Acute and Long-Term Effects of Multidirectional Treadmill Training on Gait and Balance in Parkinson Disease

Background: Treadmill training has been shown to be a promising rehabilitation strategy for improving gait and balance in persons with Parkinson disease (PD). Most studies have involved only forward walking as an intervention. The effects of multidirectional treadmill (forward, backward, and left and right sideways) on gait and balance have not been reported.

Objective: To investigate the acute and long-term effects of multidirectional treadmill training (MDTT) on gait and balance in persons with PD, and to determine the optimal training duration.

Design: Single group, repeated-measures design.

Setting: Research laboratory in a hospital.

Participants: Ten persons with PD (mean age 65.9 ± 7.4 years; average disease duration 3.90 ± 2.18 years).

Interventions: MDTT was used. Participants walked forward, backward, and left and right sideways for 5-7 minutes in each direction at their fastest tolerated speed. The training was 3 days per week continuously for 8 weeks.

Main outcome measurements: Gait speed, cadence, and stride length of forward, backward and sideways walks; time and number of steps to turn 360°; and the timed 5-step test and Timed Up-and-Go (TUG) test were performed after the first session of MDTT and every 2 weeks. Effect size of MDTT on each gait and balance variable was measured every 2 weeks for 8 weeks to determine the optimal training duration. Gait and balance variables after the first session of MDTT were compared to the baseline values (pre-MDTT) to study the acute effect of MDTT.

Results: Stride length of forward, backward, and sideways walks improved immediately after 1 session of MDTT (P = .031, .012, and .001, respectively). The number of steps to turn and the timed 5-step test score decreased after the first session (P = .016, and .010, respectively). Six weeks of training was found to yield the largest mean effect size of all gait and balance variables. At 6 weeks of MDTT, gait speed of all walking directions (P = .001-.031), stride length of backward (P < .005) and sideways (P = .001) walks, cadence of sideways walk (P = .036), number of steps to turn (P = .014), and timed 5-step test (P = .033) improved from pre-MDTT measures.

Conclusions: MDTT immediately improved gait and balance in persons with PD. Six weeks of MDTT might be the optimal training duration to improve gait and balance in the long term.

Level of evidence: IV.