Parkinson's disease (PD) is a serious condition with a major negative impact on patient's physical and mental health. Postural instability is one of the cardinal difficulties reported by patients to deal with. Neuroanatomical, animal, and clinical studies on nonparkinsonian and parkinsonian subjects suggest an important correlation between the presence of balance dysfunction and multiple mood disorders, such as anxiety, depression, and apathy. Considering that balance dysfunction is a very common symptom in PD, we can presume that by its management we could positively influence patient's state of mind too. This review is an analysis of nonpharmacological methods shown to be effective and successful for improving balance in patients suffering from PD. Strategies such as general exercise, robotic assisted training, Tai Chi, Qi Gong, Yoga, dance (such as tango or ballet), box, virtual reality-based, or neurofeedback-based techniques and so forth can significantly improve the stability in these patients. Beside this physical outcome, many methods have also shown effect on quality of life, depression level, enjoyment, and motivation to continue in practicing the method independently. The purpose of this review is to provide information about practical and creative methods designed to improve balance in PD and highlight their positive impact on patient's psychology.

1st Department of Neurology Faculty of Medicine Masaryk University St Anne's University Hospital Pekařská 53 656 91 Brno Czech Republic ; Central European Institute of Technology Behavioural and Social Neuroscience Research Group Kamenice 753 5 625 00 Brno Czech Republic

1st Department of Neurology Faculty of Medicine Masaryk University St Anne's University Hospital Pekařská 53 656 91 Brno Czech Republic ; Central European Institute of Technology Behavioural and Social Neuroscience Research Group Kamenice 753 5 625 00 Brno Czech Republic ; Department of Neurology Medical School University of Minnesota Minneapolis MN 55455 USA

International Clinical Research Center St Anne's University Hospital Pekařská 53 656 91 Brno Czech Republic ; 1st Department of Neurology Faculty of Medicine Masaryk University St Anne's University Hospital Pekařská 53 656 91 Brno Czech Republic

See more in PubMed

Jankovic J. Parkinson's disease: clinical features and diagnosis. Journal of Neurology, Neurosurgery and Psychiatry. 2008;79(4):368–376. doi: 10.1136/jnnp.2007.131045. PubMed DOI

Hague S. M., Klaffke S., Bandmann O. Neurodegenerative disorders: Parkinson's disease and Huntington's disease. Journal of Neurology, Neurosurgery and Psychiatry. 2005;76(8):1058–1063. doi: 10.1136/jnnp.2004.060186. PubMed DOI PMC

Bonnet A. M., Jutras M. F., Czernecki V., Corvol J. C., Vidailhet M. Nonmotor symptoms in Parkinson's disease in 2012: relevant clinical aspects. Parkinson's Disease. 2012;2012:15. doi: 10.1155/2012/198316.198316 PubMed DOI PMC

Obeso J. A., Rodríguez-Oroz M. C., Benitez-Temino B., et al. Functional organization of the basal ganglia: therapeutic implications for Parkinson's disease. Movement Disorders. 2008;23(supplement 3):S548–S559. doi: 10.1002/mds.22062. PubMed DOI

Lesage S., Brice A. Parkinson's disease: from monogenic forms to genetic susceptibility factors. Human Molecular Genetics. 2009;18(1):R48–R59. doi: 10.1093/hmg/ddp012. PubMed DOI

Fung F. S., Thompson P. D. Parkinson's Disease and Movement Disorders: Rigidity and Spasticity. Hagerstown, Md, USA: Tolosa; 2007.

Rodriguez-Oroz M. C., Jahanshahi M., Krack P., et al. Initial clinical manifestations of Parkinson's disease: features and pathophysiological mechanisms. The Lancet Neurology. 2009;8(12):1128–1139. doi: 10.1016/S1474-4422(09)70293-5. PubMed DOI

Hely M. A., Morris J. G. L., Traficante R., Reid W. G. J., O'Sullivan D. J., Williamson P. M. The Sydney multicentre study of Parkinson's disease: progression and mortality at 10 years. Journal of Neurology, Neurosurgery & Psychiatry. 1999;67(3):300–307. doi: 10.1136/jnnp.67.3.300. PubMed DOI PMC

Bloem B. R., Grimbergen Y. A. M., Cramer M., Willemsen M., Zwinderman A. H. Prospective assessment of falls in Parkinson's disease. Journal of Neurology. 2001;248(11):950–958. doi: 10.1007/s004150170047. PubMed DOI

Schenkman M., Cutson T. M., Kuchibhatla M., et al. Exercise to improve spinal flexibility and function for people with Parkinson's disease: a randomized, controlled trial. Journal of the American Geriatrics Society. 1998;46(10):1207–1216. doi: 10.1111/j.1532-5415.1998.tb04535.x. PubMed DOI

Toole T., Hirsch M. A., Forkink A., Lehman D. A., Maitland C. G. The effects of a balance and strength training program on equilibrium in Parkinsonism: a preliminary study. NeuroRehabilitation. 2000;14(3):165–174. PubMed

Hirsch M. A., Toole T., Maitland C. G., Rider R. A. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease. Archives of Physical Medicine and Rehabilitation. 2003;84(8):1109–1117. doi: 10.1016/s0003-9993(03)00046-7. PubMed DOI

Ashburn A., Fazakarley L., Ballinger C., Pickering R., McLellan L. D., Fitton C. A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry. 2007;78(7):678–684. doi: 10.1136/jnnp.2006.099333. PubMed DOI PMC

Gobbi L. T. B., Oliveira-Ferreira M. D. T., Caetano M. J. D., et al. Exercise programs improve mobility and balance in people with Parkinson's disease. Parkinsonism & Related Disorders. 2009;15(supplement 3):S49–S52. doi: 10.1016/s1353-8020(09)70780-1. PubMed DOI

Wong-Yu Is I. S., Mak M. Effects of a context-specific physiotherapy exercise programme on enhancing balance performance and balance confidence in people with Parkinson's disease—a randomised controlled trial. Hong Kong Physiotherapy Journal. 2013;31(2):100–101. doi: 10.1016/j.hkpj.2013.08.004. DOI

Nocera J., Horvat M., Ray C. T. Effects of home-based exercise on postural control and sensory organization in individuals with Parkinson disease. Parkinsonism & Related Disorders. 2009;15(10):742–745. doi: 10.1016/j.parkreldis.2009.07.002. PubMed DOI PMC

Kara B., Genc A., Colakoglu B. D., Cakmur R. The effect of supervised exercises on static and dynamic balance in Parkinson's disease patients. NeuroRehabilitation. 2012;30(4):351–357. doi: 10.3233/NRE-2012-0766. PubMed DOI

Frazzitta G., Abbruzzese G., Bertotti G., Boveri N., Pezzoli G., Maestri R. Effectiveness of an intensive rehabilitation treatment on different Parkinson's disease subtypes. NeuroRehabilitation. 2013;33(2):299–303. doi: 10.3233/nre-130959. PubMed DOI

Capecci M., Serpicelli C., Fiorentini L., et al. Postural rehabilitation and kinesio taping for axial postural disorders in Parkinson's disease. Archives of Physical Medicine and Rehabilitation. 2014;95(6):1067–1075. doi: 10.1016/j.apmr.2014.01.020. PubMed DOI

Conradsson D., Löfgren N., Ståhle A., Franzén E. Is highly challenging and progressive balance training feasible in older adults with Parkinson's disease? Archives of Physical Medicine and Rehabilitation. 2014;95(5):1000–1003. doi: 10.1016/j.apmr.2013.10.024. PubMed DOI

Dibble L. E., Hale T. F., Marcus R. L., Gerber J. P., LaStayo P. C. High intensity eccentric resistance training decreases bradykinesia and improves quality of life in persons with Parkinson's disease: a preliminary study. Parkinsonism & Related Disorders. 2009;15(10):752–757. doi: 10.1016/j.parkreldis.2009.04.009. PubMed DOI

Corcos D. M., Robichaud J. A., David F. J., et al. A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease. Movement Disorders. 2013;28(9):1230–1240. doi: 10.1002/mds.25380. PubMed DOI PMC

Herman T., Giladi N., Gruendlinger L., Hausdorff J. M. Six weeks of intensive treadmill training improves gait and quality of life in patients with Parkinson's disease: a pilot study. Archives of Physical Medicine and Rehabilitation. 2007;88(9):1154–1158. doi: 10.1016/j.apmr.2007.05.015. PubMed DOI

Ganesan M., Sathyaprabha T. N., Gupta A., Pal P. K. Effect of partial weight-supported treadmill gait training on balance in patients with Parkinson disease. PM & R. 2014;6(1):22–33. doi: 10.1016/j.pmrj.2013.08.604. PubMed DOI

Bello O., Sanchez J. A., Lopez-Alonso V., et al. The effects of treadmill or overground walking training program on gait in Parkinson's disease. Gait & Posture. 2013;38(4):590–595. doi: 10.1016/j.gaitpost.2013.02.005. PubMed DOI

Cakit B. D., Saracoglu M., Genc H., Erdem H. R., Inan L. The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease. Clinical Rehabilitation. 2007;21(8):698–705. doi: 10.1177/0269215507077269. PubMed DOI

Toole T., Maitland C. G., Warren E., Hubmann M. F., Panton L. The effects of loading and unloading treadmill walking on balance, gait, fall risk, and daily function in Parkinsonism. NeuroRehabilitation. 2005;20(4):307–322. PubMed

Filippin N. T., Lobo da Costa P. H., Mattioli R. Effects of treadmill-walking training with additional body load on quality of life in subjects with Parkinson's disease. Revista Brasileira de Fisioterapia. 2010;14(4):344–350. PubMed

Picelli A., Melotti C., Origano F., et al. Robot-assisted gait training in patients with Parkinson disease: a randomized controlled trial. Neurorehabilitation and Neural Repair. 2012;26(4):353–361. doi: 10.1177/1545968311424417. PubMed DOI

Picelli A., Melotti C., Origano F., Waldner A., Gimigliano R., Smania N. Does robotic gait training improve balance in Parkinson's disease? A randomized controlled trial. Parkinsonism & Related Disorders. 2012;18(8):990–993. doi: 10.1016/j.parkreldis.2012.05.010. PubMed DOI

Paker N., Bugdayci D., Goksenoglu G., Sen A., Kesiktas N. Effects of robotic treadmill training on functional mobility, walking capacity, motor symptoms and quality of life in ambulatory patients with Parkinson's disease: a preliminary prospective longitudinal study. NeuroRehabilitation. 2013;33(2):323–328. doi: 10.3233/nre-130962. PubMed DOI

Hackney M. E., Earhart G. M. Tai Chi improves balance and mobility in people with Parkinson disease. Gait & Posture. 2008;28(3):456–460. doi: 10.1016/j.gaitpost.2008.02.005. PubMed DOI PMC

Tsang W. W. N. Tai Chi training is effective in reducing balance impairments and falls in patients with Parkinson's disease. Journal of Physiotherapy. 2013;59(1, article 55) doi: 10.1016/s1836-9553(13)70148-6. PubMed DOI

Li F., Fitzgerald K. Postural stability in Parkinson's disease patients after Tai Chi training: a randomized controlled trial. Parkinsonism & Related Disorders. 2012;18(supplement 2):p. S155. doi: 10.1016/s1353-8020(11)70680-0. DOI

Kim H. D., Jae H. D., Jeong J. H. Tai Chi exercise can improve the obstacle negotiating ability of people with Parkinson’s Disease: a preliminary study. Journal of Physical Therapy Science. 2014;26(7):1025–1030. doi: 10.1589/jpts.26.1025. PubMed DOI PMC

Gao Q., Leung A., Yang Y., et al. Effects of Tai Chi on balance and fall prevention in Parkinson's disease: a randomized controlled trial. Clinical Rehabilitation. 2014;28(8):748–753. doi: 10.1177/0269215514521044. PubMed DOI

Amano S., Nocera J. R., Vallabhajosula S., et al. The effect of Tai Chi exercise on gait initiation and gait performance in persons with Parkinson's disease. Parkinsonism & Related Disorders. 2013;19(11):955–960. doi: 10.1016/j.parkreldis.2013.06.007. PubMed DOI PMC

Loftus S. L. Qi Gong to improve postural stability (QTIPS) for Parkinson fall prevention: a neuroplasticity approach. Topics in Geriatric Rehabilitation. 2014;30(1):58–69. doi: 10.1097/tgr.0000000000000007. DOI

Sharma N., Robbins K., Wagner K., Colgrove Y. A randomized controlled pilot study of the therapeutic effects of yoga in people with Parkinson's disease. International Journal of Yoga. 2015;8(1):74–79. doi: 10.4103/0973-6131.146070. PubMed DOI PMC

Boulgarides L. K., Barakatt E., Coleman-Salgado B. Measuring the effect of an eight-week adaptive yoga program on the physical and psychological status of individuals with Parkinson's disease. A pilot study. International Journal of Yoga Therapy. 2014;24:31–41. PubMed

Esculier J.-F., Vaudrin J., Bériault P., Gagnon K., Tremblay L. E. Home-based balance training programme using Wii Fit with balance board for Parkinsons’s disease: a pilot study. Journal of Rehabilitation Medicine. 2012;44(2):144–150. doi: 10.2340/16501977-0922. PubMed DOI

Mhatre P. V., Vilares I., Stibb S. M., et al. Wii Fit balance board playing improves balance and gait in Parkinson disease. Physical Medicine & Rehabilitation. 2013;5(9):769–777. doi: 10.1016/j.pmrj.2013.05.019. PubMed DOI PMC

Herz N. B., Mehta S. H., Sethi K. D., Jackson P., Hall P., Morgan J. C. Nintendo Wii rehabilitation (‘Wii-hab’) provides benefits in Parkinson's disease. Parkinsonism and Related Disorders. 2013;19(11):1039–1042. doi: 10.1016/j.parkreldis.2013.07.014. PubMed DOI

Pompeu J. E., Mendes F. A. D. S., Silva K. G. D., et al. Effect of Nintendo Wii-based motor and cognitive training on activities of daily living in patients with Parkinson's disease: a randomised clinical trial. Physiotherapy. 2012;98(3):196–204. doi: 10.1016/j.physio.2012.06.004. PubMed DOI

Pompeu J. E., Arduini L. A., Botelho A. R., et al. Feasibility, safety and outcomes of playing Kinect Adventures! for people with Parkinson's disease: a pilot study. Physiotherapy. 2014;100(2):162–168. doi: 10.1016/j.physio.2013.10.003. PubMed DOI

Summa S., Basteris A., Betti E., Sanguineti V. A feasibility study on using kinect for the rehabilitation in persons with Parkinson's disease. Gait & Posture. 2013;37(supplement 1):p. S15. doi: 10.1016/j.gaitpost.2012.12.040. DOI

Shih M., Yang Y., Wang R. Effects of virtual-reality based balance training on posture control in Parkinson's disease. Proceedings of the Physiological Society. 2014;31:283–284.

van den Heuvel M. R., Kwakkel G., Beek P. J., Berendse H. W., Daffertshofer A., van Wegen E. E. Effects of augmented visual feedback during balance training in Parkinson's disease: a pilot randomized clinical trial. Parkinsonism & Related Disorders. 2014;20:1352–1358. PubMed

Lee N. Y., Lee D. K., Song H. S. Effect of virtual reality dance exercise on the balance, activities of daily living, and depressive disorder status of Parkinson’s disease patients. Journal of Physical Therapy Science. 2015;27(1):145–147. doi: 10.1589/jpts.27.145. PubMed DOI PMC

Azarpaikan A., Torbati H. T., Sohrabi M. Neurofeedback and physical balance in Parkinson's patients. Gait & Posture. 2014;40(1):177–181. doi: 10.1016/j.gaitpost.2014.03.179. PubMed DOI

Mirelman A., Herman T., Nicolai S., et al. Audio-biofeedback training for posture and balance in patients with Parkinson's disease. Journal of NeuroEngineering & Rehabilitation. 2011;8, article 35 doi: 10.1186/1743-0003-8-35. PubMed DOI PMC

Asseman F., Bronstein A. M., Gresty M. A. Using vibrotactile feedback of instability to trigger a forward compensatory stepping response. Journal of Neurology. 2007;254(11):1555–1561. doi: 10.1007/s00415-007-0587-7. PubMed DOI

Marchant D., Sylvester J. L., Earhart G. M. Effects of a short duration, high dose contact improvisation dance workshop on Parkinson disease: a pilot study. Complementary Therapies in Medicine. 2010;18(5):184–190. doi: 10.1016/j.ctim.2010.07.004. PubMed DOI

Batson G. Feasibility of an intensive trial of modern dance for adults with Parkinson disease. Complementary Health Practice Review. 2010;15(2):65–83. doi: 10.1177/1533210110383903. DOI

Hackney M. E., Earhart G. M. Effects of dance on movement control in Parkinson’s disease: a comparison of Argentine tango and American ballroom. Journal of Rehabilitation Medicine. 2009;41(6):475–481. doi: 10.2340/16501977-0362. PubMed DOI PMC

Heiberger L., Maurer C., Amtage F., et al. Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson's disease. Frontiers in Aging Neuroscience. 2011;3, article 14 doi: 10.3389/fnagi.2011.00014. PubMed DOI PMC

Rosario E., Aiello E., Paulus K. S., et al. Effects of dance therapy on balance, gait and neuro-psychological performances in patients with Parkinson's disease and postural instability. Disability and Rehabilitation. 2012;2(3):p. 45.

Hashimoto H., Takabatake S., Miyaguchi H., Nakanishi H., Naitou Y. Effects of dance on motor functions, cognitive functions, and mental symptoms of Parkinson's disease: a quasi-randomized pilot trial. Complementary Therapies in Medicine. 2015;23(2):210–219. doi: 10.1016/j.ctim.2015.01.010. PubMed DOI

Westheimer O., McRae C., Henchcliffe C., et al. Dance for PD: a preliminary investigation of effects on motor function and quality of life among persons with Parkinson’s disease (PD) Journal of Neural Transmission. 2015 doi: 10.1007/s00702-015-1380-x. PubMed DOI

Houston S., McGill A. A mixed-methods study into ballet for people living with Parkinson's. Arts & Health. 2013;5(2):103–119. doi: 10.1080/17533015.2012.745580. PubMed DOI PMC

Hackney M. E., Earhart G. M. Short duration, intensive tango dancing for Parkinson disease: an uncontrolled pilot study. Complementary Therapies in Medicine. 2009;17(4):203–207. doi: 10.1016/j.ctim.2008.10.005. PubMed DOI PMC

Hackney M. E., Earhart G. M. Health-related quality of life and alternative forms of exercise in Parkinson disease. Parkinsonism & Related Disorders. 2009;15(9):644–648. doi: 10.1016/j.parkreldis.2009.03.003. PubMed DOI PMC

Hackney M. E., Kantorovich S., Earhart G. M. A study on the effects of argentine tango as a form of partnered dance for those with Parkinson disease and the healthy elderly. American Journal of Dance Therapy. 2007;29(2):109–127. doi: 10.1007/s10465-007-9039-2. DOI

Romenets S. R., Anang J., Fereshtehnejad S. M., Pelletier A., Postuma R. Tango for treatment of motor and non-motor manifestations in Parkinson's disease: a randomized control study. Complementary Therapies in Medicine. 2015;23(2):175–184. doi: 10.1016/j.ctim.2015.01.015. PubMed DOI

Nilsson M. H., Fransson P.-A., Jarnlo G.-B., Magnusson M., Rehncrona S. The effects of high frequency subthalamic stimulation on balance performance and fear of falling in patients with Parkinson's disease. Journal of NeuroEngineering & Rehabilitation. 2009;6, article 13 doi: 10.1186/1743-0003-6-13. PubMed DOI PMC

Vivas J., Arias P., Cudeiro J. Aquatic therapy versus conventional land-based therapy for Parkinson's disease: an open-label pilot study. Archives of Physical Medicine and Rehabilitation. 2011;92(8):1202–1210. doi: 10.1016/j.apmr.2011.03.017. PubMed DOI

Ebersbach G., Edler D., Kaufhold O., Wissel J. Whole body vibration versus conventional physiotherapy to improve balance and gait in Parkinson's disease. Archives of Physical Medicine and Rehabilitation. 2008;89(3):399–403. doi: 10.1016/j.apmr.2007.09.031. PubMed DOI

Lauhoff P., Murphy N., Doherty C., Horgan N. F. A controlled clinical trial investigating the effects of cycle ergometry training on exercise tolerance, balance and quality of life in patients with Parkinson's disease. Disability & Rehabilitation. 2013;35(5):382–387. doi: 10.3109/09638288.2012.694962. PubMed DOI

Kaski D., Dominguez R. O., Allum J. H., Islam A. F., Bronstein A. M. Combining physical training with transcranial direct current stimulation to improve gait in Parkinson's disease: a pilot randomized controlled study. Clinical Rehabilitation. 2014;28(11):1115–1124. doi: 10.1177/0269215514534277. PubMed DOI

Shen X., Mak M. K. Y. Repetitive step training with preparatory signals improves stability limits in patients with Parkinson's disease. Journal of Rehabilitation Medicine. 2012;44(11):944–949. doi: 10.2340/16501977-1056. PubMed DOI

Morris M. E., Iansek R., Kirkwood B. A randomized controlled trial of movement strategies compared with exercise for people with Parkinson's disease. Movement Disorders. 2009;24(1):64–71. doi: 10.1002/mds.22295. PubMed DOI

Scalzo P. L., Flores C. R., Marques J. R., Robini S. C. D. O., Teixeira A. L. Impact of changes in balance and walking capacity on the quality of life in patients with Parkinson's disease. Arquivos de Neuro-Psiquiatria. 2012;70(2):119–124. doi: 10.1590/S0004-282X2012000200009. PubMed DOI

Ward C. D. What contributes to quality of life in patients with Parkinson's disease? Journal of Neurology, Neurosurgery & Psychiatry. 2000;69(3):289–290. doi: 10.1136/jnnp.69.3.289. PubMed DOI PMC

Muslimović D., Post B., Speelman J. D., Schmand B., de Haan R. J., CARPA Study Group Determinants of disability and quality of life in mild to moderate Parkinson disease. Neurology. 2008;70(23):2241–2247. doi: 10.1212/01.wnl.0000313835.33830.80. PubMed DOI

Rahman S., Griffin H. J., Quinn N. P., Jahanshahi M. Quality of life in Parkinson's disease: the relative importance of the symptoms. Movement Disorders. 2008;23(10):1428–1434. doi: 10.1002/mds.21667. PubMed DOI

Melton L. J., III, Leibson C. L., Achenbach S. J., et al. Fracture risk after the diagnosis of Parkinson's disease: influence of concomitant dementia. Movement Disorders. 2006;21(9):1361–1367. doi: 10.1002/mds.20946. PubMed DOI

Stegemöller E. L., Nocera J., Malaty I., Shelley M., Okun M. S., Hass C. J. Timed up and go, cognitive, and quality-of-life correlates in Parkinson's disease. Archives of Physical Medicine and Rehabilitation. 2014;95(4):649–655. doi: 10.1016/j.apmr.2013.10.031. PubMed DOI

Nisenzon A. N., Robinson M. E., Bowers D., Banou E., Malaty I., Okun M. S. Measurement of patient-centered outcomes in Parkinson's disease: what do patients really want from their treatment? Parkinsonism and Related Disorders. 2011;17(2):89–94. doi: 10.1016/j.parkreldis.2010.09.005. PubMed DOI PMC

Soh S.-E., Morris M. E., McGinley J. L. Determinants of health-related quality of life in Parkinson's disease: a systematic review. Parkinsonism & Related Disorders. 2011;17(1):1–9. doi: 10.1016/j.parkreldis.2010.08.012. PubMed DOI

Caballol N., Martí M. J., Tolosa E. Cognitive dysfunction and dementia in Parkinson disease. Movement Disorders. 2007;22(17):S358–S366. doi: 10.1002/mds.21677. PubMed DOI

Ossowska K., Lorenc-Koci E. Depression in Parkinson's disease. Pharmacological Reports. 2013;65(6):1545–1557. doi: 10.1016/S1734-1140(13)71516-0. PubMed DOI

Visser M., Van Rooden S. M., Verbaan D., Marinus J., Stiggelbout A. M., Van Hilten J. J. A comprehensive model of health-related quality of life in Parkinson's disease. Journal of Neurology. 2008;255(10):1580–1587. doi: 10.1007/s00415-008-0994-4. PubMed DOI

Routh L. C., Black J. L., Ahlskog J. E. Parkinson's disease complicated by anxiety. Mayo Clinic Proceedings. 1987;62(8):733–735. doi: 10.1016/s0025-6196(12)65226-4. PubMed DOI

Leentjens A. F. G., Dujardin K., Marsh L., Martinez-Martin P., Richard I. H., Starkstein S. E. Symptomatology and markers of anxiety disorders in Parkinson's disease: a cross-sectional study. Movement Disorders. 2011;26(3):484–492. doi: 10.1002/mds.23528. PubMed DOI

Pontone G. M., Williams J. R., Anderson K. E., et al. Prevalence of anxiety disorders and anxiety subtypes in patients with Parkinson's disease. Movement Disorders. 2009;24(9):1333–1338. doi: 10.1002/mds.22611. PubMed DOI PMC

Dissanayaka N. N. W., Sellbach A., Matheson S., et al. Anxiety disorders in Parkinson's disease: prevalence and risk factors. Movement Disorders. 2010;25(7):838–845. doi: 10.1002/mds.22833. PubMed DOI

Pont-Sunyer C., Hotter A., Gaig C., et al. The Onset of Nonmotor Symptoms in Parkinson's disease (The ONSET PDStudy) Movement Disorders. 2015;30(2):229–237. doi: 10.1002/mds.26077. PubMed DOI

Aarsland D., Brønnick K., Alves G., et al. The spectrum of neuropsychiatric symptoms in patients with early untreated Parkinson's disease. Journal of Neurology, Neurosurgery and Psychiatry. 2009;80(8):928–930. doi: 10.1136/jnnp.2008.166959. PubMed DOI

Barone P., Antonini A., Colosimo C., et al. The PRIAMO study: a multicenter assessment of nonmotor symptoms and their impact on quality of life in Parkinson's disease. Movement Disorders. 2009;24(11):1641–1649. doi: 10.1002/mds.22643. PubMed DOI

Dujardin K., Sockeel P., Delliaux M., Destée A., Defebvre L. Apathy may herald cognitive decline and dementia in Parkinson's disease. Movement Disorders. 2009;24(16):2391–2397. doi: 10.1002/mds.22843. PubMed DOI

Pedersen K. F., Larsen J. P., Alves G., Aarsland D. Prevalence and clinical correlates of apathy in Parkinson's disease: a community-based study. Parkinsonism and Related Disorders. 2009;15(4):295–299. doi: 10.1016/j.parkreldis.2008.07.006. PubMed DOI

Friedman J. H. Parkinson's disease psychosis 2010: a review article. Parkinsonism & Related Disorders. 2010;16(9):553–560. doi: 10.1016/j.parkreldis.2010.05.004. PubMed DOI

Hassan A., Vallabhajosula S., Zahodne L. B., et al. Correlations of apathy and depression with postural instability in Parkinson disease. Journal of the Neurological Sciences. 2014;338(1-2):162–165. doi: 10.1016/j.jns.2013.12.040. PubMed DOI

Pasman E. P., Murnaghan C. D., Bloem B. R., Carpenter M. G. Balance problems with Parkinson's disease: are they anxiety-dependent? Neuroscience. 2011;177:283–291. doi: 10.1016/j.neuroscience.2010.12.050. PubMed DOI

Balaban C. D., Thayer J. F. Neurological bases for balance-anxiety links. Journal of Anxiety Disorders. 2001;15(1-2):53–79. doi: 10.1016/s0887-6185(00)00042-6. PubMed DOI

Balaban C. D. Vestibular nucleus projections to the parabrachial nucleus in rabbits: implications for vestibular influences on the autonomic nervous system. Experimental Brain Research. 1996;108(3):367–381. PubMed

Charney D. S., Charney D. S., Deutch A., Deutch A. A functional neuroanatomy of anxiety and fear: implications for the pathophysiology and treatment of anxiety disorders. Critical Reviews in Neurobiology. 1996;10(3-4):419–446. doi: 10.1615/critrevneurobiol.v10.i3-4.70. PubMed DOI

Ricardo J. A., Koh E. T. Anatomical evidence of direct projections from the nucleus of the solitary tract to the hypothalamus, amygdala, and other forebrain structures in the rat. Brain Research. 1978;153(1):1–26. doi: 10.1016/0006-8993(78)91125-3. PubMed DOI

Riche D., de Pommery J., Menetrey D. Neuropeptides and catecholamines in efferent projections of the nuclei of the solitary tract in the rat. Journal of Comparative Neurology. 1990;293(3):399–424. doi: 10.1002/cne.902930306. PubMed DOI

Moga M. M., Weis R. P., Moore R. Y. Efferent projections of the paraventricular thalamic nucleus in the rat. Journal of Comparative Neurology. 1995;359(2):221–238. doi: 10.1002/cne.903590204. PubMed DOI

Porter J. D., Balaban C. D. Connections between the vestibular nuclei and brain stem regions that mediate autonomic function in the rat. Journal of Vestibular Research: Equilibrium and Orientation. 1997;7(1):63–76. doi: 10.1016/S0957-4271(96)00138-3. PubMed DOI

Damasio A. R. Emotion in the perspective of an integrated nervous system. Brain Research Reviews. 1998;26(2-3):83–86. doi: 10.1016/s0165-0173(97)00064-7. PubMed DOI

Goddard A. W., Charney D. S. Toward an integrated neurobiology of panic disorder. Journal of Clinical Psychiatry. 1997;58(2):4–11. PubMed

Shefer S., Gordon C., Avraham K. B., Mintz M. Balance deficit enhances anxiety and balance training decreases anxiety in vestibular mutant mice. Behavioural Brain Research. 2015;276:76–83. doi: 10.1016/j.bbr.2014.06.046. PubMed DOI

Reppa G. P. The effects of a new program (balance & reform) on trait anxiety and self-esteem: a pilot study. Procedia—Social and Behavioral Sciences. 2013;84:230–232.

Bart O., Bar-Haim Y., Weizman E., Levin M., Sadeh A., Mintz M. Balance treatment ameliorates anxiety and increases self-esteem in children with comorbid anxiety and balance disorder. Research in Developmental Disabilities. 2009;30(3):486–495. doi: 10.1016/j.ridd.2008.07.008. PubMed DOI

Erez O., Gordon C. R., Sever J., Sadeh A., Mintz M. Balance dysfunction in childhood anxiety: findings and theoretical approach. Journal of Anxiety Disorders. 2004;18(3):341–356. doi: 10.1016/s0887-6185(02)00291-8. PubMed DOI

Sagna A., Gallo J. J., Pontone G. M. Systematic review of factors associated with depression and anxiety disorders among older adults with Parkinson's disease. Parkinsonism and Related Disorders. 2014;20:708–715. doi: 10.1016/j.parkreldis.2014.03.020. PubMed DOI PMC

Siemers E. R., Shekhar A., Quaid K., Dickson H. Anxiety and motor performance in Parkinson's disease. Movement Disorders. 1993;8(4):501–506. doi: 10.1002/mds.870080415. PubMed DOI

Martens K. A. E., Ellard C. G., Almeida Q. J., Balasubramaniam R. Does anxiety cause freezing of gait in Parkinson's disease? PLoS ONE. 2014;9(9) doi: 10.1371/journal.pone.0106561.e106561 PubMed DOI PMC

Reijnders J. S. A. M., Scholtissen B., Weber W. E. J., Aalten P., Verhey F. R. J., Leentjens A. F. G. Neuroanatomical correlates of apathy in Parkinson's disease: a magnetic resonance imaging study using voxel-based morphometry. Movement Disorders. 2010;25(14):2318–2325. doi: 10.1002/mds.23268. PubMed DOI

Benoit M., Robert P. H. Imaging correlates of apathy and depression in Parkinson's disease. Journal of the Neurological Sciences. 2011;310(1-2):58–60. doi: 10.1016/j.jns.2011.07.006. PubMed DOI

Frisina P. G., Haroutunian V., Libow L. S. The neuropathological basis for depression in Parkinson's disease. Parkinsonism and Related Disorders. 2009;15(2):144–148. doi: 10.1016/j.parkreldis.2008.04.038. PubMed DOI PMC

Gallagher D. A., Schrag A. Psychosis, apathy, depression and anxiety in Parkinson's disease. Neurobiology of Disease. 2012;46(3):581–589. doi: 10.1016/j.nbd.2011.12.041. PubMed DOI

Reijnders J. S. A. M., Ehrt U., Lousberg R., Aarsland D., Leentjens A. F. G. The association between motor subtypes and psychopathology in Parkinson's disease. Parkinsonism and Related Disorders. 2009;15(5):379–382. doi: 10.1016/j.parkreldis.2008.09.003. PubMed DOI

Lord S., Galna B., Coleman S., Burn D., Rochester L. Mild depressive symptoms are associated with gait impairment in early Parkinson's disease. Movement Disorders. 2013;28(5):634–639. doi: 10.1002/mds.25338. PubMed DOI

Burn D. J. The effects of deep brain stimulation and levodopa on postural sway in subjects with Parkinson's disease. Journal of Neurology, Neurosurgery & Psychiatry. 2002;73(3, article 240) doi: 10.1136/jnnp.73.3.240. PubMed DOI PMC

Bauman A., Schoo M. E. M. M. M. Optimizing Exercise and Physical Activity in Older People. Oxford, UK: Butterworth-Heinemann; 2004. Health benefits of physical activity for older adults—epidemiological approaches to the evidence; pp. 1–25.

Smith A. D., Zigmond M. J. Can the brain be protected through exercise? Lessons from an animal model of parkinsonism. Experimental Neurology. 2003;184(1):31–39. doi: 10.1016/j.expneurol.2003.08.017. PubMed DOI

Bello O., Marquez G., Camblor M., Fernandez-Del-Olmo M. Mechanisms involved in treadmill walking improvements in Parkinson's disease. Gait and Posture. 2010;32(1):118–123. doi: 10.1016/j.gaitpost.2010.04.015. PubMed DOI

Ross A., Thomas S. The health benefits of yoga and exercise: a review of comparison studies. Journal of Alternative and Complementary Medicine. 2010;16(1):3–12. doi: 10.1089/acm.2009.0044. PubMed DOI

Raub J. A. Psychophysiologic effects of Hatha Yoga on musculoskeletal and cardiopulmonary function: a literature review. Journal of Alternative and Complementary Medicine. 2002;8(6):797–812. doi: 10.1089/10755530260511810. PubMed DOI

Schmid A. A., van Puymbroeck M., Koceja D. M. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study. Archives of Physical Medicine and Rehabilitation. 2010;91(4):576–583. doi: 10.1016/j.apmr.2009.12.018. PubMed DOI

Moriello G., Denio C., Abraham M., DeFrancesco D., Townsley J. Incorporating yoga into an intense physical therapy program in someone with Parkinson's disease: a case report. Journal of Bodywork and Movement Therapies. 2013;17(4):408–417. doi: 10.1016/j.jbmt.2013.01.005. PubMed DOI

Hall E., Verheyden G., Ashburn A. Effect of a yoga programme on an individual with Parkinson's disease: a single-subject design. Disability and Rehabilitation. 2011;33(15-16):1483–1489. doi: 10.3109/09638288.2010.529233. PubMed DOI

Bisson E., Contant B., Sveistrup H., Lajoie Y. Functional balance and dual-task reaction times in older adults are improved by virtual reality and biofeedback training. Cyberpsychology & Behavior. 2007;10(1):16–23. doi: 10.1089/cpb.2006.9997. PubMed DOI

Butler D. P., Willett K. Wii-habilitation: is there a role in trauma? Injury. 2010;41(9):883–885. doi: 10.1016/j.injury.2010.03.024. PubMed DOI

Yen C.-Y., Lin K.-H., Hu M.-H., Wu R.-M., Lu T.-W., Lin C.-H. Effects of virtual reality-augmented balance training on sensory organization and attentional demand for postural control in people with Parkinson disease: a randomized controlled trial. Physical Therapy. 2011;91(6):862–874. doi: 10.2522/ptj.20100050. PubMed DOI

Faridnia M., Shojaei M., Rahimi A. The effect of neurofeedback training on the anxiety of elite female swimmers. Annals of Biological Research. 2012;3(2):1020–1028.

Caro X. J., Winter E. F. EEG biofeedback treatment improves certain attention and somatic symptoms in fibromyalgia: a pilot study. Applied Psychophysiology Biofeedback. 2011;36(3):193–200. doi: 10.1007/s10484-011-9159-9. PubMed DOI

Robinson K., Dennison A., Roalf D., et al. Falling risk factors in Parkinson's disease. NeuroRehabilitation. 2005;20(3):169–182. doi: 10.1017/S1537592705380145. PubMed DOI

Contreras A., Grandas F. Risk of falls in Parkinson's disease: a cross-sectional study of 160 patients. Parkinson's Disease. 2012;2012:10. doi: 10.1155/2012/362572.362572 PubMed DOI PMC

Rossi-Izquierdo M., Ernst A., Soto-Varela A., et al. Vibrotactile neurofeedback balance training in patients with Parkinson's disease: reducing the number of falls. Gait & Posture. 2013;37(2):195–200. doi: 10.1016/j.gaitpost.2012.07.002. PubMed DOI

Kattenstroth J.-C., Kolankowska I., Kalisch T., Dinse H. R. Superior sensory, motor, and cognitive performance in elderly individuals with multi-year dancing activities. Frontiers in Aging Neuroscience. 2010;2, article 31 doi: 10.3389/fnagi.2010.00031. PubMed DOI PMC

Hackney M. E., Earhart G. M. Effects of dance on gait and balance in Parkinsons disease: a comparison of partnered and nonpartnered dance movement. Neurorehabilitation and Neural Repair. 2010;24(4):384–392. doi: 10.1177/1545968309353329. PubMed DOI PMC

Baláž M. Deep brain stimulation in Parkinson's disease. Neurologie Pro Praxi. 2013;14:229–231.

Nilsson M. H., Törnqvist A. L., Rehncrona S. Deep-brain stimulation in the subthalamic nuclei improves balance performance in patients with Parkinson's disease, when tested without anti-parkinsonian medication. Acta Neurologica Scandinavica. 2005;111(5):301–308. doi: 10.1111/j.1600-0404.2005.00394.x. PubMed DOI

Hariz M. I., Rehncrona S., Quinn N. P., Speelman J. D., Wensing C. Multicenter study on deep brain stimulation in Parkinson's disease: an independent assessment of reported adverse events at 4 years. Movement Disorders. 2008;23(3):416–421. doi: 10.1002/mds.21888. PubMed DOI

Tommasi G., Lopiano L., Zibetti M., et al. Freezing and hypokinesia of gait induced by stimulation of the subthalamic region. Journal of the Neurological Sciences. 2007;258(1-2):99–103. doi: 10.1016/j.jns.2007.03.002. PubMed DOI

Bakker M., Esselink R. A. J., Munneke M., Limousin-Dowsey P., Speelman H. D., Bloem B. R. Effects of stereotactic neurosurgery on postural instability and gait in Parkinson's disease. Movement Disorders. 2004;19(9):1092–1099. doi: 10.1002/mds.20116. PubMed DOI

Krack P., Batir A., van Blercom N., et al. Five-year follow-up of bilateral stimulation of the subthalamic nucleus in advanced Parkinson's disease. The New England Journal of Medicine. 2003;349(20):1925–1934. doi: 10.1056/nejmoa035275. PubMed DOI

Fasano A., Romito L. M., Daniele A., et al. Motor and cognitive outcome in patients with Parkinson's disease 8 years after subthalamic implants. Brain. 2010;133(9):2664–2676. doi: 10.1093/brain/awq221. PubMed DOI

Schüpbach W. M. M., Chastan N., Welter M. L., et al. Stimulation of the subthalamic nucleus in Parkinson's disease: a 5 year follow up. Journal of Neurology, Neurosurgery and Psychiatry. 2005;76(12):1640–1644. doi: 10.1136/jnnp.2005.063206. PubMed DOI PMC

Romito L. M., Contarino M. F., Vanacore N., Bentivoglio A. R., Scerrati M., Albanese A. Replacement of dopaminergic medication with subthalamic nucleus stimulation in Parkinson's disease: long-term observation. Movement Disorders. 2009;24(4):557–563. doi: 10.1002/mds.22390. PubMed DOI

Plaha P., Gill S. S. Bilateral deep brain stimulation of the pedunculopontine nucleus for Parkinson's disease. NeuroReport. 2005;16(17):1883–1887. doi: 10.1097/01.wnr.0000187637.20771.a0. PubMed DOI

Stefani A., Lozano A. M., Peppe A., et al. Bilateral deep brain stimulation of the pedunculopontine and subthalamic nuclei in severe Parkinson's disease. Brain. 2007;130(6):1596–1607. doi: 10.1093/brain/awl346. PubMed DOI

Mathieson I., Curran S., Hallam S., Corne J.

Combs S. A., Diehl D., Staples W. H., et al. Boxing training for patients with parkinson disease: a case series. Physical Therapy. 2011;91(1):132–142. doi: 10.2522/ptj.20100142. PubMed DOI

Kluding P., McGinnis P. Q. Multidimensional exercise for people with Parkinson's disease: a case report. Physiotherapy Theory and Practice. 2006;22(3):153–162. doi: 10.1080/09593980600724261. PubMed DOI

Ellis T., Boudreau J. K., DeAngelis T. R., et al. Barriers to exercise in people with parkinson disease. Physical Therapy. 2013;93(5):628–636. doi: 10.2522/ptj.20120279. PubMed DOI PMC

Motion and emotion: anxiety-axial connections in Parkinson's disease