Objective: To examine the potential benefit of a simple home-based gait and balance training on fear of fall in patients with Parkinson’s (PwP).

Background: PwP experience reduced balance and walking speed, causing fear of falling and decreased physical function. The high costs of equipment and standard training often discourage them, raising the question if home-based therapies could be effective.

Method: Home based gait and balance training was performed by PwP at home for 24 sessions composed of 45 minutes of gait and balance exercises (Fig-1). Sessions were repeated two or three times a week, with at least one rest day between each session. Each patient was treated ON-phase, at the same time of the day across sessions, with one Tele Follow up during the intervention. Fear of falling was assessed before and after the intervention using Fall Efficacy Scale-International (FES-I) as compared to the ‘No Exercise’ Control group.

Results:

Total 71 PwP (M:F-45:26) (PD:Parkinsonism 45:26) who were on stable Levodopa (LD) therapy participated.  Their mean age was 65 years with a mean duration of 81 months.  They were assigned to three groups (Exercise + LD=44; Exercise +Levodopa+Amantadine=17 and NO exercises +Levodopa=10)

Both the Amantadine and Levodopa exercise groups showed a decrease in the mean FES scores from pre (Amantadine PRE FES Mean:55.35, Levodopa PRE FES Mean:55.33) to post (Amantadine POST FES Mean:39.94, Levodopa POST FES Mean:38.51), indicating an improvement in fear of fall. The No Exercise Group showed mild worsening of scores over an 8 weeks period. (PRE FES Mean: 36.80, POST FES Mean: 41.00) (TABLE 1) (Fig-2)

Gender analysis within each subgroup showed that both male and female participants improved in balance in the exercise groups, with female participants in the Levodopa group showing more pronounced improvement.

Linear regression analysis suggested a slight decrease in the effectiveness of the exercise program with increasing age for the Levodopa (-0.0295) and No Exercise groups (-0.0708). Interestingly, the Amantadine Exercise Group showed a positive relationship between age and improvement in balance (0.2687), suggesting amantadine addition in older participants might have addon benefit. (Fig-3)

Conclusion: Simple home based exercises are beneficial for reducing fear of fall and might increase compliance in therapies.

FIGURE 1: Home Based Training Exercises Program

FIGURE 2: Whole cohort Pre and Post FES scores

FIGURE 3: FES Scores in Amantadine group

TABLE 1: Whole Cohort FES scores Comparisions

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MDS Abstracts - https://www.mdsabstracts.org/abstract/can-simple-home-based-exercises-reduce-the-fear-of-falling-in-parkinson-disorders/