Task-oriented circuit training combined with aerobic training improves motor performance and balance in people with Parkinson′s Disease

  • Fatih SokeEmail author
  • Arzu Guclu-Gunduz
  • Bilge Kocer
  • Isil Fidan
  • Pembe Keskinoglu
Original article


Goal-based training such as task practice combined with aerobic training (AT) has been suggested to improve motor performance and neuroplasticity for people with Parkinson′s Disease (PwPD); however, its effect on clinical outcomes is unclear. Therefore, the main aim was to investigate the effects of task-oriented circuit training combined with AT (TOCT-AT) on balance and gait in PwPD. The secondary aim was to investigate the effects of TOCT-AT on functional mobility, balance confidence, disease severity, and quality of life. Twenty-six PwPD were randomly assigned to either to the experimental group (n = 14) or the control group (n = 12). The control group received AT, while the experimental group received TOCT-AT three times a week for 8 weeks. The main outcomes were the Berg Balance Scale (BBS), Postural Stability Test (PST), Limits of Stability Test (LOS), Pull Test (PT), Six Minute Walk Test (6MWT), Timed Up and Go Test (TUG), Activities-specific Balance Confidence Scale (ABC), Unified Parkinson′s Disease Rating Scale (UPDRS), and eight-item Parkinson′s Disease Questionnaire (PDQ-8) were secondary outcomes. After intervention, between-group comparisons showed that the experimental group significantly improved more than the control group in all outcomes (p < 0.05). Additionally, both groups significantly improved in BBS, 6MWT, TUG, ABC, UPDRS-II, UPDRS-III, UPDRS total, and PDQ-8 (p < 0.05), while only the experimental group significantly improved in PST, LOS, and PT (p < 0.001). This study suggest that TOCT-AT could improve balance and gait performance, which could also be positively translated into functional mobility, balance confidence, disease severity, and quality of life in PwPD.


Parkinson′s Disease Task-oriented circuit training Aerobic training Rehabilitation Balance Gait 




Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the study involving human participants were in accordance with the ethical standards of the Institutional Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all participants.


  1. 1.
    Abbruzzese G, Marchese R, Avanzino L, Pelosin E (2016) Rehabilitation for Parkinson’s disease: current outlook and future challenges. Parkinsonism Relat Disord 22:60–64CrossRefGoogle Scholar
  2. 2.
    Schoneburg B, Mancini M, Horak F, Nutt JG (2013) Framework for understanding balance dysfunction in Parkinson’s disease. Mov Disord 28:1474–1482PubMedPubMedCentralCrossRefGoogle Scholar
  3. 3.
    Adkin AL, Frank JS, Jog MS (2003) Fear of falling and postural control in Parkinson’s disease. Mov Disord 18:496–502PubMedCrossRefPubMedCentralGoogle Scholar
  4. 4.
    Marras C, McDermott MP, Rochon PA, Tanner CM, Naglie G et al (2008) Predictors of deterioration in health-related quality of life in Parkinson’s disease: results from the DATATOP trial. Mov Disord 23:653–659PubMedCrossRefPubMedCentralGoogle Scholar
  5. 5.
    Bohnen NI, Cham R (2006) Postural control, gait, and dopamine functions in parkinsonian movement disorders. Clin Geriatr Med 22:797–812PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    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 23:631–640PubMedCrossRefPubMedCentralGoogle Scholar
  7. 7.
    Shen X, Wong-Yu IS, Mak MK (2016) Effects of exercise on falls, balance, and gait ability in Parkinson’s disease: a meta-analysis. Neurorehabil Neural Repair 30:512–527PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Petzinger GM, Fisher BE, Van Leeuwen JE, Vukovic M, Akopian G et al (2010) Enhancing neuroplasticity in the basal ganglia: the role of exercise in Parkinson’s disease. Mov Disord 25:141–145CrossRefGoogle Scholar
  9. 9.
    Francardo V, Schmitz Y, Sulzer D, Cenci MA (2017) Neuroprotection and neurorestoration as experimental therapeutics for Parkinson’s disease. Exp Neurol 298:137–147PubMedCrossRefPubMedCentralGoogle Scholar
  10. 10.
    Shu HF, Yang T, Yu SX, Huang HD, Jiang LL et al (2014) Aerobic exercise for Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. PLoS One 9:e100503PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Niemann C, Godde B, Voelcker-Rehage C (2014) Not only cardiovascular, but also coordinative exercise increases hippocampal volume in older adults. Front Aging Neurosci 6:170PubMedPubMedCentralCrossRefGoogle Scholar
  12. 12.
    Richards LG, Stewart KC, Woodbury ML, Senesac C, Cauraugh JH (2008) Movement-dependent stroke recovery: a systematic review and meta-analysis of TMS and fMRI evidence. Neuropsychologia 46:3–11PubMedCrossRefPubMedCentralGoogle Scholar
  13. 13.
    Flachenecker P (2015) Clinical implications of neuroplasticity-the role of rehabilitation in multiple sclerosis. Front Neurol 6:1–4CrossRefGoogle Scholar
  14. 14.
    Hubbard IJ, Parsons MW, Neilson C, Carey LM (2009) Task-specific training: evidence for translation to clinical practice. Occup Ther Int 16:175–189PubMedCrossRefPubMedCentralGoogle Scholar
  15. 15.
    Langhorne P, Bernhardt J, Kwakkel G (2011) Stroke rehabilitation. Lancet 377:1693–1702PubMedCrossRefPubMedCentralGoogle Scholar
  16. 16.
    Jeon BJ, Kim WH, Park EY (2015) Effect of task-oriented training for people with stroke: a meta-analysis focused on repetitive or circuit training. Top Stroke Rehabil 22:34–43PubMedCrossRefPubMedCentralGoogle Scholar
  17. 17.
    Straudi S, Martinuzzi C, Pavarelli C, Charabati AS, Benedetti MG et al (2014) A task-oriented circuit training in multiple sclerosis: a feasibility study. BMC Neurol 14:124PubMedPubMedCentralCrossRefGoogle Scholar
  18. 18.
    Mak MK, Hui-Chan CW (2008) Cued task-specific training is better than exercise in improving sit-to-stand in patients with Parkinson’s disease: a randomized controlled trial. Mov Disord 23:501–509PubMedCrossRefPubMedCentralGoogle Scholar
  19. 19.
    Sunvisson H, Ekman SL, Hagberg H, Lökk J (2001) An education programme for individuals with Parkinson’s disease. Scand J Caring Sci 15:311–317PubMedCrossRefPubMedCentralGoogle Scholar
  20. 20.
    Frazzitta G, Maestri R, Ghilardi MF, Riboldazzi G, Perini M et al (2014) Intensive rehabilitation increases BDNF serum levels in parkinsonian patients: a randomized study. Neurorehabil Neural Repair 28:163–168PubMedCrossRefPubMedCentralGoogle Scholar
  21. 21.
    Monticone M, Ambrosini E, Laurini A, Rocca B, Foti C (2015) In-patient multidisciplinary rehabilitation for Parkinson’s disease: a randomized controlled trial. Mov Disord 30:1050–1058PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Faul F, Erdfelder E, Buchner A, Lang AG (2009) Statistical power analyses using G* Power 3.1: tests for correlation and regression analyses. Behav Res Methods 41:1149–1160PubMedCrossRefPubMedCentralGoogle Scholar
  23. 23.
    Hughes AJ, Daniel SE, Lees AJ (2001) Improved accuracy of clinical diagnosis of Lewy body Parkinson’s disease. Neurology 57:1497–1499PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Hoehn MM, Yahr MD (1967) Parkinsonism: onset, progression, and mortality. Neurology 17:427–442PubMedCrossRefPubMedCentralGoogle Scholar
  25. 25.
    Scott NW, McPherson GC, Ramsay CR, Campbell MK (2002) The method of minimization for allocation to clinical trials: a review. Control Clin Trials 23:662–674PubMedCrossRefPubMedCentralGoogle Scholar
  26. 26.
    Fahn S, Elton RL, Members of the UPDRS Development Committee (1987) Unified Parkinson’s disease rating scale. In: Fahn S, Goldstein M, Calne DB (eds) Recent developments in Parkinson’s disease II. MacMillan, New York, pp 153–163Google Scholar
  27. 27.
    Berg KO, Wood-Dauphine S, Williams J, Gayton D (1989) Measuring balance in the elderly: preliminary development of an instrument. Physiother Can 41:304–311CrossRefGoogle Scholar
  28. 28.
    Guyatt GH, Sullivan MJ, Thompson PJ, Fallen EL, Pugsley SO et al (1985) The 6-minute walk: a new measure of exercise capacity in patients with chronic heart failure. Can Med Assoc J 132:919–923PubMedPubMedCentralGoogle Scholar
  29. 29.
    Podsiadlo D, Richardson S (1991) The timed “Up and Go”: a test of basic functional mobility for frail elderly persons. J Am Geriatr Soc 39:142–148PubMedCrossRefPubMedCentralGoogle Scholar
  30. 30.
    Powell LE, Myers AM (1995) The activities-specific balance confidence (ABC) scale. J Gerontol A Biol Sci Med Sci 50:28–34CrossRefGoogle Scholar
  31. 31.
    Jenkinson C, Fitzpatrick R, Peto V, Greenhall R, Hyman N (1997) The PDQ-8: development and validation of a short-form Parkinson’s disease questionnaire. Psychol Health 12:805–814CrossRefGoogle Scholar
  32. 32.
    Steffen T, Seney M (2008) Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Phys Ther 88:733–746PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Hinman MR (2000) Factors affecting reliability of the Biodex Balance System: a summary of four studies. J Sport Rehabil 9:240–252CrossRefGoogle Scholar
  34. 34.
    Paker N, Bugdayci D, Demircioglu UB, Sabirli F, Ozel S (2017) Reliability and validity of the Turkish version of Activities-specific Balance Confidence scale in symptomatic knee osteoarthritis. J Back Musculoskelet Rehabil 30:461–466PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Kahraman T, Genç A, Söke F, Göz E, Çolakoğlu BD et al (2018) Validity and Reliability of the Turkish Version of the 8-Item Parkinson’s Disease Questionnaire. Noro Psikiyatr Ars 55:337–340PubMedPubMedCentralGoogle Scholar
  36. 36.
    Fletcher GF, Ades PA, Kligfield P, Arena R, Balady GJ et al (2013) Exercise standards for testing and training: a scientific statement from the American Heart Association. Circulation 128:873–934PubMedCrossRefPubMedCentralGoogle Scholar
  37. 37.
    Borg GA (1982) Psychophysical bases of perceived exertion. Med Sci Sports Exerc 14:377–381PubMedGoogle Scholar
  38. 38.
    Tomlinson CL, Patel S, Meek C, Herd CP, Clarke CE et al (2013) Physiotherapy versus placebo or no intervention in Parkinsonʹs Disease. Cochrane Database Syst Rev 9:CD002817Google Scholar
  39. 39.
    Allen NE, Sherrington C, Paul SS, Canning CG (2011) Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Mov Disord 26:1605–1615PubMedCrossRefPubMedCentralGoogle Scholar
  40. 40.
    Chisari C, Venturi M, Bertolucci F, Fanciullacci C, Rossi B (2014) Benefits of an intensive task-oriented circuit training in multiple sclerosis patients with mild disability. NeuroRehabilitation 35:509–518PubMedPubMedCentralGoogle Scholar
  41. 41.
    Outermans JC, van Peppen RP, Wittink H, Takken T, Kwakkel G (2010) Effects of a high-intensity task-oriented training on gait performance early after stroke: a pilot study. Clin Rehabil 24:979–987PubMedCrossRefPubMedCentralGoogle Scholar
  42. 42.
    Knox M, Stewart A, Richards CL (2018) Six hours of task-oriented training optimizes walking competency post stroke: a randomized controlled trial in the public health-care system of South Africa. Clin Rehabil 32:1057–1068PubMedCrossRefPubMedCentralGoogle Scholar
  43. 43.
    Smania N, Corato E, Tinazzi M, Stanzani C, Fiaschi A et al (2010) Effect of balance training on postural instability in patients with idiopathic Parkinson’s disease. Neurorehabil Neural Repair 24:826–834PubMedCrossRefPubMedCentralGoogle Scholar
  44. 44.
    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 21:698–705PubMedCrossRefPubMedCentralGoogle Scholar
  45. 45.
    Schoneburg B, Mancini M, Horak F, Nutt JG (2013) Framework for understanding balance dysfunction in Parkinson’s disease. Mov Disord 28:1474–1482PubMedPubMedCentralCrossRefGoogle Scholar
  46. 46.
    Kurt EE, Büyükturan B, Büyükturan Ö, Erdem HR, Tuncay F (2018) Effects of Ai Chi on balance, quality of life, functional mobility, and motor impairment in patients with Parkinson’s disease. Disabil Rehabil 40:791–797PubMedCrossRefPubMedCentralGoogle Scholar
  47. 47.
    Mhatre PV, Vilares I, Stibb SM, Albert MV, Pickering L et al (2013) Wii Fit balance board playing improves balance and gait in Parkinson disease. PM R 5:769–777PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R et al (2012) Tai chi and postural stability in patients with Parkinson’s disease. N Engl J Med 366:511–519PubMedPubMedCentralCrossRefGoogle Scholar
  49. 49.
    Mancini M, Rocchi L, Horak FB, Chiari L (2008) Effects of Parkinson’s disease and levodopa on functional limits of stability. Clin Biomech (Bristol, Avon) 23:450–458CrossRefGoogle Scholar
  50. 50.
    Gerards MH, McCrum C, Mansfield A, Meijer K (2017) Perturbation-based balance training for falls reduction among older adults: current evidence and implications for clinical practice. Geriatr Gerontol Int 17:2294–2303PubMedPubMedCentralCrossRefGoogle Scholar
  51. 51.
    Canning CG, Ada L, Johnson JJ, McWhirter S (2006) Walking capacity in mild to moderate Parkinson’s disease. Arch Phys Med Rehabil 87:371–375PubMedCrossRefPubMedCentralGoogle Scholar
  52. 52.
    Perera S, Mody SH, Woodman RC, Studenski SA (2006) Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc 54:743–749PubMedCrossRefPubMedCentralGoogle Scholar
  53. 53.
    van Wissen K, Blanchard D (2019) Circuit class therapy for improving mobility after stroke: a Cochrane review summary. Int J Nurs Stud 97:130–131PubMedCrossRefPubMedCentralGoogle Scholar
  54. 54.
    English C, Hillier SL, Lynch EA (2017) Circuit class therapy for improving mobility after stroke. Cochrane Database Syst Rev 6:CD007513PubMedPubMedCentralGoogle Scholar
  55. 55.
    Combs SA, Diehl MD, Chrzastowski C, Didrick N, McCoin B et al (2013) Community-based group exercise for persons with Parkinson disease: a randomized controlled trial. NeuroRehabilitation 32:117–124PubMedPubMedCentralGoogle Scholar
  56. 56.
    Carda S, Invernizzi M, Baricich A, Comi C, Croquelois A et al (2012) Robotic gait training is not superior to conventional treadmill training in parkinson disease: a single-blind randomized controlled trial. Neurorehabil Neural Repair 26:1027–1034PubMedCrossRefPubMedCentralGoogle Scholar
  57. 57.
    Cugusi L, Solla P, Serpe R, Carzedda T, Piras L et al (2015) Effects of a nordic walking program on motor and non-motor symptoms, functional performance and body composition in patients with Parkinson’s disease. NeuroRehabilitation 37:245–254PubMedCrossRefPubMedCentralGoogle Scholar
  58. 58.
    Schrag A, Sampaio C, Counsell N, Poewe W (2006) Minimal clinically important change on the unified Parkinson’s disease rating scale. Mov Disord 21:1200–1207PubMedCrossRefPubMedCentralGoogle Scholar
  59. 59.
    Luo N, Tan LC, Zhao Y, Lau PN, Au WL et al (2009) Determination of the longitudinal validity and minimally important difference of the 8-item Parkinson’s Disease Questionnaire (PDQ-8). Mov Disord 24:183–187PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Belgian Neurological Society 2019

Authors and Affiliations

  1. 1.Department of Physiotherapy and Rehabilitation, Faculty of Health SciencesGazi UniversityAnkaraTurkey
  2. 2.Department of NeurologyDiskapi Yildirim Beyazit Teaching and Research HospitalAnkaraTurkey
  3. 3.Department of Medical Microbiology, Faculty of MedicineGazi UniversityAnkaraTurkey
  4. 4.Department of Biostatistics, School of MedicineDokuz Eylul UniversityIzmirTurkey

Personalised recommendations