Barre Exercise for People With Parkinson Disease
Phase: PHASE1
Conditions: Parkinson Disease
Sponsor: Washington University School of Medicine

 
 
 
 
 
 
 
Barre Exercise in Parkinson’s 
NCT Number: NCT06203990 
5/20/2025 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

I. 
SPECIFIC AIMS 
The primary objectives of this study are to: 1) evaluate the feasibility and 
acceptability of a barre exercise intervention and 2) gather preliminary data regarding 
the effect of a barre exercise intervention on balance, strength, functional mobility and 
quality of life in individuals with mild to moderate Parkinson disease (PD). Individuals 
with PD (N=15) will be recruited to participate in a pilot barre exercise class led by a 
certified barre instructor. The intervention will include 24, 45-50 minute group classes 
(twice weekly for 12 weeks, excluding holidays). Pre- and post-intervention data 
collection will include assessments of balance, lower extremity strength, and functional 
mobility.  
Specific Aim 1: Assess the feasibility and acceptability of a pilot barre exercise 
intervention for individuals with mild to moderate PD.  
 
Hypothesis 1a: Participants will participate in the intervention, defined as 75% of 
participants attending and engaging in 75% of the exercise sessions.  
Hypothesis 1b: Participants will complete the intervention study, defined as 75% 
of total recruited participants remaining enrolled for the total duration of the study.   
Hypothesis 1c Participants will rate the intervention as acceptable and 
satisfactory, as measured by a post-intervention survey. 
 
Specific Aim 2: Determine preliminary effects of a pilot barre exercise intervention on 
balance, strength, functional mobility and quality of life in individuals with mild to 
moderate PD. 
  
Hypothesis 2a: Barre will improve functional balance, defined as an improved 
score on the Mini-BESTest. 
Hypothesis 2b: Barre will improve functional lower extremity strength, defined as 
decreased time taken to complete the Five Times Sit to Stand assessment. 
Additional functional strength assessments explored include a timed stair ascent 
and descent task and the Timed Up and Go test.   
Hypothesis 2c: Barre will improve functional mobility, defined as an improvement 
in average gait speed measured in the Ten Meter Walk Test. Additional gait 
assessments explored include fast as possible and backwards walking in the Ten 
Meter Walk Test and distance covered in the Two Minute Walk Test.  
Exploratory Hypothesis 2d: Barre will improve quality of life, as measured by the 
Parkinson’s Disease Questionnaire (PDQ-39).  
 
 
 

II. BACKGROUND AND SIGNIFICANCE 
Parkinson disease (PD) is the second most common neurodegenerative disease 
after Alzheimer disease; and is becoming more common, with over 12 million people 
expected to have PD in 2040.1 PD is a hypokinetic disease characterized by motor 
symptoms including bradykinesia (slowness), rigidity, postural instability, and gait and 
balance problems.2 The average onset age for PD is around 60 years.3 While 
pharmaceutical methods such as levodopa, the primary medication for PD, have been 
shown to be effective, some symptoms are unresponsive to medication. Long-term use 
of levodopa can also lead to gradual efficacy loss and unwanted side effects.4 Due to 
the progressive nature and long disease duration of PD, other treatments are needed.  
Along with medication, exercise has been shown to improve both motor symptoms 
and quality of life, with numerous studies demonstrating gait, balance, strength, and 
flexibility gains in people with PD who participate in exercise programs.5–7 While 
traditional exercise programs are effective, they are not always enjoyable or motivating 
and often suffer from high attrition.8 Common barriers to exercise for people with PD 
include fear of falling, environmental factors such as one’s social environment and 
support from a teacher or coach, lack of time, and low outcome expectations. 8,9  
Barre is an exercise modality that combines elements of classical ballet with strength 
training. Barre involves high repetitions of low impact, isometric movements, requires 
little to no equipment, and is highly modifiable for different fitness levels.10 Barre is 
traditionally performed in a class setting, which promotes increased social interaction 
and builds community. Furthermore, interventions with dance elements exhibit high 
adherence rates (often > 80%).11,12 The exercises in a barre class are also performed 
holding on to a fixed barre or on the floor, which may address people with PD’s fear of 
falling.  
Barre incorporates elements of classical ballet, a codified dance technique that 
focuses on fluid movement through set positions.13 While participating in a traditional 
ballet class may not be of interest or suitable to everyone, there are benefits from 
performing ballet-based movements including better posture, increased mobility, and 
improved flexibility.10 Ballet dancers exhibit better overall postural stability compared to 
non-dancers.14 This emphasis on upright alignment and lengthening of the upper body 
is particularly relevant for this population, as people with PD often demonstrate impaired 
posture including a flexed neck and trunk.2 Furthermore, ballet movements often focus 
on isolation of the lower extremities while maintaining a stationary upper body. This 
element may improve trunk stability during movement and help to address the common 
symptom of postural instability of PD.2 Currently, there is limited research on the 
benefits of ballet for people with PD. However, initial evidence suggests that a ballet-
based intervention can lead to improvements in balance for this population.15 Similar 
preliminary evidence illustrates that ballet can also lead to improvements in balance and 
ataxia in other neurological populations, namely individuals with chronic stroke and 
multiple sclerosis.16,17 Therefore, a ballet-based intervention such as barre may be of 

particular interest to individuals with PD, especially to address the symptoms of postural 
instability. 
In addition to potential improvements in postural stability, barre incorporates 
elements of resistance training, which improves strength and functional capacity in 
people with PD.18 Individuals with PD often exhibit muscle weakness, particularly in the 
hip flexors and ankle plantar flexors, which further contributes to postural instability and 
gait difficulty.19 Adequate muscle strength is therefore vital for functional mobility in this 
population. Progressive resistance training leads to significant improvements in 
functional strength and mobility measures such as the Six Minute Walk Test (6 MWT), 
Timed Up and Go Test (TUG), Five Times Sit to Stand (FTSTS), and timed stair ascent 
and descent.18,20,21 Additionally, the Five Times Sit to Stand (FTSTS) is useful in 
determining fall risk22, which is extremely important, as people with PD are at an 
increased risk for falls which can lead to injury and further reduced mobility.23 A recent 
umbrella review suggests that clinicians should encourage and motivate patients to 
participate in progressive resistance training as part of their usual care exercise 
regimens.24 Furthermore, strength training is also championed by community 
organizations such as the Parkinson’s Foundation, who suggest incorporating this type 
of training 2-3 non-consecutive days a week for a least 30 minutes a session.25 Thus, 
participating in a barre class may be a motivating and enjoyable way to incorporate 
strength training, which is vital for functional mobility, into an exercise routine.  
To our knowledge, there is no prior literature on the effects of a barre exercise 
intervention for individuals with Parkinson disease. However, the combined benefits of 
incorporating elements of ballet and strength training into one exercise class may lead 
to higher benefits overall in comparison to each exercise modality on its own. Therefore, 
barre could have the potential to improve balance, strength, and more than current 
exercise programs. Additionally, the increased social interaction and dance elements of 
a barre exercise class may lead to higher adherence and enjoyment, which could help 
individuals with PD establish consistent exercise regimens outside of intervention 
sessions.  
This study aims to pilot a barre exercise intervention to assess the feasibility and 
acceptability of this form of exercise for individuals with Parkinson disease as well as 
preliminarily evaluate barre’s potential effects on motor outcomes, including balance, 
strength, and functional mobility. 
III. METHODS 
PARTICIPANT RECRUITMENT 
Recruitment of participants will occur through:  
• Movement Disorders Clinic in the Department of Neurology at Washington 
University School of Medicine 
• Flyers posted around Washington University campuses 
• Posted flyers on Washington University Physical Therapy social media pages 

o To protect participant privacy, all comments will be turned off for social 
media posts.   
o Social media accounts:  
▪ Washington University in St. Louis Program in Physical Therapy 
Facebook Page: https://www.facebook.com/WashUPT 
▪ Washington University in St. Louis Program in Physical Therapy 
Instagram Page: https://www.instagram.com/wustl_pt/  
• Participants who have completed studies within our lab that state they are 
interested in future research studies.  
• Posted flyers at local Parkinson disease community organizations such as the St. 
Louis chapter of the American Parkinson Disease Association and Rock Steady 
Boxing.  
Once participants have been identified, they will go through a phone screening to 
determine eligibility. The information collected during the phone screen will only be used 
for recruitment purposes and will not be used if the person qualifies for the study and 
signs the consent. Information collected during the phone screen will not be retained if 
the participants do not qualify. 
PARTICIPANT INCLUSION AND EXCLUSION CRITERIA 
For inclusion in the study, participants must be:  
• diagnosed by a neurologist with idiopathic Parkinson disease  
• at least 18 years of age 
• a score on the Hoehn & Yahr (H&Y) scale between I-III to indicate mild to 
moderate disease severity 
• able to provide informed consent  
• able to walk for 10 continuous minutes without assistance from another person   
• stable medication regimen for at least one month prior to enrollment 
 
Participants with PD will be excluded if they have any of the following: 
• any neurological condition other than PD  
• history of orthopedic or other medical conditions that limit the ability to safely 
participate in the intervention or  
• language, visual, or hearing barriers to participation  
• evidence of dementia (Montreal Cognitive Assessment < 24) to ensure 
understanding of the intervention class instructions  
Participants with PD will remain on their normal PD medications throughout the study. 
Pre- and post-intervention assessments will be conducted in the ON medication state 
because this represents everyday life. Pre- and post-intervention assessments will 
occur at the same time of day.  
Participants will be paid, via check, for their participation. Participants can receive up to 
$100 for completing the entire study. Participants will receive $50 for the pre-

intervention in-lab visit 1 and can receive another $50 for the post-intervention in-lab 
visit 2.  
RISKS AND POTENTIAL BENEFITS 
Risks:  
• Likely/Common  
o Mild 
▪ Fatigue – Participants may feel tired or weak during the strength, 
balance, and walking assessment tasks. Additionally, participants 
may feel tired or weak while participating in the exercise 
intervention. Research team members will monitor participants and 
help them take breaks or discontinue the study if necessary.  
▪ Muscle Soreness- Participants may experience muscle soreness 
after repeated sessions of the exercise intervention. Research team 
members will monitor participants and help them take breaks when 
necessary.  
▪ Discomfort in answering questions – Participants may experience 
some discomfort or uneasiness when completing the 
questionnaires. Participants have the right to refuse to answer any 
question for any reason. 
• Less Likely/Less Common  
o Mild  
▪ Stumbling- There is the possibility that participants may stumble 
during the intervention exercises or assessment tasks. Participants 
will be fitted with a gait belt that a research team member will use to 
assist participants in regaining their balance. During all assessment 
tasks, a member of the research team will be close to the 
participant to make sure they do not fall to the floor. During the 
exercise intervention sessions, participants will perform the majority 
of exercises holding on to the back of a chair or laying down on a 
yoga mat for support.  
• Rare 
o Serious  
▪ Falling- It is unlikely that a participant will fall during testing or the 
exercise intervention and will be injured as a result of a fall. 
Participants will be closely attended by trained members of the 
research team during testing and the intervention sessions to 
ensure the safest of conditions. Breaks and exercise modifications 
will be encouraged, and participants can discontinue testing or the 
exercise session if they feel unsteady or unsafe.  
Benefits:  
Participants may benefit from the barre exercise sessions by showing improved 
functional mobility, balance, and strength.  

MATERIALS 
 
Pre-assessment materials via phone 
• Phone screen to inform the participant about the study and ask questions to 
determine eligibility.  
Evaluation materials during pre-intervention visit 1 and post-intervention visit 2 
• Six Opal inertial sensors (APDM, Inc.) will be worn to output postural sway and 
gait measures during the balance, gait, and functional strength assessments. 
These sensors are attached with elastic Velcro bands and are placed on the tops 
of the feet, wrists, sternum, and lumbar spine.  
 
Barre exercise intervention session materials  
• Ballet barre- Participants will be provided with a sturdy ballet barre to use as their 
barre.  
• Chairs- Each participant will be provided with a sturdy chair to use for seated 
warm-up and cool-down.  
• Yoga mats – Each participant will be provided with a yoga mat to support them 
during floor-based exercises.  
• Yoga blocks – Each participant will be provided with a yoga block to support 
them during floor-based exercises and aid with individual modifications.  
 
PROTOCOL 
 
Pre-Intervention Visit 1 
 
Participants will receive and sign the informed consent document during the first pre-
intervention visit. A trained researcher will go through this document with the participant 
to explain the study objectives, outline the procedure, and ensure participants have 
ample opportunity to ask questions and clarify understanding.  
 
After consent is obtained, a trained researcher will administer the Montreal Cognitive 
Assessment (MoCA), the New Freezing of Gait Questionnaire (NFOG-Q), and the MDS-
UPDRS-III. In addition, the research team will collect demographic information, medical 
history, and obtain a current medication list. After this in-person screening, the research 
team will determine if the participant meets the inclusion criteria.  
 
If the participant meets the inclusion criteria following in-person screening, sensors will 
be placed on both feet, wrists, the sternum, and lumbar spine to record data during gait, 
balance, and functional strength assessments. All participants will be also be fitted with 
a gait belt and closely monitored by members of the research team to prevent falls. 
 

Balance Assessment: Participants will first complete the Mini-BESTest, which is a 
clinically relevant balance test that is both valid and reliable for individuals with PD.26 
The sensors will record postural sway and gait data during the various sections of this 
test.  
 
Gait Assessments: After completing the Mini-BESTest, participants will complete gait 
assessments. The sensors will record spatiotemporal gait variables during each walking 
task. 
 
Two Minute Walk Test: This gait assessment will be used to measure walking 
endurance. Participants are asked to cover as much ground as possible over the 
course of two minutes. Following this assessment, the Borg Scale Rating of 
Perceived Exertion will be administered to measure exertion levels during the 
Two Minute Walk Test.  
 
 
Ten Meter Walk Test: This gait assessment will be used to assess average gait 
speed. Participants will be asked to complete this test under three conditions: 1) 
normal forwards gait speed, 2) fast as possible gait speed, and 3) backwards 
walking at a normal, safe gait speed. Only the first condition, normal forwards 
gait speed, will be used as a primary outcome.  
 
Functional Strength Assessments: Following the gait assessments, participants will 
complete the following functional strength assessments. These assessments will serve 
as proxy measures for lower extremity strength. The Borg Scale Rating of Perceived 
Exertion will again be administered following all of the functional strength assessments 
listed below.  
 
 
Five Times Sit to Stand: Participants will be asked to start sitting with their arms 
folded across their chest and with their back against the chair. Participants are 
then asked to stand up and sit down five times as quickly as they can.  
 
Stair Ascent and Descent: Participants will be asked to ascend and descend one 
flight of stairs (building’s standard flight of 12 stairs) as quickly and safely as 
possible under close supervision by a research team member.  
 
Timed Up and Go (TUG): This test is administered as part of the Mini-BESTest. 
Participants will be asked to stand up from a chair, walk three meters at their 
normal, comfortable gait speed, and sit back down.  
 
All motor assessments, including the MDS-UPDRS-III, balance, gait, and functional 
strength assessments will be filmed with participant consent. These video recordings 
will be stored in a secure online Box folder and will only be accessed by members of the 
research team to regrade assessments as necessary. Video records will be destroyed 
after all analyses and publications are complete.  
 

Upon completion of the above motor evaluations, participants will be asked to complete 
three surveys. These include the Parkinson disease Questionnaire (PDQ-39), used to 
measure quality of life, the Activities-specific Balance Confidence Scale (ABC), and 
questions regarding current exercise habits. 
 
Intervention 
 
All participants will be assigned to the pilot barre exercise intervention. The intervention 
classes will occur in the Movement Disorders Research Center and consist of twice 
weekly, 45-50 minute group exercise classes for 12 weeks (excluding holidays). In total, 
participants will receive 24 classes. The barre exercise intervention will be delivered by 
an International Ballet Barre Fitness Association (IBBFA) certified barre instructor with a 
bachelor of arts (BA) in dance and extensive dance-teaching experience. Additional 
research team members will also be present in the classes to monitor safety and help 
participants when needed. The barre exercise program will combine elements of 
classical ballet and strength training, focusing on repetition of low impact, isometric 
movements. The class will begin with a short seated warm-up, move into 30 minutes of 
barre exercises holding on to the back of a chair as the fixed barre, continue into core 
exercises performed laying down on a mat, and finish with a cool down. After each 
class, the participants will rate how difficult the session was using a visual analog scale 
(VAS). This scale will be used to determine to what level the class should progress at as 
the weeks go on. Progression may include introduction of more challenging exercises 
and increased repetitions. Participants will be encouraged to modify the exercises as 
needed for safety.  
 
Post-Intervention Visit Two 
 
All assessments and procedures will be repeated after completion of the barre exercise 
program as mentioned in “Pre-Intervention Visit 1”. This includes the MDS-UPDRS-III, 
the New Freezing of Gait Questionnaire (NFOG-Q), all motor assessments, and the 
PDQ-39.  
 
Again, all motor assessments, including the MDS-UPDRS-III, balance, gait, and 
functional strength assessments will be filmed with participant consent. Video records 
will again be destroyed after all analyses and publications are complete.  
 
 
An additional survey will be administered, measuring participant experiences with the 
exercise classes, including satisfaction and acceptability.  
 
OUTCOME MEASURES 
 
A variety of outcome measures will be used for this study.  
 
• Primary Outcomes 
o Feasibility and Acceptability  

▪ Participation- defined as the number of individuals who attend and 
participate in at least 75% of the classes 
▪ Retention- defined as the percentage of participants who complete 
the intervention, regardless of the number of sessions they 
attended 
▪ Client Satisfaction and Acceptability Questionnaire (CSQ)- mean 
group rating on measure of self-reported satisfaction of a program 
• Secondary Outcomes 
o Balance  
▪ Mini-BESTest– a measure that quantifies overall balance 
dysfunction 
o Gait 
▪ Gait Speed in the 10MWT- a measure of how quickly someone 
walks at their normal, comfortable gait speed across a 10-meter 
distance; measured in meters/second  
o Functional Strength  
▪ Five Times Sit to Stand Time – total time it takes for an individual to 
perform five repetitions of standing up and sitting back down in a 
chair as quickly as possible 
 
• Additional Outcomes 
o Gait 
▪ 10MWT fast as possible gait speed- a measure used to assess 
average maximum gait speed to determine ability to modulate gait  
▪ 10MWT backwards walking at comfortable pace – a measure used 
to assess gait speed in a more challenging condition that also 
assesses dynamic balance and spatial awareness 
▪ 2MWT distance- total distance a person can cover while walking 
continuously for two minutes; a measure of walking endurance 
o Functional Strength  
▪ Stair Ascent and Descent – total time it takes for an individual to 
ascend and descend a standard flight of 10 stairs as quickly and 
safely as possible 
▪ TUG- total time it takes for an individual to stand up from the chair, 
walk three meters, and sit back down in the chair at normal, 
comfortable gait speed 
o Quality of Life  
▪ Parkinson Disease Questionnaire (PDQ-39) – a patient-reported 
questionnaire that assesses PD-specific health quality of life in the 
past month 
o New Freezing of Gait Questionnaire (NFOG-Q) – a patient-reported 
questionnaire that assesses frequency, severity, and duration of freezing 
of gait episodes 
o Borg Rating Scale of Perceived Exertion – a 15-point scale with written 
descriptors designed to standardize perceived exertion across tasks and 
individuals  

 
The following forms and assessments will also be collected during Pre-Intervention Visit 
1:  
• Montreal Cognitive Assessment (MoCA)- a valid, sensitive screening tool for mild 
cognitive impairment 
• Demographics Form  
• Medical History  
• Medication List  
• Current exercise habits survey 
• Activities-specific Balance Confidence Scale (ABC) – a patient-reported 
questionnaire that assesses balance confidence while performing various 
activities 
• MDS-UPDRS- gold standard measure of global disease severity in PD, including 
motor and non-motor symptoms as well as activities of daily living  
 
IV. STATISICAL ANALYSES 
Aim 1: Assess the feasibility and acceptability of a pilot barre exercise intervention for 
individuals with mild to moderate PD.  
• Feasibility Objectives 
o Participation: 75% of participants will attend 75% of the 24 sessions.  
o Retention: 75% of recruited participants will complete the intervention and 
remain enrolled for the duration of the study.  
• Satisfaction and Acceptability- Demonstrate that this group exercise class is 
acceptable, defined as a minimum average rating of > 1.5 out of 4 on the Client 
Satisfaction and Acceptability Questionnaire (CSQ).  
 
 
Due to the preliminary nature of the study and small expected sample size, only motor 
trends, defined as average group change in score from pre- to post-intervention will be 
reported.  Additionally, published MCIDs will be used to establish if the average 
improvement of the group reached clinical significance.  
Aim 2: Determine the effects of a pilot barre exercise intervention on balance, strength, 
functional mobility and quality of life in individuals with mild to moderate PD. 
 
Hypothesis 2a: Barre will improve functional balance, defined as an improved score 
on the Mini-BESTest. 
 
• MCID- A 4-point increase in total score will denote a clinically-meaningful 
improvement in functional balance.27 
 
Hypothesis 2b: Barre will improve functional lower extremity strength, defined as 
decreased time taken to complete the Five Times Sit to Stand assessment. 
Additional functional strength assessments explored include a timed stair ascent 
and descent task and the Timed Up and Go test.   

 
 
• MCID- A 2.3 second decrease28will denote a clinically-meaningful 
improvement in Five Times Sit to Stand assessment. There are no valid 
MCIDs for the timed stair ascent and descent task and the Timed Up and Go 
test. Therefore, a small effect size will be considered a positive effect for 
each of these tests. 
 
Hypothesis 2c: Barre will improve functional mobility, defined as an improvement 
average gait speed measured in the Ten Meter Walk Test. Additional gait 
assessments explored include fast as possible and backwards walking in the Ten 
Meter Walk Test and distance covered in the Two Minute Walk Test. 
 
• MCID- A 0.05 m/s increase in gait speed will denote a moderate clinically- 
meaningful improvement in forward, normal gait speed.29  There is no valid 
MCID for the Two Minute Walk Test. Therefore, a small effect size will be 
considered a positive effect.  
Exploratory Hypothesis 2d: Barre will improve quality of life, as measured by the 
Parkinson’s Disease Questionnaire (PDQ-39).  
• MCID- A 4.22-point increase on the PDQ-39 will denote clinically-meaningful 
improvement in quality of life.30 
 
V. MONITORING 
The data safety and monitoring plan includes recording all reportable events according 
to the IRB policy. The PI will review all reportable events as they occur.  
Study progress and safety will be checked monthly for accuracy, compliance, and 
completeness by the senior scientist and concerns will be discussed with the PI.  
   
 
 
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