Date Presented 4/7/2016
Both group and individual exercise show promise as methods for reducing fall risk in people with Parkinson’s disease. Current research provides only preliminary evidence and does not explore how a reduction in fall risk might affect participation in meaningful occupations and activities of daily living.
Primary Author and Speaker: Karina Lathrop
Contributing Authors: Sophie E. Goloff, Kristen A. Pickett
PURPOSE: To compare previously published research involving the effects of group and individual exercise on fall prevention in people with Parkinson’s disease (PD)
RATIONALE: People with PD have a significantly higher risk of falling than do healthy adults. Falls increase incidence of injury and decrease independence. Although exercise has consistently been shown to improve motor symptoms associated with PD, no clear best method of exercise has emerged, and the effects of exercise on falls in particular remain unclear.
DESIGN: A systematic review was conducted to compare the effects of group and individual exercise on fall risk in people with PD.
METHOD: Relevant articles were identified in PubMed and CINAHL Plus databases using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and according to the following inclusion criteria: diagnosis of PD, type of fall risk assessment used, Level I or II research design, and study methods that clearly distinguish between group and individual exercise.
RESULTS: Ten studies fit the search criteria: Six examined group exercise interventions (Tai Chi, n = 3, and tango dance, n = 3), and 4 focused on individual exercise interventions. Conflicting results were found in regard to effect on fall risk. Four of 6 group exercise studies and 2 of 4 individual exercise studies provided preliminary evidence supporting a reduction in fall risk. Studies with greater generalizability and increased power, which measure fall risk using a comprehensive assessment battery, are needed.
DISCUSSION: Individual and group exercise approaches show promise for reducing falls in people with PD, but due to conflicting results, small effect sizes, and unreliable methods of measurement, the evidence is inconclusive. Missing from the research is an examination of how falls relate to activities of daily living (ADLs) either pre- or postintervention. This is a striking gap in the literature because it would provide a clear path to targeted intervention strategies.
IMPACT STATEMENT: Current literature shows that both group and individual exercise methods offer protection against falls in people with PD. To best serve this population, additional research is needed to determine which methods of exercise best effect positive changes in meaningful activities and ADLs. A better understanding of this issue will allow occupational therapists to better educate clients with PD to reduce risk of falls and prolong safe participation in meaningful life activities.
