title: Exercise for falls prevention in Parkinson disease: a randomized controlled trial.
abstract: OBJECTIVE
  To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors, i.e., poor balance, reduced leg muscle strength, and freezing of gait, in people with Parkinson disease.
  
  
  METHODS
  Two hundred thirty-one people with Parkinson disease were randomized into exercise or usual-care control groups. Exercises were practiced for 40 to 60 minutes, 3 times weekly for 6 months. Primary outcomes were fall rates and proportion of fallers during the intervention period. Secondary outcomes were physical (balance, mobility, freezing of gait, habitual physical activity), psychological (fear of falling, affect), and quality-of-life measures.
  
  
  RESULTS
  There was no significant difference between groups in the rate of falls (incidence rate ratio [IRR] = 0.73, 95% confidence interval [CI] 0.45-1.17, p = 0.18) or proportion of fallers (p = 0.45). Preplanned subgroup analysis revealed a significant interaction for disease severity (p < 0.001). In the lower disease severity subgroup, there were fewer falls in the exercise group compared with controls (IRR = 0.31, 95% CI 0.15-0.62, p < 0.001), while in the higher disease severity subgroup, there was a trend toward more falls in the exercise group (IRR = 1.61, 95% CI 0.86-3.03, p = 0.13). Postintervention, the exercise group scored significantly (p < 0.05) better than controls on the Short Physical Performance Battery, sit-to-stand, fear of falling, affect, and quality of life, after adjusting for baseline performance.
  
  
  CONCLUSIONS
  An exercise program targeting balance, leg strength, and freezing of gait did not reduce falls but improved physical and psychological health. Falls were reduced in people with milder disease but not in those with more severe Parkinson disease.
  
  
  METHODS
  This study provides Class III evidence that for patients with Parkinson disease, a minimally supervised exercise program does not reduce fall risk. This study lacked the precision to exclude a moderate reduction or modest increase in fall risk from exercise.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry (ACTRN12608000303347).
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia. colleen.canning@sydney.edu.au.
authors.forename: Colleen G
authors.initials: CG
authors.lastname: Canning
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Catherine
authors.initials: C
authors.lastname: Sherrington
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Lord
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Jacqueline C T
authors.initials: JC
authors.lastname: Close
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Stephane
authors.initials: S
authors.lastname: Heritier
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Gillian Z
authors.initials: GZ
authors.lastname: Heller
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Howard
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Natalie E
authors.initials: NE
authors.lastname: Allen
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Latt
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Murray
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Sandra D
authors.initials: SD
authors.lastname: O'Rourke
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Serene S
authors.initials: SS
authors.lastname: Paul
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Jooeun
authors.initials: J
authors.lastname: Song
authors.affiliation: From the Clinical and Rehabilitation Sciences Research Group, Faculty of Health Sciences (C.G.C., N.E.A., S.M.M., S.D.O., J.S.), The George Institute for Global Health, Sydney Medical School (C.S., S.S.P.), Sydney School of Public Health (K.H.), and Sydney Medical School (S.H., V.S.C.F.), The University of Sydney, Australia; Neuroscience Research Australia and University of New South Wales (S.R.L.), Sydney; Prince of Wales Clinical School, University of New South Wales, and Neuroscience Research Australia (J.C.T.C.), Sydney; Department of Epidemiology and Preventive Medicine (S.H.), Monash University, Melbourne; Department of Statistics (G.Z.H.), Macquarie University, and Statistics Division, The George Institute for Global Health, Sydney; Department of Aged Care (M.D.L.), Royal Prince Alfred Hospital, Sydney; and Movement Disorders Unit (V.S.C.F.), Department of Neurology, Westmead Hospital, Sydney, Australia.
authors.forename: Victor S C
authors.initials: VS
authors.lastname: Fung
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010300:Parkinson Disease / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation*; D010349:Patient Compliance; D010808:Physical Examination; D012189:Retrospective Studies; D016037:Single-Blind Method; D013997:Time Factors