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

Overall aim

The BETA-PD project aims to translate knowledge from basic neuroscience into applied research and clinical understanding and implement the evaluation methods and highly-challenging balance training program into clinical practice. Our main hypothesis is that highly challenging exercise will lead to greater gait and balance ability, increased levels of physical activity and an improved health related quality of life.

Project description

The BETA-PD study consists of several steps: method development and laboratory studies, an efficacy study, an effectiveness/implementation study and neuroplasticity studies.


Method development (Step 1)

We have tested the validity and reliability of the measurement methods that we use. We have also conducted kinematic and kinetic studies in movement laboratories (at KI and at Sunnaas rehabilitation hospital) in which we have investigated straight walking, variability and turning strategies as well as the effect of levodopa on these strategies in individuals with PD (ON and OFF their medication) compared to controls.

Efficacy (Step 2)

We have developed the HiBalance program and showed the program to be feasible and effective to improve balance performance, gait velocity, step length, cognitive performance while dual-tasking, as well as beneficial transfer effects to everyday living, seen as increased physical activity and improved activities of daily living. Analysis of the long-term effects showed that effects on gait, balance and physical activity attenuated after the training period and at 6 months no group effects were evident.

Findings from a qualitative study, suggest that being pushed to the limits of balance capacity provoked people with mild-moderate PD to re-think their individual motor and cognitive resources, a process that was further enabled by the PD-specific group setting.

The implementation/effectiveness (Step 3)

The implementation/effectiveness consists of a clinical effectiveness trial together with implementation research. We are here using a type-1 hybrid design by testing effects of the HiBalance program delivered in clinical setting on relevant patient outcome measures while observing and gathering information on barriers and facilitators to the implementation process We have performed a pilot study in primary care facilities in Stockholm. During spring 2016, we started the full implementation and effectiveness trial. Training and data collection concerning the outcome evaluation of the trial was completed at all clinics in February 2018. Analysis is ongoing. Additionally, we have performed a series of longitudinal focus-group interviews with the trainers in which we have followed their perceptions of implementing the program over two years.

Neuroplasticity study (Step 4)

In this study we compare the HiBalance program with an active control group (HiCommunication) with the aim to characterise and link the effects on physical and cognitive symptoms to structural and functional changes in the brain as well as wet biomarkers after the training. During fall 2017 we performed a feasibility/pilot study of the RCT and during spring 2018 the larger trial started. The aim is also to determine which biomarkers in the central nervous system may explain these changes.[EF1]

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Primary investigator


Erika Franzén

Telefon: 08-524 888 78
Enhet: Sektionen för fysioterapi

Project members/Collaborators

Hanna Johansson, PhD student

Malin Freidle, PhD student

Linda Rennie, PhD student

Petra Koski, research assistant

Breiffni Leavy, Postdoc

Conran Joseph, Postdoc

Niklas Löfgren, Postdoc

David Conradsson, PhD

Håkan Nero, PhD

Martin Benka Wallén, Postdoc

Kirsti Skavberg-Roaldsen, PhD

Caroline Paquette, Assistant professor

Maria Hagströmer, Associate professor

Ellika Schalling, Associate professor

Per Svenningsson, Professor

Urban Ekman, PhD/Postdoc

Alexander Lebedev, Postdoc

Arve Opheim, PhD

Martin Lövdén, Professor

Staffan Holmin, Professor

Agneta Ståhle, Professor

Johan Lökk, Professor

Espen Dietrich, Professor

Master students

Bachelor students

Trainers and assesors (physioterapists/speech therapists)

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

Parkinsons Research Foundation

Extrastiftelsen, Helse & Rehabilitering

Selected publications