Motor–Cognitive Treadmill Training With Virtual Reality in Parkinson’s Disease: The Effect of Training Duration

Elisa Pelosin*, Chiara Ponte, Martina Putzolu, Giovanna Lagravinese, Jeffrey M. Hausdorff, Alice Nieuwboer, Pieter Ginis, Lynn Rochester, Lisa Alcock, Bastiaan R. Bloem, Freek Nieuwhof, Andrea Cereatti, Ugo Della Croce, Anat Mirelman, Laura Avanzino

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Treadmill training with virtual reality (TT + VR) has been shown to improve gait performance and to reduce fall risk in Parkinson’s disease (PD). However, there is no consensus on the optimal training duration. This study is a sub-study of the V-TIME randomized clinical trial (NCT01732653). In this study, we explored the effect of the duration of training based on the motor–cognitive interaction on motor and cognitive performance and on fall risk in subjects with PD. Patients in Hoehn and Yahr stages II–III, aged between 40 and 70 years, were included. In total, 96 patients with PD were assigned to 6 or 12 weeks of TT + VR intervention, and 77 patients completed the full protocol. Outcome measures for gait and cognitive performance were assessed at baseline, immediately after training, and at 1- and 6-month follow-up. The incident rate of falls in the 6-month pre-intervention was compared with that in the 6-month post-intervention. Dual-task gait performance (gait speed, gait speed variability and stride length under cognitive dual task and obstacle negotiation, and the leading foot clearance in obstacle negotiation) improved similarly in both groups with gains sustained at 6-month follow-up. A higher decrease in fall rate and fear of falling were observed in participants assigned to the 12-week intervention than the 6-week intervention. Improvements in cognitive functions (i.e., executive functions, visuospatial ability, and attention) were seen only in participants enrolled in 12-week training up to 1-month follow-up but vanished at the 6-month evaluation. Our results suggest that a longer TT + VR training leads to greater improvements in cognitive functions especially those directly addressed by the virtual environment.

Original languageEnglish
Article number753381
JournalFrontiers in Aging Neuroscience
StatePublished - 5 Jan 2022


FundersFunder number
Seventh Framework ProgrammeV-TIME-278169
European Commission


    • Parkinson’s disease
    • cognitive functions
    • falls
    • gait
    • treadmill training (TT)
    • virtual reality


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