Abstract

Background. Gait and postural instability are key determinants of functional independence and fall risk in Parkinson’s disease (PD). Blood flow restriction (BFR) training may provide a high neuromuscular stimulus at relatively low mechanical load, but its added value when embedded within task-oriented functional training in PD remains unclear. Methods. We conducted an assessor-blinded, three-arm, parallel pilot randomized controlled trial. Thirty-three adults with idiopathic PD (Hoehn & Yahr stage 1–3) were randomized 1:1:1 to (i) BFR plus functional training (BFR+Func), (ii) functional training alone (Func), or (iii) control (health education). Training was delivered for 8 weeks (3 sessions/week; ~60 min/session). In BFR+Func, thigh cuffs were applied intermittently during selected functional-task sets at 60% limb occlusion pressure. Outcomes were assessed at baseline and post-intervention, including activities of daily living (Schwab & England ADL scale; self-reported Barthel Index), dynamic balance (Mini-BESTest), mobility (Timed Up and Go), walking endurance (6-minute walk test), and gait spatiotemporal parameters and variability (coefficient of variation). Intervention effects were estimated using linear mixed-effects models with covariate and baseline adjustment. Results. Compared with control at week 8, BFR+Func demonstrated greater improvements in ADL and function: Schwab & England (+6.91 points; 95% CI [2.47, 11.35]), self-reported Barthel Index (+1.68; [0.42, 2.93]), Mini-BESTest (+4.00; [1.27, 6.74]), Timed Up and Go (−3.23 s; [−4.96, −1.50]), and 6-minute walk distance (+69.71 m; [29.26, 110.17]). BFR+Func also improved gait performance and stability versus control, including gait speed (+0.23 m/s; [0.12, 0.34]), step length (+0.08 m; [0.03, 0.13]), step time (−0.06 s; [−0.08, −0.03]), gait speed variability (−3.45%; [−5.10, −1.79]), and step length variability (−2.33%; [−4.38, −0.28]). Func showed smaller benefits versus control for Schwab & England (+5.05; [0.50, 9.60]) and selected gait outcomes (e.g., gait speed +0.13 m/s; [0.01, 0.24]). Mild adverse events were reported in 0/11 (control), 2/11 (Func), and 3/11 (BFR+Func), mainly transient soreness or fatigue; no serious events occurred. Conclusions. In this pilot three-arm trial, both functional training programs improved daily function compared with health education, while adding BFR to task-oriented functional training yielded larger gains in balance, mobility, walking endurance, and gait stability with acceptable tolerability. Larger, adequately powered trials with longer follow-up are warranted to confirm efficacy and durability.