Secondary analysis of two HiBalance trials (n=97) showed that overall balance training did not significantly change balance discordance in PD, but baseline sedentary behavior significantly modified post-intervention discordance in the clinical cohort.

Although not addressing molecular targets, the result is clinically relevant for tailoring and stratifying rehabilitation interventions (and related trials) by sedentary behavior to better address perceived-versus-actual balance and potentially reduce fall risk.

Individuals with Parkinson's disease (PD) often experience a misalignment between their perceived and actual balance ability, known as balance discordance, which has been associated with falls. We examined whether high-intensity balance and gait training (HiBalance) alters balance discordance in individuals with PD, and whether baseline sedentary behavior influences these changes. A secondary analysis examining pre- to post-intervention discordance changes of two HiBalance clinical trials (N = 97) using linear regression with interactions between sedentary behavior and pre-intervention discordance. The sample included two cohorts: one clinical and one research based. The model including sedentary behavior and its interaction with pre-intervention discordance explained 49% of variance. Significant predictors of post-intervention discordance were pre-intervention discordance (β = 8.78, p < 0.001) and cohort (β = 8.82, p = 0.006), while the interaction between pre-intervention discordance and sedentary time did not reach significance (β = -2.64, p = 0.05). Sensitivity analyses revealed that the clinical-based cohort model explained 24.7% of the variance in post-intervention discordance, with the interaction between pre-intervention discordance and sedentary time (β = -7.23, p = 0.004) as a significant predictor. HiBalance training did not significantly alter balance discordance. However, pre-intervention sedentary behavior may influence how much individuals with PD recalibrate the relationship between perceived and actual balance following physical rehabilitation.