Parkinson’s and falls prevention: What works?

The Bottom Line

  • More than 100, 000 Canadians live with Parkinson’s disease.
  • Falls are a common and serious issue amongst this population.
  • In people living with Parkinson’s disease, exercise and cholinesterase inhibitor medications may help to reduce the number of falls experienced.

Each day, 30 people in Canada are diagnosed with Parkinson’s disease; joining the over 100,000 Canadians that already live with the condition (1). Parkinson’s is a progressive brain condition that negatively impacts various aspects of one’s health, such as movements, sleep, and mental well-being (2). Falls, especially ones that lead to injuries like broken bones, are a huge concern for this population (3-8). In fact, every year, around 60% of those living with Parkinson’s have a fall, most of whom have several falls (3-5).

What factors increase the risk of falls for people living with Parkinson’s? Well, there are plenty. These include how severe an individual’s disease is, if they’ve fallen before, fear of falling, cognitive impairment, lack of lower limb strength, and more (3;7-13).

Surprisingly, strategies that specifically aim to prevent falls for people living with Parkinson’s have only more recently started to gather interest. To help us gain a better understanding of which strategies appear to be effective, let’s dive deeper into a recent systematic review on the topic (3).

What the research tells us

The review looked at drug-based strategies compared to a placebo medication and non-drug strategies compared to usual care or a non-active strategy. The drug-based strategies involved cholinesterase inhibitors (rivastigmine and donepezil), which are medications used to prevent or delay cognitive impairment. On the other hand, non-drug strategies included exercise of all types, falls prevention education, and a combination of the two.

Two potentially effective strategies were identified — exercise and cholinesterase inhibitors. But, before breaking down the results, it should be noted that the findings on exercise are relevant for people with mild-to-moderate Parkinson’s, specifically. Moreover, while the studies on cholinesterase inhibitors included people with more severe Parkinson’s disease, the results are based on a small number of studies.

When it comes to how often people living with Parkinson’s fall, exercise appears likely to decrease falls by approximately 26%, while the cholinesterase inhibitors studied may do so by approximately 50%. Fully supervised exercise may be especially effective. Moving onto the number of people with Parkinson’s who fall one or more times, exercise likely helps to slightly reduce this number by approximately 10%, while it’s uncertain whether cholinesterase inhibitors have an impact here. Finally, health-related quality of life may see a small boost with exercise, immediately after engaging in an exercise program, but again we are uncertain about whether cholinesterase inhibitors make a difference.

The safety of these strategies is also important to consider. The review identified that the use of cholinesterase inhibitors may have the potential to increase negative side effects by almost 60%. But most of the reported side effects are temporary and minor. On the other hand, we are uncertain whether exercise also increases the number of negative side effects experienced.

While some promising results have been found, more research is still needed to support the results, fill in where there’s uncertainty, and learn more about the safety of different strategies and the most effective exercise types and prescriptions (5). People living with Parkinson’s disease should discuss falls prevention strategies with their healthcare team. These discussions should take into consideration their disease severity, preferences, and weigh the cost and benefits of engaging in such strategies.

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Author Details


  1. Parkinson Canada. Parkinson’s Disease. [Internet] 2023. [cited March 2023]. Available from:
  2. World Health Organization. Parkinson disease. [Internet] 2023. [cited March 2023]. Available from:
  3. Allen NE, Canning CG, Almeida LRS, et al. Interventions for preventing falls in Parkinson's disease. Cochrane Database Sys Rev. 2022; 6:CD011574. doi: 10.1002/14651858.CD011574.pub2.
  4. Allen NE, Schwarzel AK, Canning CG. Recurrent falls in Parkinson's disease: A systematic review. Parkinson's Dis. 2013; 2013:906274. doi: 10.1155/2013/906274.
  5. Bloem BR, Grimbergen YA, Cramer M, et al. Prospective assessment of falls in Parkinson's disease. J Neurol. 2001; 248(11):950-958. doi: 10.1007/s004150170047.
  6. Paul SS, Harvey L, Canning CG, et al. Fall-related hospitalization in people with Parkinson's disease. Eur J Neurol. 2017; 24(3):523-529. doi: 10.1111/ene.13238. 
  7. Walker RW, Chaplin A, Hancock RL, et al. Hip fractures in people with idiopathic Parkinson's disease: Incidence and outcomes. Mov Disord. 2013; 28(3):334-340. doi: 10.1002/mds.25297. 
  8. Kalilani L, Asgharnejad M, Palokangas T, et al. Comparing the incidence of falls/fractures in Parkinson's disease patients in the US population. PLOS One. 2016; 11(9):1-11. doi: 10.1371/journal.pone.0161689.
  9. Allcock LM, Rowan EN, Steen IN, et al. Impaired attention predicts falling in Parkinson's disease. Parkinsonism Relat Disord. 2009; 15(2):110-115. doi: 10.1016/j.parkreldis.2008.03.010.
  10. Latt MD, Lord SR, Morris JG, et al. Clinical and physiological assessments for elucidating falls risk in Parkinson's disease. Mov Disord. 2009; 24(9):1280-1289. doi: 10.1002/mds.22561.
  11. Paul SS, Canning CG, Sherrington C, et al. Three simple clinical tests to accurately predict falls in people with Parkinson's disease. Mov Disord. 2013; 28(5):655-625. doi: 10.1002/mds.25404. 
  12. Kerr GK, Worringham CJ, Cole MH, et al. Predictors of future falls in Parkinson disease. Neurology. 2010; 75(2):116-1124. doi: 10.1212/WNL.0b013e3181e7b688. 
  13. Mak MK, Pang MY. Fear of falling is independently associated with recurrent falls in patients with Parkinson’s disease: A 1-year prospective study. J Neurol. 2009; 256(10):1689-1695. doi: 10.1007/s00415-009-5184-5. 

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