Pathophysiological mechanisms of postural changes leading to sagittal imbalances in PD remain unknown and problematic, contributing to falls through all stages of PD. Research is needed regarding tummy time across the lifespan as a countermeasure for sagittal imbalances and as an optimal position for gravity-resisted exercise interventions for the posterior chain.

The purpose of this pilot study was to explore the impact of modified tummy time (MTT) with posterior chain strength training (PCST) on sagittal imbalances, postural instability, strength, falls, and QOL in individuals with PD. Six individuals with PD were recruited and randomly assigned to a treatment group (N=3) receiving a prone exercise (MTT/ PCST) intervention or a control group (N=3) receiving a standard care intervention. Both exercise interventions required a frequency of five times a week for four weeks. Subjects for both groups met separately for supervised group exercise via Zoom video conferencing three times a week and completed exercise interventions independently two times a week. Statistically significant differences were observed for main effect of time in left hip extension (P = 0.01, F= 20.791,η2= 0.839), right hip abduction (P = 0.026, F= 11.944, η2= 0.749), and left hip abduction (P = 0.007, F= 26.582, η2= 0.869). Marginal significance noted for main effect of time for right hip extension (P=0.057, F= 6.977, η2= 0.636). Simple main effects analysis revealed statistically significant results for the prone exercise group, utilizing the MTT/PCST intervention with increased right hip extension strength (from M =8.43 lbs, SD = 5.39 lbs to M = 15.77 lbs, SD =4.48 lbs, P = .037), left hip extension (from M =11.27 lbs, SD = 5.69 lbs to M = 16.67 lbs, SD = 6.61 lbs, P = .008), right hip abduction (from M =8.97 lbs, SD = 4.29 lbs to M = 15.63 lbs, SD =4.37 lbs, P = .013) and left hip abduction (from M = 10.50 lbs, SD = 4.57 lbs to M = 16.97 lbs, SD = 4.96 lbs, P = .005), whereas no statistically significant difference in strength was found for the control group in right hip extension (P=.547), left hip extension (P=.182), right hip abduction(P=.558), and left hip abduction(P=.164) following the standard care intervention. Simple main effects analysis shows the prone exercise group demonstrated statistically significant improvement for postural stability using BBS for the interaction/time x group (from M =45.33, SD = 8.51 to M =53.00, SD = 8.61, P = .033), whereas no statistically significant difference of postural stability using BBS (from M= 53.67, SD=0.58 to M=54.33, SD=0.58, P=.795) was found in the control group following the standard care intervention.

This pilot study is an initial step for exploring the novel intervention of MTT/PCST as a suitable non-surgical intervention to preserve, manage and minimize the progression of postural deformities in PD. The results generate knowledge of feasibility and guides modifications needed in planning a larger randomized controlled trial(RCT).

Date of publication

Summer 8-23-2021

Document Type




Persistent identifier


Committee members

Dr. X. Neil Dong, Ph.D., Dr. Melinda Hermanns,PhD, RN, PMH-BC, CNE, ANEF, Dr. Arturo Arce-Esquivel, M.D., Ph.D


Master of Science in Kinesiology