BETA- PD: Balance Elderly Training and Activity in Parkinson’s disease.

Overall aim

The BETA-PD project aims to translate basic neuroscience into applied research and clinical understanding and implement the evaluation methods and training program into clinical practice. We hypothesize that increased balance control following training will lead to greater confidence in everyday life, increased levels of physical activity and an improved health related quality of life. With this new concept of balance training, our outcome measurements and educational curriculum, we foresee a paradigm shift in how balance training is applied and evaluated in clinical practice for elderly with balance deficits.

Project description

Poor balance control and in elderly leads to a sedentary life with physical inactivity and an increased risk for falls. Parkinson’s disease (PD) is a neurodegenerative disease where the prevalence increases with age. PD affects many physiological systems essential for balance control. The first choice therapy is pharmacology treatment; however the effects on balance are limited. New findings suggest that intensive, challenging and cognitively demanding exercises could induce neuroplasticity in PD. We have therefore developed a new balance training (the HiBalance program), emphasizing critical aspects of balance control through highly challenging and progressive exercises incorporating dual/multi tasks with the addition of physical activity prescription. The research proposal consists of an efficacy study in a hospital setting and a subsequent clinical effectiveness and implementation study to translate the knowledge into real world settings. Preliminary results of the efficacy study show improved balance, gait and physical activity level in favor for the training group. Long-term follow-up, applied for here, will further explore these effects and also the effect on fear of falling and quality of life. Thereafter, we will evaluate the effectiveness on patient level and whether the HiBalance program was implemented as intended by conducting a process evaluation. Facilitators and barriers for performing the program as part of clinical routines will also be explored. With an improved balance, physical activity level and quality of life, participants in the program will not only reduce their risk of falling and the burden on the health care system but also gain health benefits related to an active lifestyle. Our training will expand techniques and tools for health care professionals treating elderly with balance disorders, as well as important strategies for implementation.

Primary investigator

Senior lecturer

Erika Franzén

Phone: 08-524 888 78
Organizational unit: Division of Physiotherapy

Project members

David Conradsson, PhD student

Niklas Löfgren, PhD student

Linda Rennie, PhD student

Håkan Nero, PhD student 

Martin Benka Wallén, Postdoc

Kirsti Skavberg-Roaldsen, PhD 

Caroline Paquette, Assistant professor

Maria Hagströmer, Associate professor

Agneta Ståhle, Professor

Johan Lökk, Professor

Espen Dietrich

Arve Opheim

Master students

Bachelor students


Financial support

The Swedish research council



National School in Health Care Sciences

NEURO Sweden

Stockholm County Council research funds

StratNeuro, Karolinska Institutet

Swedish Parkinson foundation

Extrastiftelsen, Helse & Rehabilitering

Selected publications

Conradsson D, Löfgren N, Ståhle A, Hagströmer M, Franzén E. A novel conceptual framework for balance training in Parkinson's disease-study protocol for a randomised controlled trial. BMC Neurol. 2012 Sep 27;12:111. PMID:23017069, JIF(2011) 2.167 

Conradsson D, Löfgren N, Ståhle A, Franzén E. Is Highly Challenging and Progressive Balance Training Feasible in Elderly with Parkinson's Disease? Archives of Physical Medicine and Rehabilitation. In print. PMID: 24239585 

Benka Wallén M, Dohrn I-M, Ståhle A, Franzén E, Hagströmer M. Comparison of pedometer and accelerometer derived steps in elderly individuals with Parkinson’s disease or osteoporosis under free-living conditions. Accepted in Journal of Aging and Physical Activity. PMID: 24306767 

Benka Wallén M, Nero M, Franzén E, Hagströmer M. Comparison of two accelerometer filter settings in individuals with Parkinson’s disease. Accepted in Physiological Measurement 2014-07-21