Effects of a Highly Challenging Balance Training Program on Motor Function and Brain Structure in Parkinson's Disease

J Parkinsons Dis. 2021;11(4):2057-2071. doi: 10.3233/JPD-212801.


Background: Parkinson's disease (PD) is characterized by motor deficits and brain alterations having a detrimental impact on balance, gait, and cognition. Intensive physical exercise can induce changes in the neural system, potentially counteracting neurodegeneration in PD and improving clinical symptoms.

Objective: This randomized controlled trial investigated effects of a highly challenging, cognitively demanding, balance and gait training (HiBalance) program in participants with PD on brain structure.

Methods: 95 participants were assigned to either the HiBalance or an active control speech training program. The group-based interventions were performed in 1-hour sessions, twice per week over a 10-week period. Participants underwent balance, gait, cognitive function, and structural magnetic resonance imaging assessments before and after the interventions. Voxel-based morphometry was analyzed in 34 HiBalance and 31 active controls. Additionally, structural covariance networks were assessed.

Results: There was no significant time by group interaction between the HiBalance and control training in balance, gait, or brain volume. Within-HiBalance-group analyses showed higher left putamen volumes post-training. In repeated measures correlation a positive linear, non-significant relationship between gait speed and putamen volume was revealed. In the HiBalance group we found community structure changes and stronger thalamic-cerebellar connectivity in structural covariance networks. Neither brain volume changes nor topology changes were found for the active controls after the training.

Conclusion: Thus, subtle structural brain changes occur after balance and gait training. Future studies need to determine whether training modifications or other assessment methods lead to stronger effects.

Keywords: Randomized controlled trial; gait; gray matter; idiopathic Parkinson’s disease; magnetic resonance imaging; physical exercise; putamen.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Brain* / diagnostic imaging
  • Brain* / pathology
  • Brain* / physiopathology
  • Exercise Therapy*
  • Gait
  • Humans
  • Parkinson Disease* / diagnostic imaging
  • Parkinson Disease* / physiopathology
  • Postural Balance