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Three Part Question

In [patients with Parkinsons Disease] does [an exercise programme] [reduce the rate and risk of falls].

Clinical Scenario

79 year old patient with Parkinson’s disease and a history of falls. You wonder if an exercise programme would reduce the rate and risk of falls.

Search Strategy

MEDLINE 1966-11/12 via the OVID interface,
PubMed,Cochrane Database and PEDro Database.

MEDLINE, Cochrane Database: parkinsons AND exercise AND falls.
PubMed: parkinsons AND exercise AND falls. LIMIT: Humans and English Language
PEDro: parkinsons disease AND exercise AND falls

Search Outcome

Medline: 32 hits, PubMed: 63 hits, Cochrane Database: 0 hits , PEDro: 11 hits.
After accounting for duplicates only 4 papers were relevant of which 1 was a Systematic Review including 2 of the other 3. 2 relevant papers taken forward for appraisal.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Allen NE et al 2011 Australia	15 RCT’s n= 747 . 2 RCT’s which recorded falls.	Systematic Review	Berg Balance Scale, Timed Up and Go, Gait Velocity/Time, Turning Time, Sit – Stand Time, Functional Reach, Single Leg StandTime, Falls.	There was no evidence of an affect of the intervention on fallers. The 2 studies which recorded falls were of good quality. Exercise may improve balance and balance is an important falls risk-factor in this population.	Only 2 of the RCT’s recorded the rate of falls and only 1 of these used an exercise programme as the intervention. 8 of the included trials were unclear 7 were of moderate to good quality.
Goodwin VA et al. 2011 UK	N=130 Clinical Diagnosis of Idiopathic Parkinson’s Disease with 2 or more falls in the last year. 2 Groups; Intervention n=64, Control n=66	RCT	Falls, Fall Related Injuries.	Statistically non-significant reduction in the rate of falls among people with PD undertaking an exercise intervention. when adjusting for geographical group, a statistically significant difference was observed during the intervention period. Although not statistically significant can be considered clinically significant. However, statistically significant differences in balance and fear of falling were observed.	PEDro score 7/10. NO; Blind therapists, Blind Assessors and Adequate Follow Up. Failed to recruit the number of participants indicated by the a priori sample size calculation.

Comment(s)

The Systematic Review showed that there was no statistically significant evidence to show that exercise and motor training can reduce falls in people with Parkinson’s Disease. However, it also showed exercise may improve balance and balance is an important falls risk-factor in this population. The RCT also showed no statistically significant difference in the rate of falls in patients with Parkinson’s Disease. However, the results are still potentially clinically significant but a Type 2 error cannot be ruled out. Furthermore, the RCT also showed statistically significant differences in balance and fear of falling. Further research is needed to show whether or not exercise can prevent falls in patients with Parkinson’s Disease

Clinical Bottom Line

There is some weak evidence that exercise interventions reduce falls in people with Parkinson’s Disease in the short term

References

1. Allen NE, Sherrington C, Paul SS et al. Balance and falls in Parkinsons disease: a meta-analysis of the effect of exercise and motor training. Mov Disord. 2011 Aug 1;26(9):1605-15.
2. Goodwin VA, Richards SH, Henley W et al. An exercise intervention to prevent falls in people with Parkinsons disease: a pragmatic randomised controlled trial. J Neurol Neurosurg Psychiatry. 2011 Nov;82(11):1232-8.