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Journal of Neural Transmission

, Volume 118, Issue 5, pp 773–781 | Cite as

Physical, occupational, speech and swallowing therapies and physical exercise in Parkinson’s disease

  • G. RansmayrEmail author
Movement Disorders - Review Article

Abstract

Former studies on the effects of physical exercise, physical and occupational therapy (PT, OT) and speech and swallowing therapy (ST, SwT) in Parkinson’s disease (PD) have demonstrated little or uncertain effects. New pathophysiological concepts have been developed. Recent controlled high-level studies demonstrate improvement of mobility and balance after training of muscular strength and endurance, trunk control, and amplitude and rhythmicity of movements (treadmill). Attentional and cognitive strategies were found to enforce body awareness and improve movement sequences. Dance, sensory (auditory, visual, tactile) and cognitive cueing are effective for problems of gait and balance. Whether PT and OT reduce the risk of falls remains uncertain. ST including Lee Silverman Voice Treatment has been shown to relieve speech problems. SwT and OT are frequently applied, however, further studies are necessary. Therapeutic interventions need to be evaluated with regard to consistency, intensity, frequency, duration, side effects, home versus institution based and standardized versus individualized training, quality standards, practicability in real life, and cost-effectiveness. Parkinson patients should resume or continue physical exercise as long as possible. There is hope that regular sport may modify PD risk and progression.

Keywords

Levodopa Gait Speed Muscular Strength Gait Parameter Body Weight Support 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. Abbruzzese G, Trompetto C, Marinelli L (2009) The rationale for motor learning in Parkinson’s disease. Eur J Phys Rehabil Med 45:209–214PubMedGoogle Scholar
  2. Allen NE, Sherrington C, Canning CG, Fung VS (2010a) Reduced muscle power is associated with slower walking velocity and falls in people with Parkinson’s disease. Parkinsonism Relat Disord 16:261–264PubMedCrossRefGoogle Scholar
  3. Allen NE, Canning CG, Sherrington C, Lord SR, Latt MD, Close JC, O’Rourke SD, Murray SM, Fung VS (2010b) The effects of an exercise program on fall risk factors in people with Parkinson’s disease: a randomized controlled trial. Mov Disord 25:1217–1225PubMedCrossRefGoogle Scholar
  4. Ashburn A, Fazakarley L, Ballinger C, Pickering R, McLellan LD, Fitton C (2007) A randomized controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease. J Neurol Neurosurg Psychiatry 78:678–684PubMedCrossRefGoogle Scholar
  5. Ashour R, Jankovic J (2006) Joint and skeletal deformities in Parkinson’s disease, multiple system atrophy, and progressive supranuclear palsy. Mov Disord 21:1856–1863PubMedCrossRefGoogle Scholar
  6. Bächlin M, Plotnik M, Roggen D, Maiden I, Hausdorff JM, Giladi N, Tröster G (2010) Wearable assistant for Parkinson’s disease patients with the freezing of gait symptom. IEEE Trans Inf Technol Biomed 14:436–446PubMedCrossRefGoogle Scholar
  7. Baijens LW, Speyer R (2009) Effects of therapy for dysphagia in Parkinson’s disease: systematic review. Dysphagia 24:91–102PubMedCrossRefGoogle Scholar
  8. Bartolo M, Serrao M, Tassoreli C, Don R, Ranavolo A, Draicchio F, Pacchetti C, Buscone S, Perrotta A, Fumari A, Bramanti P, Padua L, Pierelli F, Sandrini G (2010) Four-week trunk-specific rehabilitation treatment improves lateral trunk flexion in Parkinson’s disease. Mov Disord 25:325–331PubMedGoogle Scholar
  9. Blin J, Dubois B, Bonnet AM, Vidailhet M, Brandabur M, Agid Y (1991) Does ageing aggravate parkinsonian disability? J Neurol Neurosurg Psychiatry 54:780–782PubMedCrossRefGoogle Scholar
  10. Bonnet AM, Loria Y, Saint-Hilaire MH, Lhermitte F, Agid Y (1987) Does long-term aggravation of Parkinson’s disease result from nondopaminergic lesions? Neurology 37:1539–1542PubMedGoogle Scholar
  11. Boonstra TA, van der Kooij H, Munneke M, Bloem BR (2008) Gait disorders and balance disturbances in Parkinson’s disease: clinical update and pathophysiology. Curr Opin Neurol 21:461–471PubMedCrossRefGoogle Scholar
  12. Bushmann M, Dobmeyer SM, Leeker L, Perlmutter JS (1989) Swallowing abnormalities and their response to treatment in Parkinson’s disease. Neurology 39:1309–1314PubMedGoogle Scholar
  13. Cakit BD, Saracoglu M, Genc H, Erdem HR, Inan L (2007) The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson’s disease. Clin Rehabil 21:698–705PubMedCrossRefGoogle Scholar
  14. Cano-de-la-Cuerda R, Pérez-de-Heredia M, Miangolarra-Page JC, Muñoz-Hellín E, Fernández-de-Las-Peñas C (2010) Is there muscular weakness in Parkinson’s disease? Am J Phys Med Rehabil 89:70–76PubMedCrossRefGoogle Scholar
  15. Ceravolo MG (2009) Rehabilitation goals and strategies in Parkinson’s disease. Eur J Phys Rehabil Med 45:205–208PubMedGoogle Scholar
  16. Chen H, Zhang SM, Schwarzschild MA, Hernán MA, Ascherio A (2005) Physical activity and the risk of Parkinson disease. Neurology 64:664–669PubMedGoogle Scholar
  17. Crizzle AM, Newhouse IJ (2006) Is physical exercise beneficial for persons with Parkinson’s disease? Clin J Sport Med 16:422–425PubMedCrossRefGoogle Scholar
  18. D’Alatri L, Paludetti G, Contarino MF, Galla MarcheseMR, Bentivoglio AR (2008) Effects of bilateral subthalamic nucleus stimulation and medication on parkinsonian speech impairment. J Voice 22:365–372PubMedCrossRefGoogle Scholar
  19. De Letter M, Santens P, Estercam I, Van Maele G, De Bodt M, Boon P, Van Borsel J (2007) Levodopa-induced modifications of prosody and comprehensibility in advanced Parkinson’s disease as perceived by professional listeners. Clin Linguist Phon 21:783–791PubMedCrossRefGoogle Scholar
  20. Deane KH, Jones D, Playford ED, Ben-Shlomo Y, Clarke CE (2001) Physiotherapy for patients with Parkinson’s disease: a comparison of techniques. Cochrane Database Syst Rev 3:CD002817Google Scholar
  21. Deane KH, Ellis-Hill C, Jones D, Whurr R, Ben-Shlomo Y, Playford ED, Clarke CE (2002) Systematic review of paramedical therapies for Parkinson’s disease. Mov Disord 17:984–991PubMedCrossRefGoogle Scholar
  22. Dereli EE, Yaliman A (2010) Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme on quality of life in patients with Parkinson’s disease. Clin Rehabil 24:352–362PubMedCrossRefGoogle Scholar
  23. Di Benedetto P, Cavazzon M, Mondolo F, Rugiu G, Peratoner A, Biasutti E (2009) Voice and choral singing treatment: a new approach for speech and voice disorders in Parkinson’s disease. Eur J Phys Rehabil Med 45:13–19PubMedGoogle Scholar
  24. Dibble LE, Addison O, Papa E (2009a) The effects of exercise on balance in persons with Parkinson’s disease: a systematic review across the disability spectrum. J Neurol Phys Ther 33:14–26PubMedGoogle Scholar
  25. Dibble LE, Hale TF, Marcus RL, Gerber JP, LaStayo PC (2009b) High intensity eccentric resistance training decreases bradykinesia and improves quality of life in persons with Parkinson’s disease: a preliminary study. Parkinsonism Relat Disord 15:752–757PubMedCrossRefGoogle Scholar
  26. Dixon L, Duncan D, Johnson P, Kirkby L, O’Connell H, Taylor H, Deane KH (2007) Occupational therapy for patients with Parkinson’s disease. Cochrane Database Syst Rev 3:CD002813Google Scholar
  27. Earhart GM (2009) Dance as therapy for individuals with Parkinson disease. Eur J Phys Rehabil Med 45:231–238PubMedGoogle Scholar
  28. Ebersbach G (2005) Übende Therapie bei Morbus Parkinson. Akt Neurol 32:71–76CrossRefGoogle Scholar
  29. Ebersbach G, Ebersbach A, Edler D, Kaufholf O, Kusch M, Kupsch A, Wissel J (2010) Comparing exercise in Parkinson’s disease—The Berlin LSVT®BIG study. Mov Disord 25:1902–1908PubMedCrossRefGoogle Scholar
  30. Ellis T, de Goede CJ, Feldman RG, Wolters EC, Kwakkel G, Wagenaar RC (2005) Efficacy of a physical therapy program in patients with Parkinson’s disease: a randomized controlled trial. Arch Phys Med Rehabil 86:626–632PubMedCrossRefGoogle Scholar
  31. Elston J, Honan W, Powell R, Gormley J, Stein K (2010) Do metronomes improve quality of life in people with Parkinson’s disease? A pragmatic, single-blind, randomized cross-over trial. Clin Rehabil 24:523–532PubMedCrossRefGoogle Scholar
  32. Falvo MJ, Schilling BK, Earhart GM (2008) Parkinson’s disease and resistive exercise: rationale, review, and recommendations. Mov Disord 23:1–11PubMedCrossRefGoogle Scholar
  33. Farley BG, Koshland GF (2005) Training BIG to move faster: the application of the speed–amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res 167:462–467PubMedCrossRefGoogle Scholar
  34. Fertl E, Doppelbauer A, Auff E (1993) Physical activity and sports in patients suffering from Parkinson’s disease in comparison with healthy seniors. J Neural Transm Park Dis Dement Sect 5:157–161PubMedCrossRefGoogle Scholar
  35. Ford MP, Malone LA, Nyikos I, Yelisetty R, Bickel CS (2010) Gait training with progressive external auditory cueing in persons with Parkinson’s disease. Arch Phys Med Rehabil 91:1255–1261PubMedCrossRefGoogle Scholar
  36. Fox CM, Ramig LO, Ciucci MR, Sapir S, McFarland DH, Farley BG (2006) The science and practice of LSVT/LOUD: neural plasticity-principled approach to treating individuals with Parkinson disease and other neurological disorders. Semin Speech Lang 27:283–299PubMedCrossRefGoogle Scholar
  37. Frazzitta G, Maestri R, Uccellini D, Bertotti G, Abelli P (2009) Rehabilitation treatment of gait in patients with Parkinson’s disease with freezing: a comparison between two physical therapy protocols using visual and auditory cues with or without treadmill training. Mov Disord 24:1139–1143PubMedCrossRefGoogle Scholar
  38. Frazzitta G, Maestri R, Bertotti G, Uccellini D, Bazzini G, Abelli P, Aquilani R (2010) Rehabilitation in Parkinson’s disease: assessing the outcome using objective metabolic measurements. Mov Disord 25:609–614PubMedGoogle Scholar
  39. Gobbi LT, Oliveira-Ferrra MD, Caetan MJ, Lirani-Silva E, Barbieri FA, Stella F, Gobb S (2009) Exercise programs improve mobility and balance in people with Parkinson’ disease. Parkinsonism Relat Disord 15(Suppl 3):S49–S52PubMedCrossRefGoogle Scholar
  40. Goetz CG, Thelen JA, MacLeod CM, Carvey PM, Bartley EA, Stebbins GT (1993) Blood levodopa and unified Parkinson’s disease rating scale function: with and without exercise. Neurology 43:1040–1042PubMedGoogle Scholar
  41. Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL (2008) The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 23:631–640PubMedCrossRefGoogle Scholar
  42. Guo L, Jiang Y, Yatsuya H, Yoshida Y, Sakamoto J (2009) Group education with personal rehabilitation for idiopathic Parkinson’s disease. Can J Neurol Sci 36:51–59PubMedGoogle Scholar
  43. Hackney ME, Earhart GM (2008) Tai Chi improves balance and mobility in people with Parkinson disease. Gait Posture 28:456–460PubMedCrossRefGoogle Scholar
  44. Hackney ME, Earhart GM (2010a) Effects of dance on balance and gait in severe Parkinson disease: a case study. Disabil Rehabil 32:679–684PubMedCrossRefGoogle Scholar
  45. Hackney ME, Earhart GM (2010b) Effects of dance on gait and balance in Parkinson’s disease: a comparison of partnered and nonpartnered dance movement. Neurorehabil Neural Repair 24:384–392PubMedCrossRefGoogle Scholar
  46. Herman T, Giladi N, Hausdorff JM (2009) Treadmill training for the treatment of gait disturbances in people with Parkinson’s disease: a mini-review. J Neural Transm 116:307–318PubMedCrossRefGoogle Scholar
  47. Hirsch MA, Farley BG (2009) Exercise and neuroplasticity in persons living with Parkinson’s disease. Eur J Phys Rehabil Med 45:215–229PubMedGoogle Scholar
  48. Ho AK, Bradshaw JL, Iansek R (2008) For better or worse: the effect of levodopa on speech in Parkinson’s disease. Mov Disord 23:574–580PubMedCrossRefGoogle Scholar
  49. Kerr GK, Worringham CJ, Cole MH, Lacherez PF, Wood JM, Silburn PA (2010) Predictors of future falls in PD. Neurology 75:116–124PubMedCrossRefGoogle Scholar
  50. Keus SHJ, Hendriks HJM, Bloem BR et al (2004) Clinical practice guidelines or physical therapy in patients with Parkinson’s disease. Ned Tijdschr Fysiother 114(Suppl):3Google Scholar
  51. Keus SHJ, Bloem BR, Hendriks EJM, Bredero-Cohen AB, Munneke M (2007) Evidence-based analysis of physical therapy in Parkinson’s disease with recommendations for practice and research. Mov Disord 22:451–460PubMedCrossRefGoogle Scholar
  52. Keus SHJ, Munneke M, Nijkrake MJ, Kwakkel G, Bloem BR (2009) Physical therapy in Parkinson’s disease: evolution and future challenges. Mov Disord 24:1–14PubMedCrossRefGoogle Scholar
  53. Kuroda K, Tatara K, Takatorige T, Shinsho F (1992) Effect of physical exercise on mortality in patients with Parkinson’s disease. Acta Neurol Scand 86:55–59PubMedCrossRefGoogle Scholar
  54. Kurtais Y, Kutlay S, Tur BS, Gok H, Akbostanci C (2008) Does treadmill training improve lower-extremity tasks in Parkinson’s disease? A randomized controlled trial. Clin Sport Med 18:289–291CrossRefGoogle Scholar
  55. Kwakkel G, de Goede CJ, van Wegen EE (2007) Impact of physical therapy for Parkinson’s disease: a critical review of the literature. Parkinsonism Relat Disord 13:478–487CrossRefGoogle Scholar
  56. Ledger S, Galvin R, Lynch D, Stokes EK (2008) A randomized controlled trial evaluating the effect f an individual auditory cueing device on freezing and gait speed in people with Parkinson’s disease. BMC Neurol 8:46PubMedCrossRefGoogle Scholar
  57. Lee MS, Ernst E (2009) Qigong for movement disorders: a systematic review. Mov Disord 24:301–303PubMedCrossRefGoogle Scholar
  58. Lee MS, Lam P, Ernst E (2008) Effectiveness of tai chi for Parkinson’s disease: a critical review. Parkinsonism Relat Disord 14:589–594PubMedCrossRefGoogle Scholar
  59. Lim A, Leow L, Huckabee ML, Frampton C, Anderson T (2008) A pilot study of respiration and swallowing integration in Parkinson’s disease: “on” and “off” levodopa. Dysphagia 23:76–81PubMedCrossRefGoogle Scholar
  60. Lim I, van Wegen E, Jones D, Rochester L, Nieuwboer A, Willems AM, Baker K, Hetherington V, Kwakkel G (2010) Does cueing training improve physical activity in patients with Parkinson’s disease? Neurorehabil Neural Repair 24:469–477PubMedCrossRefGoogle Scholar
  61. Maitra KK (2007) Enhancement of reaching performance via self-speech in people with Parkinson’s disease. Clin Rehabil 21:418–424PubMedCrossRefGoogle Scholar
  62. Mehrholz J, Friis R, Kugler J, Twork S, Storch A, Pohl M (2010) Treadmill training for patients with Parkinson’s disease. Cochrane Database Syst Rev 1:CD007830Google Scholar
  63. Miller N, Allcock L, Hildreth AJ, Jones D, Noble E, Burn DJ (2009) Swallowing problems in Parkinson disease: frequency and clinical correlates. J Neurol Neurosurg Psychiatry 80:1047–1049PubMedCrossRefGoogle Scholar
  64. Morris ME, Iansek R, Kirkwood B (2009) A randomized controlled trial of movement strategies compared with exercise for people with Parkinson’s disease. Mov Disord 24:64–71PubMedCrossRefGoogle Scholar
  65. Morris ME, Martin CL, Schenkman ML (2010) Striding out with Parkinson disease: evidence-based physical therapy for gait disorders. Phys Ther 90:280–288PubMedCrossRefGoogle Scholar
  66. Mouradian MM, Juncos JL, Serrati C, Fabbni G, Palmeri S, Chase TN (1987) Exercise and the antiparkinsonian response to levodopa. Clin Neuropharmacol 4:351–355CrossRefGoogle Scholar
  67. Müller T, Muhlack S (2010) Effect of exercise on reactivity and motor behaviour in patients with Parkinson’s disease. J Neurol Neurosurg Psychiatry 81:747–753PubMedCrossRefGoogle Scholar
  68. Munneke M, Nijkrake MJ, Keus SH, Kwakkel G, Berendse HW, Roos RA, Borm GF, Adang EM, Overeem S, Bloem BR (2010) Efficacy of community-based physiotherapy networks for patients with Parkinson’s disease: a cluster-randomised trial. Lancet Neurol 9:46–54PubMedCrossRefGoogle Scholar
  69. Narayana S, Jacks A, Robin DA, Poizner H, Zhang W, Franklin C, Liotti M, Vogel D, Fox PT (2009) A noninvasive imaging approach to understanding speech changes following deep brain stimulation in Parkinson’s disease. Am J Speech Lang Pathol 18:146–161PubMedCrossRefGoogle Scholar
  70. Narayana S, Fox PT, Zhang W, Franklin C, Robin DA, Vogel D, Ramig LO (2010) Neural correlates of efficacy of voice therapy in Parkinson’s disease identified by performance-correlation analysis. Hum Brain Mapp 31:222–236PubMedGoogle Scholar
  71. Nieuwboer A, Kwakkel G, Rochester L, Jones D, van Wegen E, Willems AM, Chavret F, Hetherington V, Baker K, Lim I (2007) Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial. J Neurol Neurosurg Psychiatry 78:134–140PubMedCrossRefGoogle Scholar
  72. Nijkrake MJ, Keus SHJ, Ewalds H, Overeem S, Braspenning JCC, Oostendorp RAB, Hendriks EJM, Bloem BR, Munneke M (2009) Quality indicators for physiotherapy in Parkinson’s disease. Eur J Phys Rehabil Med 45:239–245PubMedGoogle Scholar
  73. Nocera J, Horvat M, Ray CT (2009) Effects of home-based exercise on postural control and sensory organization in individuals with Parkinson disease. Parkinsonism Relat Disord 15:742–745PubMedCrossRefGoogle Scholar
  74. Nocera JR, Buckley T, Waddell D, Okun MS, Hass CJ (2010) Knee extensor strength, dynamic stability, and functional ambulation: are they related in Parkinson’s disease? Arch Phys Med Rehabil 91:589–595PubMedCrossRefGoogle Scholar
  75. O’Brien M, Dodd KJ, Bilney B (2008) A qualitative analysis of a progressive resistance exercise programme for people with Parkinson’s disease. Disabil Rehabil 30:1350–1357PubMedCrossRefGoogle Scholar
  76. Pang MY, Mak MK (2009a) Muscle strength is significantly associated with hip bone mineral density in women with Parkinson’s disease: a cross-sectional study. J Rehabil Med 41:223–230PubMedCrossRefGoogle Scholar
  77. Pang MYC, Mak MKY (2009b) Trunk muscle strength, but not trunk rigidity, is independently associated with bone mineral density of the lumbar spine in patients with Parkinson’s disease. Mov Disord 24:1176–1182PubMedCrossRefGoogle Scholar
  78. Pedersen SW, Öberg B, Insulander A, Vretman M (1990) Group training in Parkinsonism: quantitative measurements of treatment. Scand J Rehab Med 22:207–211Google Scholar
  79. Pinto S, Ozsancak C, Tripoliti E, Thobois S, Limousin-Dowsey P, Auzou P (2004) Treatments for dysarthria in Parkinson’s disease. Lancet Neurol 3:547–556PubMedCrossRefGoogle Scholar
  80. Quinn NP, Ring H, Honavar M, Marsden CD (1988) Contractures of the extremities in parkinsonian subjects: a report of three cases with a possible association with bromocriptine treatment. Clin Neuropharmacol 11:268–277PubMedCrossRefGoogle Scholar
  81. Ramig LO, Fox C, Sapir S (2008) Speech treatment for Parkinson’s disease. Expert Rev Neurother 8:297–309PubMedCrossRefGoogle Scholar
  82. Rao AK (2010) Enabling functional independence in Parkinson’s disease: update on occupational therapy intervention. Mov Disord 25(Suppl 1):S146–S151PubMedCrossRefGoogle Scholar
  83. Ridgel AL, Vitek JL, Alberts JL (2009) Forced, not voluntary, exercise improves motor function in Parkinson’s disease patients. Neurorehabil Neural Repair 23:600–608PubMedCrossRefGoogle Scholar
  84. Rochester L, Burn DJ, Woods G, Godwin J, Nieuwboer A (2009) Does auditory rhythmical cueing improve gait in people with Parkinson’s disease and cognitive impairment? A feasibility study. Mov Disord 24:839–845PubMedCrossRefGoogle Scholar
  85. Sage MD, Almeida QJ (2009) Symptom and gait changes after sensory attention focused exercise vs. aerobic training in Parkinson’s disease. Mov Disord 24:1132–1138PubMedCrossRefGoogle Scholar
  86. Sapir S, Spielman JL, Ramig LO, Story BH, Fox C (2007) Effects of intensive voice treatment (the Lee Silverman voice treatment [LSVT]) on vowel articulation in dysarthric individuals with idiopathic Parkinson disease: acoustic and perceptual findings. J Speech Lang Hear Res 50:899PubMedCrossRefGoogle Scholar
  87. Sasco AJ, Paffenbarger RS Jr, Gendre I, Wing AL (1992) The role of physical exercise in the occurrence of Parkinson’s disease. Arch Neurol 49:360–365PubMedGoogle Scholar
  88. Scott S, Caird FI (1984) The response of the apparent receptive speech disorder of Parkinson’s disease to speech therapy. J Neurol Neurosurg Psychiatry 47:302–304PubMedCrossRefGoogle Scholar
  89. Skodda S, Visser W, Schlegel U (2010) Short- and long-term dopaminergic effects on dysarthria in early Parkinson’s disease. J Neural Transm 117:197–205PubMedCrossRefGoogle Scholar
  90. Suchowersky O, Gronseth G, Perlmutter J, Reich S, Zesiewicz T, Weiner WJ (2006) Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 66:976–982PubMedCrossRefGoogle Scholar
  91. Thacker EL, Chen H, Patel AV, McCullough ML, Calle EE, Thun MJ, Schwarzschild MA, Ascherio A (2008) Recreational physical activity and risk of Parkinson’s disease. Mov Disord 23:69–74PubMedCrossRefGoogle Scholar
  92. Tickle-Degnen L, Ellis T, Saint-Hilaire MH, Thomas CA, Wagenaar RC (2010) Self-management rehabilitation and health-related quality of life in Parkinson’s disease: a randomized controlled trial. Mov Disord 30:194–204CrossRefGoogle Scholar
  93. van Eijkeren FJM, Reijmers RSJ, Kleinveld MJ, Minten A, ter Bruggen JP, Bloem BR (2008) Nordic walking improves mobility in Parkinson’s disease. Mov Disord 23:2239–2243PubMedCrossRefGoogle Scholar
  94. Watts JJ, McGinley JL, Huxham F, Menz HB, Iansek R, Murphy AT, Waller ER, Morris ME (2008) Cost effectiveness of preventing falls and improving mobility in people with Parkinson disease: protocol for an economic evaluation alongside a clinical trial. BMC Geriatrics 8:1–8CrossRefGoogle Scholar
  95. White DK, Wagenaar RC, Ellis TD, Tickle-Degnen L (2009) Changes in walking activity and endurance following rehabilitation for people with Parkinson disease. Arch Phys Med Rehabil 90:43–50PubMedCrossRefGoogle Scholar
  96. Wulf G, Landers M, Lewthwaite R, Töllner T (2009) External focus instructions reduce postural instability in individuals with Parkinson disease. Phys Ther 89:162–168PubMedCrossRefGoogle Scholar
  97. Xu Q, Park Y, Huang X, Hollenbeck A, Blair A, Schatzkin A, Chen H (2010) Physical activities and future risk of Parkinson disease. Neurology 75:341–348PubMedCrossRefGoogle Scholar
  98. Yang YR, Lee YY, Cheng SJ, Wang RY (2010) Downhill walking training in individuals with Parkinson’s disease: a randomized controlled trial. Am J Phys Med Rehabil 89:706–714PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  1. 1.Department of Neurology and PsychiatryGeneral Hospital of the City of LinzLinzAustria

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