Parkinson's disease (PD) is a neurological disease which causes tremors, slow movement, poor mobility, and balance. The current prevalence of PD in the UK is 1 in 37, but by 2025 this is thought to increase by 23.2% due to an increasingly ageing population (1).
Parkinson's Disease and Falls Risk
"Two thirds of people with Parkinson's disease fall each year" (1).
PD patients are twice as likely to fall than their peers. This is caused by motor symptoms such as postural instability, bradykinesia (slow movement), and rigidity (stiffness). But non-motor symptoms may also cause falls, these include low blood pressure, fatigue, dizziness, and a decline in cognitive function (2). This increased risk of falls exposes the individuals to potential injury and decreased quality of life (3).
Falls Prevention
A study by Sparrow et al (4), studied the effects of a highly challenging and progressive balance programme on individuals with PD. The study found that after 3 months individuals' risk of falls significantly decreased along with a reduced fear of falls and an increase of balance. However, this study had a very small sample size and only included those with mild-moderate PD.
A systematic review and meta-analysis by Mansfield et al (5) also reviewed the effects of balance training programmes on falls prevention. The review included 8 studies, 3 of those consisting of PD patients. The meta-analysis suggested that the balance exercise interventions successfully reduced risk of falls. Although, the study stated that the interventions reviewed varied greatly and no ideal intervention model has been created yet.
Berg-Balance Test
The Berg Balance Test (6) is a great tool to assess balance before you start including balance exercises in your exercise routine and after to track improvements. It has been shown to be a reliable and valid test with PD patients (2,7,8). The test consists of a series of 14 items, ranging from sitting to standing, to standing on one leg. Each item is scored, scores are then added together to create a final score of balance. If performing the test at home, ensure you have someone stable to supervise in case of a fall.
Recommended Balance Exercises
Here is a video of a variety of balance exercises used successfully in previous interventions.
Exercise Guidelines
The American College of Sports Medicine (ACSM) recommend that individuals with PD incorporate balance exercises into a daily routine, or if not possible perform for at least 2/3 days a week (9). The ACSM PD guidelines also detail that these individuals should partake in strength and aerobic exercises along with a range of stretches for 2-3 days a week for at least 30 minutes. This is said to improve motor and non-motor symptoms of PD (9).
Further Falls Prevention
The Parkinson's Foundation (2) recommend keeping the home a clutter free space to eliminate risk of falls. This includes tucking away electrical cords, removing rugs, and anything else that can act as a potential trip hazard. Installing grab bars around the bathroom is also suggested to prevent a possible fall.
In case a fall does occur, the following video demonstrates how to get up from the floor safely.
References
1. National Institute for Health and Care Excellence, Parkinson's Disease, 2022.
2. Parkinson's Foundation: Falls prevention, 2018.
3. Pelicioni PH, Menant JC, Latt MD, Lord SR. Falls in Parkinson’s disease subtypes: risk factors, locations and circumstances. International journal of environmental research and public health. 2019 Jan;16(12):2216.
4. Sparrow, D., DeAngelis, T.R., Hendron, K., Thomas, C.A., Saint-Hilaire, M. and Ellis, T., 2016. Highly challenging balance program reduces fall rate in Parkinson disease. Journal of neurologic physical therapy: JNPT, 40(1), p.24.
5. Mansfield, A., Wong, J.S., Bryce, J., Knorr, S. and Patterson, K.K., 2015. Does perturbation-based balance training prevent falls? Systematic review and meta-analysis of preliminary randomized controlled trials. Physical therapy, 95(5), pp.700-709.
6. Berg K, Maki B, Williams JI, Holliday P, Wood-Dauphinee S: A comparison of clinical and
laboratory measures of postural balance in an elderly population. Arch Phys Med Rehabil, 73:
1073-1083, 1992.
7. Qutubuddin, A.A., Pegg, P.O., Cifu, D.X., Brown, R., McNamee, S. and Carne, W., 2005. Validating the Berg Balance Scale for patients with Parkinson’s disease: a key to rehabilitation evaluation. Archives of physical medicine and rehabilitation, 86(4), pp.789-792.
8. Babaei-Ghazani, A., Mohammadi, H., Shahidi, G.A., Habibi, S.A.H., Forogh, B., Ahadi, T. and Eftekharsadat, B., 2017. Reliability and validity of the Persian translation of Berg Balance Scale in Parkinson disease. Aging clinical and experimental research, 29(5), pp.857-862.
9. Lisa Hoffman, American College of Sports Medicine: Exercise Guidelines for Parkinson's, 2021.
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