Parkinson's disease is a progressive neurodegenerative disorder that affects neurophysiologic function, movement abilities, and quality of life (QOL). Research examining the effects of exercise has suggested benefits related to a variety of outcomes; however, no reviews have synthesized research findings across the spectrum of disability. This project sought to systematically review studies that examined the impact of exercise interventions on balance outcomes for people with Parkinson's disease, within the categories defined by the World Health Organization in the International Classification of Functioning, Disability, and Health (ICF) model. A systematic review of medical literature databases was performed using keywords Parkinson's disease and exercise. Studies were eligible if the intervention included exercise and examined variables within one of the three ICF categories. Following the ICF model, outcomes regarding Body Structure and Function, Activity, and Participation were measured, respectively, in terms of postural instability, balance task performance, and QOL and fall events. Within the Body Structure and Function category, there was moderate evidence that exercise resulted in improvements in postural instability. Within the Activity category, there was moderate evidence that exercise was effective for improving balance task performance. In contrast, within the Participation category, there was limited evidence that exercise resulted in improvements in QOL measures or fall events. Regardless of the strength of the evidence, the studies reviewed all report that exercise resulted in improvements in postural stability and balance task performance. Despite these improvements, the number and quality of the studies and the outcomes used were limited. There is a need for longer term follow-up to establish trajectory of change and to determine if any gains are retained long term. The optimal delivery and content of exercise interventions (dosing, component exercises) at different stages of the disease are not clear.

Postural control problems, falls, and fall-related injuries are a common source of morbidity in elderly individuals, especially those with Parkinson disease (PD). Clinical balance tests such as the Berg balance scale and the functional reach have been reported to be useful in assessing fall risk in elderly individuals. However, the utility of commonly used clinical balance tests as accurate screens for fall risk has not been sufficiently examined in persons with PD. The purposes of this study were to identify which commonly used clinical balance tests of persons with PD were predictive of falls, to re-examine the cutoff scores for these tests with the goal of maximizing sensitivity as well as minimizing the negative likelihood ratio, and to determine which of the clinical balance tests had the most value in predicting falls. Forty-five persons with a diagnosis of idiopathic PD, aged 39-90 years (mean [sd] =69.94 [11.28]; mean [sd] Hoehn and Yahr level = 2.60 [.66]) participated. Upon initial contact with participants, demographics and fall history were gathered and baseline physical examinations were performed. Each individual underwent balance testing with the functional reach test, the Berg balance scale, the dynamic gait index, timed up and go, and the cognitive timed up and go. Fallers and nonfallers were divided based on fall history and groups were compared on balance test performance. Sensitivity, specificity, likelihood ratios, and receiver operator characteristic curves were calculated for all balance tests. Twenty-five (55%) participants had a history of falls. Using cut-off scores reported in previous studies, the sensitivity of all tests was low (less than 0.60) and the specificity was high (greater than 0.85). Reconsideration of the cut-off scores resulted in increased sensitivity for all tests (greater than 0.75) and low negative likelihood ratios (less then .30). Given the large financial, psychological, and physical complications that are associated with a fall and relatively little harmful effects of fall prevention interventions, we propose consideration of cut-off scores that maximize sensitivity for individuals with PD. Regardless of the performance on any individual clinical balance test, the multifactorial nature of postural instability in PD may necessitate a battery of tests to provide the most accurate identification of fall risk.

Background and Purpose: Relatively little is known about the natural evolution of physical activity–related participation restrictions associated with Parkinson's disease (PD). We examined this issue prospectively, using continuous monitoring technology to capture the free-living ambulatory activity of persons with PD engaging in life situations. We specifically sought (1) to explore natural, long-term changes in daily ambulatory activity and (2) to compare the responsiveness of ambulatory activity parameters to clinical measures of gait and disease severity. Methods: Thirty-three persons with PD participated (Hoehn and Yahr range of 1–3). Participants wore a step activity monitor for up to 7 days at baseline and again at 1-year follow-up. Mean daily values were calculated for parameters indicative of amount, intensity, frequency, and duration of ambulatory activity. Clinical measures included the Unified Parkinson Disease Rating Scale, the 6-Minute Walk, and Maximal Gait Speed. Parametric tests for paired samples were used to investigate changes in ambulatory activity parameters and clinical measures. Results: Participants had significant declines in the amount and intensity of daily ambulatory activity but not in its frequency and duration (P < 0.007). Declines occurred in the absence of changes in clinical measures of gait or disease severity. The greatest 1-year decline occurred in the number of daily minutes participants spent engaging in at least moderate-intensity ambulatory activity. Conclusion: Continuous monitoring of ambulatory activity beyond mere step counts may serve as a distinct and important means of quantifying declining ambulatory behavior associated with disease progression or improved ambulatory behavior resulting from rehabilitation and medical and/or surgical interventions in persons with PD.