Exercise and Balance in Older Adults with Movement Disorders

This chapter concerns balance, gait function, exercise, and current rehabilitation options for older adults with Parkinson’s disease (PD) and stroke, within the context of aging in the absence of neurodegenerative disease or neuroinsult. We outline the primary balance and gait deficits and their impact on falls’ rates for PD and stroke, with discussion regarding impairment in dual tasking and cognitive disturbances. We consider current options in physical therapy and exercise-based therapy for PD and stroke, particularly for interlimb coordination and gait function. Crossover approaches in rehabilitative techniques from PD/stroke to normal aging motor impairments often go under-utilized in the clinic. Therefore, implications for older adults without movement disorders, who often have purely aging-related symptoms similar to those of PD are discussed. Currently, research is especially engaged in investigating novel approaches to multimodal exercise, which have emerged as promising therapies for balance impairments including aerobic exercise, tai chi, and dance. Efficacy of such interventions is presented with respect to new research showing cognitive effects. We conclude this chapter by discussing hypotheses regarding mechanisms underlying deficit and recovery in these populations. Understanding the mechanisms for rehabilitative gains is crucial for developing targeted and efficient therapy for PD and stroke populations.