Parkinson’s disease (PD) is the world’s most rapidly growing neurological disorder, with projections indicating that 12 million people will suffer from the disease by 2040 . PD impairs patients’ cognitive function, psychosocial abilities, movement, and autonomous system . Physical therapy is an important way to counteract some of the symptoms of Parkinson’s disease . Exercise can improve patients’ quality of life, likelihood of falling, mobility, and balance .
The effects of exercise on PD patients’ ability to balance are particularly promising. A 2004 study analyzed how patients with stage III Parkinson’s responded to physical therapy by using several balance tests . For patients without a tendency to fall, physical therapy led to significant improvements in their response to internal and external perturbations of balance . For patients with a tendency to fall, only external perturbations demonstrated significant changes following the physical therapy regimen . A 2009 study had similar results: moderate evidence indicated that exercise led to improved balance in PD patients . However, the latter study only focused on people with mild to moderate PD, whereas the former focused on patients with more advanced PD [2, 3]. Overall, these two studies together suggest that, regardless of the severity of a patient’s disease, physical therapy can improve balance in PD patients [2, 3].
Those studies took a general approach toward analyzing the relationship between balance and exercise. To provide more tailored physical regimens, clinicians require a closer look at what types of physical therapy prove more effective at combating PD-related balance impairments. Flynn et al. studied the effects of home-based exercise on balance . In the study, home-based exercise was defined as targeted gait, standing balance, and/or physical exercises, two-thirds of which had to be completed at home . The researchers found that home-based exercises significantly improved balanced-related activities in PD patients . Given that home-based exercise regimens generally require fewer resources, the adoption of this type of therapy into PD patients’ routines make it an especially attractive treatment for balance .
Other studies have compared the relative effects of hydro- versus land-based physical therapy. One such experiment, conducted by Volpe et al., divided 34 patients with stage 2.5 to 3 Parkinson’s disease into two groups based on each type of therapy . While land-based therapy is the norm, the researchers found hydrotherapy comparably safe and feasible . Furthermore, hydrotherapy was more effective on several balance markers, including the Berg Balance Scale and the Activities-Specific Balance Confidence scale . Therefore, aquatic exercises could be a meaningful method for Parkinson’s patients to improve their balance.
Lastly, music-based therapy has been suggested as another means of combating balance deficiencies [5, 6]. Music-based therapy requires patients to follow cueing techniques while engaging in regular physical activity that tests their balance and cognitive movement . Rather than focus on their current limitations in terms of mobility, patients concentrate on the music around them . Dance therapy, especially that of the partnered form, has been shown to improve patients’ standing balance control . Admittedly, current research on music-based therapy is limited due to small sample sizes, but multiple studies have found benefits to this approach [5, 6].
Physical therapy is an excellent way for patients with PD to improve their balance, be it through home-based exercises, hydrotherapy, or dance therapy. Regardless of what type of exercise a patient chooses to participate in, the choice to exercise in any way is an important step towards preventing a worsening of one’s balance due to Parkinson’s disease .
 A. Flynn et al., “Home-based prescribed exercise improves balance-related activities in people with Parkinson’s disease and has benefits similar to centre-based exercise: a systematic review,” Journal of Physiotherapy, vol. 65, no. 4, p. 189-199, October 2019. [Online]. Available: https://doi.org/10.1016/j.jphys.2019.08.003.
 I. Stankovic, “The effect of physical therapy on balance of patients with Parkinson’s disease,” International Journal of Rehabilitation Research, vol. 27, no. 1, p. 53-57, March 2004. [Online]. Available: https://doi.org/10.1097/00004356-200403000-00007.
 L. E. Dibble, O. Addison, and E. Papa, “The Effects of Exercise on Balance in Persons with Parkinson’s Disease: A Systematic Review Across the Disability Spectrum,” Journal of Neurologic Physical Therapy, vol. 33, no. 1, p. 14-26, March 2009. [Online]. Available: https://doi.org/10.1097/NPT.0b013e3181990fcc.
 D. Volpe et al., “Comparing the effects of hydrotherapy and land-based therapy on balance in patients with Parkinson’s disease: a randomized controlled pilot study,” Clinical Rehabilitation, vol. 28, no. 12, p. 1210-1217, June 2014. [Online]. Available: https://doi.org/10.1177/0269215514536060.
 M. J. de Dreu et al., “Rehabilitation, exercise therapy and music in patients with Parkinson’s disease: a meta-analysis of the effects of music-based movement therapy on walking ability, balance and quality of life,” Parkinsonism & Related Disorders, vol. 18, supp. 1, p. S114-S119, January 2012. [Online]. Available: https://doi.org/10.1016/S1353-8020(11)70036-0.
 R. D. Hidalgo-Agudo et al., “Additional Physical Interventions to Conventional Physical Therapy in Parkinson’s Disease: A Systematic Review and Meta-Analysis of Randomized Clinical Trials,” Journal of Clinical Medicine, vol. 9, no. 4, p. 1038, April 2020. [Online]. Available: https://doi.org/10.3390/jcm9041038.