Evidence Summary
Physical activity improves gait including walking speed, endurance stride length & cadence.

Evidence summary: A growing body of moderate quality data from systematic review and meta-analysis of randomised controlled trials shows activity interventions have a positive effect on improving gait, increasing stride length, improving cadence and walking speed that can be maintained over time [1 – 6]. This includes treadmill training, traditional physiotherapy, Qigong, Pilates and Nordic Walking [1 – 6]. Walking with Nordic Walking poles increase stride length and postural stability by altering the trunk position (6). Qigong at least twice a week can improve walking and balance ability with lessening effect with advancing age [3].

The recommended minimum activity sessions are 12-14 sessions over 10-12 weeks in a supervised session for short term improvement depending on the type of training [1].

Quality of Evidence
B – This is based on a number of systematic reviews and meta-analysis but the studies looked at have small study sizes.

Strength of Recommendation
1 – The studies are in general agreement that walking ability can be improved with various types of activity. Very few adverse effects were reported.

Conclusion
A variety of activities can help People with Parkinson’s improve their walking ability and movement which includes walking speed, endurance, stride length postural stability and cadence.

References
[1] Ni M et al. Exercise guidelines for gait function in Parkinson’s disease: A systematic, review and meta-analysis. Neurorehabilitation and Neural Repair; Oct 2018; vol. 32 (no. 10); p. 872-86
[2] Wu et al. Effectiveness of physical activity on patients with depression and Parkinson’s disease: A systematic review. PLoS One. 2017 Jul 27;12(7):e0181515.
[3] Nadeau A et al. Effects of 24 wk of treadmill training on gait performance in Parkinson’s disease. Medicine and Science in Sports and Exercise; Apr 2014; vol. 46 (no. 4); p. 645-55
[4] Chen S et al. The effect of Qigong-based therapy on patients with Parkinson’s disease: a systematic review and meta-analysis. Clin Rehabil . 2020 Dec;34(12):1436-1448.
[5] Gougeon M-A et al. Nordic Walking improves trunk stability and gait spatial-temporal characteristics in people with Parkinson disease. NeuroRehabilitation. 2017;41(1):205-210.
[6] Suárez-Iglesias D et al. Benefits of Pilates in Parkinson’s Disease: A Systematic Review and Meta-Analysis. Medicina (Kaunas). 2019 Aug 13;55(8):476.