BETA-PD: Balance Elderly Training and Activity in Parkinson’s disease.
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.
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]
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
Håkan Nero, PhD
Martin Benka Wallén, Postdoc
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
Trainers and assesors (physioterapists/speech therapists)
The Swedish research council
National School in Health Care Sciences
Stockholm County Council research funds
StratNeuro, Karolinska Institutet
Swedish Parkinson foundation
Parkinsons Research Foundation
Extrastiftelsen, Helse & Rehabilitering