Objective: To characterize responsiveness to a highly challenging balance and gait intervention (HiBalance) in participants with Parkinson’s disease (PD).

Background: Exercise potentially improves gait, balance, and physical activity in people with PD. However, given the heterogeneous nature of the disease, it is likely that people respond differently to exercise interventions. “One size does not fit all” is highly applicable to exercise interventions and factors determining responsiveness need further investigation.

Method: Thirty-nine participants with mild-moderate PD (mean age 70, range 61-83 years) who underwent the HiBalance intervention from our randomized controlled trial (1) were included. We explored three different response domains 1) balance based on the Mini-BESTest, 2) gait based on gait velocity measured with a pressure-sensitive mat, and 3) physical activity based on steps per day measured with accelerometers. In each domain, we defined responsiveness levels according to the change from pre- to post-intervention, divided into three levels: high, low, or non-responders based on cut-offs for clinically meaningful differences. Separate Random Forest Supervised Classification Analyses were used for each responder domain including clinically relevant variables.

Results: Only the Random Forest for the balance domain classified all responsiveness levels above the chance level. The number of falls, gait velocity, and dual-task ability (Timed up and go with a cognitive task) were most important for responsiveness classification. Slow gait velocity indicated high responders in the balance domain but showed low probabilities for low and non-responders. For low and non-responders, fall history or no falls, respectively, were more important.

Conclusion: Among the three responder domains and responsiveness levels, the balance domain was the best at classify responders. Previous falls and slower gait velocity indicated higher response to the HiBalance intervention. These results can guide inclusion criteria for balance-targeted, personalized intervention studies in PD.

References: 1. Freidle M, Johansson H, Ekman U, V. Lebedev A, Schalling E, Hedley Thompson W, Svenningsson P, Lövdén M, Abney A, Albrecht F, Steurer H, Leavy B, Holmin S, Hagströmer M, Franzén E. Behavioural and neuroplastic effects of a double-blind randomised controlled balance exercise trial in people with Parkinson’s disease. npj Parkinsons Dis. 8, 12 (2022).

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MDS Abstracts - https://www.mdsabstracts.org/abstract/responders-to-a-highly-challenging-balance-and-gait-intervention-in-people-with-parkinsons-disease/