Parkinson’s Disease: Physical Therapy for Balance

June 7, 2021

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 [1]. PD impairs patients’ cognitive function, psychosocial abilities, movement, and autonomous system [2]. Physical therapy is an important way to counteract some of the symptoms of Parkinson’s disease [1]. Exercise can improve patients’ quality of life, likelihood of falling, mobility, and balance [1].

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 [2]. For patients without a tendency to fall, physical therapy led to significant improvements in their response to internal and external perturbations of balance [2]. For patients with a tendency to fall, only external perturbations demonstrated significant changes following the physical therapy regimen [2]. A 2009 study had similar results: moderate evidence indicated that exercise led to improved balance in PD patients [3]. 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 [1]. 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 [1]. The researchers found that home-based exercises significantly improved balanced-related activities in PD patients [1]. 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 [1].

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 [4]. While land-based therapy is the norm, the researchers found hydrotherapy comparably safe and feasible [4]. Furthermore, hydrotherapy was more effective on several balance markers, including the Berg Balance Scale and the Activities-Specific Balance Confidence scale [4]. 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 [5]. Rather than focus on their current limitations in terms of mobility, patients concentrate on the music around them [5]. Dance therapy, especially that of the partnered form, has been shown to improve patients’ standing balance control [5]. 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 [3].


[1] 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

[2] 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

[3] 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

[4] 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

[5] 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

[6] 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.