Name: Jodelle C.

Lauron
Title of Journal: Balance versus resistance training on postural control in patients with
Parkinson’s disease: a randomized controlled trial
PICO ANALYSIS

Category Description
Introduction The main purpose of the study was to evaluate the effects of
balance training with directional exercises for postural control
and resistance muscular training on postural control measures in
individuals with PD. The researchers hypothesized that
compared to resistance training, balance approach by motor
control principles would relate better with balance results.

Population A total of 40 individuals were recruited and randomly divided

and assigned to either the balance training (BT; n=21) group or
the resistance-training (RT; n=19) group.

Patients eligible to participate in the study have to meet the

following inclusion criteria: individuals with idiopathic PD
according to criteria from the UK Brain Bank, classified in stages
1.5 to 3 according to the Hoehn and Yahr Staging Scale, aged ≥
50 years of age, able to walk independently, and unenrolled in
any therapeutic program besides medication.

The exclusion criteria were as follows: individuals with

preexisting neurological or musculoskeletal diseases, associated
or cognitive disorders.

Intervention Balance training has been used to maximize functional skills,

improve quality of life, and also minimize the risk of secondary
complications. It is a specific and task-driven protocol which is
deemed essential in developing sensory-motor integration and
is more easily managed in the recovery of motor function and
acquisition of skills. In terms of the intervention for the BT
group, the exercise training program applied principles of
postural control and hence, integrated balance, sensory
integration, agility, motor coordination, stability limits,
anticipatory and reactive adjustments, functional independence
and gait.

The program consisted of foam exercises, exercises on a step

bench and trampoline, and balance exercises using a Bobath
ball. Sessions were divided into three stages: stage 1 (sessions
 1-8), stage 2 (sessions 9-16), and stage 3 (sessions 17-24), with
the later stages having more complex and challenging
parameters. Training was supervised with trained
physiotherapists and held twice a week, each session lasting 60
mins in a total of 8 weeks.

Comparison Resistance training in individuals with PD is considered to be

most efficient to develop gains in muscular strength and
endurance of lower-limbs, hypertrophy, and mobility. In terms of
the intervention conducted for the RT Group, muscle
strengthening and stretching exercises involving the lower limbs
and trunk were performed in the supine, lateral decubitus, and
standing positions. Each exercise was performed with 2 sets of
10 repetitions to avoid accumulating fatigue. Similar to the BT
group, the sessions were divided into three stages, with a
progressive increase in intensity and number of repetitions.
Starting load intensity was 1 kg which would later increase up to
2 kg. Moreover, training was still supervised with trained
physiotherapists and a 60-min session held twice a week for 8
weeks.

Outcome Postural balance assessment was evaluated using a force

platform with center of pressure (COP) sway measure in various
balance conditions. COP parameters calculated from force
platform data can provide finer information related to
biomechanical and neuromuscular control strategies for
maintaining balance among different populations.

To determine the effects of both interventions on postural

control, Balance Evaluation Systems Test (BESTest) scale was
employed. This test provides a clinical measurement of postural
balance and comprises 36 items rated from zero to three with a
total score of 108 points.

According to the authors of the study, gold standard instruments

were utilized in the assessment of balance, including the use of
scales which have clinical applicability in terms of being low cost,
valid, and easily acceptable. Hence, it would guide the
management of physiotherapists both in their decision-making
and in clinical practice.

Conclusion When training in a directional and specific balance program

related to motor control principles, postural control in
 individuals with PD is improved in balance training compared to
resistance training. As perspective, the researchers posited that
rehabilitation programs for patients with PD should not
emphasize the implementation of a series of isolated exercises
but on sequences of activities that involve various systems in
increasing skill levels with beneficial functional impact that can
enable PD patients to transfer their learning and thus improve
particular skills related to postural control into their respective
daily routines.

Citation Santos, S. M., da Silva, R. A., Terra, M. B., Almeida, I. A., de Melo,
L. B., & Ferraz, H. B. (2017). Balance versus resistance training on
postural control in patients with Parkinson's disease: a
randomized controlled trial. European Journal of Physical and
Rehabilitation Medicine, 53(2), 173–183.
https://doi.org/10.23736/S1973-9087.16.04313-6