title: Highly Challenging Balance Program Reduces Fall Rate in Parkinson Disease.
abstract: OBJECTIVE
  There is a paucity of effective treatment options to reduce falls in Parkinson disease (PD). Although a variety of rehabilitative approaches have been shown to improve balance, evidence of a reduction in falls has been mixed. Prior balance trials suggest that programs with highly challenging exercises had superior outcomes. We investigated the effects of a theory-driven, progressive, highly challenging group exercise program on fall rate, balance, and fear of falling.
  
  
  METHODS
  Twenty-three subjects with PD participated in this randomized cross-over trial. Subjects were randomly allocated to 3 months of active balance exercises or usual care followed by the reverse. During the active condition, subjects participated in a progressive, highly challenging group exercise program twice weekly for 90 minutes. Outcomes included a change in fall rate over the 3-month active period and differences in balance (Mini-Balance Evaluation Systems Test [Mini-BESTest]), and fear of falling (Falls Efficacy Scale-International [FES-I]) between active and usual care conditions.
  
  
  RESULTS
  The effect of time on falls was significant (regression coefficient = -0.015 per day, P < 0.001). The estimated rate ratio comparing incidence rates at time points 1 month apart was 0.632 (95% confidence interval, 0.524-0.763). Thus, there was an estimated 37% decline in fall rate per month (95% confidence interval, 24%-48%). Improvements were also observed on the Mini-BESTest (P = 0.037) and FES-I (P = 0.059).
  
  
  CONCLUSIONS
  The results of this study show that a theory-based, highly challenging, and progressive exercise program was effective in reducing falls, improving balance, and reducing fear of falling in PD.Video abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A120).
authors.affiliation: VA Boston Healthcare System and Department of Medicine (D.S.), Boston University School of Medicine, Boston, Massachusetts; Center for Neurorehabilitation (T.R.D., K.H., T.E.), Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent, Boston University, Boston, Massachusetts; and Department of Neurology (C.A.T., M.S.H.), Boston University Medical Campus, Boston University, Boston, Massachusetts.
authors.forename: David
authors.initials: D
authors.lastname: Sparrow
authors.forename: Tamara R
authors.initials: TR
authors.lastname: DeAngelis
authors.forename: Kathryn
authors.initials: K
authors.lastname: Hendron
authors.forename: Cathi A
authors.initials: CA
authors.lastname: Thomas
authors.forename: Marie
authors.initials: M
authors.lastname: Saint-Hilaire
authors.forename: Terry
authors.initials: T
authors.lastname: Ellis
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D018592:Cross-Over Studies; D005081:Exercise Therapy / Q000379:methods*; D005239:Fear; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data*; D010300:Parkinson Disease / Q000534:rehabilitation*; D004856:Postural Balance / Q000502:physiology*; D016896:Treatment Outcome