Effects of Structured Functional Turning Practice Within a Time-Matched Exercise Program on Functional Mobility, Gait Speed, and Balance in Early-Stage Parkinson’s Disease: A Randomized Controlled Trial

Abstract

Background/Objectives: Turning frequently precipitates falls in Parkinson’s disease (PD) but is rarely trained systematically. We examined whether replacing part of a conventional exercise session with structured turning practice improves functional mobility, gait speed, and balance in early-stage PD. Methods: Fifty patients with PD (Hoehn and Yahr stage 1–2; aged 50–70 years) were randomized to a time-matched program in which 18–20 min of each 45–50 min session was devoted to turning practice and the remainder to a reduced conventional program (n = 25), or to a full conventional program (n = 25), three times weekly for 12 weeks. The primary outcome was the Timed Up and Go test (TUG); secondary outcomes were gait speed (10-Meter Walk Test) and the Berg Balance Scale (BBS). Outcome assessment was not blinded. Groups were compared with baseline-adjusted analysis of covariance (ANCOVA). Results: All participants completed the study. Adjusted differences favored the turning group for TUG (−1.79 s; 95% confidence interval [CI] −1.98 to −1.61), gait speed (0.116 m/s; 95% CI 0.108 to 0.124), and BBS (1.84 points; 95% CI 1.50 to 2.17) (all p < 0.001). Conclusions: In high-functioning patients with early-stage PD, a time-matched program including structured turning practice produced larger short-term improvements in TUG performance, gait speed, and balance than conventional exercise alone. The effects were unusually large and were obtained with unblinded assessment and with test tasks partly practiced during training; falls and turning quality were not measured. Assessor-blinded trials with turning-specific outcomes and fall recording are needed. Trial registration: ClinicalTrials.gov, NCT07442370.