Reducing Fall Rates for People with Parkinson’s

Reducing Fall Rates for People with Parkinson’s

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Falling and fear of falling terrify many people with moderate-to-advanced Parkinson’s disease.  According to a 2016 study (Highly Challenging Balance Program Reduces Fall Rate in Parkinson Disease), “Sixty-eight percent of people living with PD…sustain at least one fall per year, which is double the fall rate reported in healthy older adults.”

Furthermore, “Falls are a major cause of disability and reduced quality of life in people with PD and result in devasting injuries such as hip fractures, which are significantly more common in PD than in those with other medical conditions.  In addition, falls are associated with increased risk of hospital and nursing home admissions and ultimately with decreased survival rates.  The economic impact related to health care costs is about twice as much in fallers as nonfallers with PD.”

What’s not to hate?

Fortunately, the authors review previous research before embarking on their own project to reduce falls.  “Balance exercises alone, balance combined with strengthening exercises, cueing, gait training on a treadmill, tai chi, and functional training have all been shown to improve balance control in PD,” they write, adding that these approaches suggest that “higher doses of training and highly challenging balance training (i.e., exercises that specifically involved movement of the center of mass, narrowing the base of support, and minimizing the upper extremity support ) had the most robust outcomes…and may be necessary to reduce falls.”

The authors set up their own experiment, a three-month, high-intensity balance program for mild-to-moderate Parkies (average age:  67 years old; average disease duration:  4.3 years).  What was unique, in my opinion, was that the researchers did the experiment twice.  They divided their group of 23 participants into two separate cohorts:  One cohort received rigorous training (90 minutes of intensive exercises, twice a week) to improve their balance for three months, while the other cohort was left to their usual routines, whatever those were.  At the end of three months, both groups were tested and interviewed.  Then they switched:  the members of the first group, which had already received the training, were left to their own devices, while the second group participated in the training.  For both groups, the training sessions were modified for the individual Parkie.  If someone was managing the exercises so well it was no longer a challenge, the researchers added weighted vests or varied the surface conditions to beef up the challenge.

It’s unclear to me precisely what happened during the training, as the authors don’t describe it.  But apparently, these were some of the things that the participants worked on:

• Calf raises
• Push-ups or planks
• Reaching overhead
• Squats
• Stand unassisted from sitting
• Ball toss (while walking? it’s not clear)
• Standing on an incline
• Standing on foam
• Squats on foam
• Walking while doing another task
• Walking backwards

And while the experiment succeeded in reducing falls and fear of falling, I can’t say by how much, as that section of the article dives deeply into the wonderful, wackadoodle world of statistics.  Sample sentence:  “A repeated measures negative binomial regression using the generalized estimating equation approach indicated a statistically significant effect (coefficient = -0.015 per day, P < 0.001).”  If I understand it correctly, there was an overall 37% decline in the fall rates per month of training.

What are some of the take-aways?

1. Balance training alone doesn’t succeed as well as balance training with added strength training.
2. High doses of physical training are a must (90 minutes, twice a week).
3. Unfortunately, the effects of training wear off over time, meaning you must continue these exercises and increase the challenges in the future.

I see I can apply this information to my own workouts, especially by adding the bulleted list of activities above (calf raises, squats on foam, push-ups) to my daily routines.