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

Franziska Albrecht, Joana B. Pereira, Mite Mijalkov, Malin Freidle, Hanna Johansson, Urban Ekman, Eric Westman, Erika Franzén

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish
Pages (from-to)2057-2071
Number of pages15
JournalJournal of Parkinson's Disease
Issue number4
Publication statusPublished - 2021

Subject classification (UKÄ)

  • Neurology

Free keywords

  • gait
  • gray matter
  • idiopathic Parkinson's disease
  • magnetic resonance imaging
  • physical exercise
  • putamen
  • Randomized controlled trial


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