Gait Training

Produced by: Parkinson Disease Knowledge Translation Task Force

Physical therapists should implement gait training to reduce motor disease

Fact Sheet severity, and improve stride length, gait speed, mobility, and balance in
individuals with Parkinson disease.

Types individuals with PD who would most/least benefit from the intervention
• Studies have been primarily conducted in individuals with mild-moderate PD
(H&Y I-III); less is known about the effects of gait training on those with severe
disease (H&Y IV-V).

How to perform the intervention

• Gait training consists of interventions such as treadmill training (with or without
body weight support), robotic assisted gait training, and overground gait training.
• Optimal dosing has not been determined. However, many studies reveal a
benefit of gait training when implemented 20-60 minutes, 3-5 days/week, for 4-12
weeks. Importantly, a functional decline occurred in most studies during a 3-6
month post-training period, indicating that gait training may need to be a
continued activity to decrease the decline in functional outcomes.
• Given variability across studies, specific parameters (overground, treadmill
with/without robotic assistance, cardiovascular intensity, and body weight
support) cannot be identified. No single gait training intervention demonstrates
greater improvement than other types of gait training.
• Nordic walking is a form of walking that utilizes 2 walking poles and is usually
performed outdoors. The use of 2 walking poles provides total body activation
and a training effect on the coordination of reciprocal upper extremity movement.

Considerations related to safety (precautions, contraindications; when should you

NOT choose the intervention; consider including info from the CPG that has
“Exclusion” sections)
• Individuals who are at high risk for falls may require a harness or safety device to
optimize safety. Screening for the presence of comorbidities that may interfere
with participation in gait training should be implemented.

Considerations for progression

• Gait training when implemented as recommended above may be needed to
progress activity level and reduce decline in functional outcomes.
• The use of equipment or tapering away from equipment allows therapists to
adjust progression for gait training. For example, reducing the amount of support
provided overtime to mimic everyday walking including progressing to
overground, uneven surfaces, and salient gait training specific to the individual’s
needs.
• Progression of gait training can be done by manipulating variables such as
cadence, incline, distance, walking surfaces, striving towards a more
autonomous learning stage, altering the environment, and the addition of a dual
motor and/or cognitive task.

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Published April 2022
 Considerations for cost, space
• Access to a facility with equipment and trained clinicians is needed for
implementation including treadmill training (including body weight support
treadmill training, circular treadmill training) and robotic assisted gait training.
• Gait training equipment may also be cumbersome requiring adequate space
and maintenance for optimal safety.
• Overground gait training can be more readily incorporated into indoor and
outdoor areas with less of a cost and training burden for the clinician and PD
individual.

Type of Training What it FITT Tools for

improves assessment
Treadmill (may include • Motor disease • 3-5 • UPDRS III
forward and backward severity days/week • Berg Balance Scale
stepping, downhill • Balance for 6-12 or Functional Gait
walking, perturbations, • Gait parameters weeks Assessment
and/or dual tasking) including gait • 30-60’ • 10 Meter Walk Test
Results are mixed speed, stride sessions (10MWT)
regarding benefit of length • Six Minute Walk
body weight support • Endurance Test (6MWT)
• May improve • Freezing of Gait
freezing of gait Questionnaire
• May reduce falls • Activities-Specific
and fear of Balance Confidence
falling scale (ABC); Falls
Efficacy Scale

Overground (i.e multi • Reduction of • 20-60 • UPDRS III

directional walking; motor disease minute • Six Minute Walk
with or without an severity sessions Test (6MWT)
assistive device; • Balance • 3-5 • Timed Up and Go
Nordic walking) • Strength/ power days/week (TUG)
• Gait parameters • total for 4- • Ten Meter Walk
including stride 12 weeks Test (10MWT)
and gait speed • Berg Balance Scale
• Stability
• Baroreflex
sensitivity
• Cognition

Produced by Robotic • General motor • 3-5x/wk for • UPDRS III

Parkinson Disease symptoms 4-5 weeks • Tinetti Assessment
Knowledge Translation • Balance • 30-45 • Berg Balance Scale
Task Force • Functional minute • Timed Up and Go
mobility sessions (TUG)
• Gait parameters • Ten Meter Walk
including Test (10MWT)
velocity and • Six Minute Walk
step/stride Test (6MWT)
length • Activities-Specific
• May improve Balance Confidence
freezing of gait scale (ABC)
• Freezing Of Gait
Questionnaire
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Published April 2022