changes in clinical outcomes following the intervention. However, during quiet standing, sway area on a foam surface without vision was reduced for the exercise group at 12 (−6.9 ± 3.1 cm; 95% confidence interval [CI] = −13.1 to −0.7; P = 0.029; d = 0.66) and 24 weeks (−7.9 ± 3.1 cm; 95% CI = −14.1 to −1.7; P = 0.013; d = 0.76). Furthermore, the exercise group demonstrated reduced sway variability at 12 (−0.2 ± 0.1 cm; 95% CI = −0.4 to 0.0; P = 0.042; d = 0.62) and 24 weeks in the medial-lateral direction (−0.2 ± 0.1 cm; 95% CI = −0.4 to 0.0; P = 0.043; d = 0.62). No changes in quiet standing balance were recorded for the education group.

Discussion and Conclusions: The results of this study suggest that exercise-based interventions targeting trunk strength, endurance, and mobility may be effective for improving quiet-standing balance in people with PD. However, additional research is needed to determine whether these improvements are sufficient to reduce falls risk.

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

Department of Kinesiology, Wesley College, Dover, Delaware (R.P.H.); Australian Catholic University, School of Exercise Science, Banyo, Queensland, Australia (R.P.H., M.H.C.); Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia (P.A.S.); and Australian Catholic University, School of Exercise Science, Fitzroy, Victoria, Australia (G.A.N.).

Correspondence: Ryan P. Hubble, PhD, MD, Department of Kinesiology, Wesley College, 120 North State St, Dover, DE 19901 ( or Michael H. Cole, PhD, Australian Catholic University, School of Exercise Science, PO Box 456, Virginia, Queensland, Australia 4014 (

Authors R.H. and M.C. were involved with the research project conception, organization and execution, statistical analysis design, execution and review and critique, and the manuscript review and critique. Author R.H. was responsible for writing the first draft of the manuscript. Author P.S. was involved with the organization of the project and the review and critique of the manuscript. Author G.N. was involved with the review and critique of the manuscript.

The authors declare no conflict of interest.

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

Australian and New Zealand Clinical Trials Registry Number: ACTRN12613001175763.

© 2019 Academy of Neurologic Physical Therapy, APTA