Effects of Exercise on Gait and Functional Performance in Individuals With Idiopathic Normal Pressure Hydrocephalus: A Scoping Review

Abstract

Background and Purpose:

Exercise is recommended for individuals with idiopathic normal pressure hydrocephalus (iNPH), but its effects on gait and functional performance remain underexplored. This scoping review aimed to search (1) effects of exercise or physical therapy on gait and functional outcomes in individuals with iNPH, along with its underlying physiological and biomechanical mechanisms; (2) challenges to exercise implementation; and (3) replication potential of interventions.

Methods:

Five databases (PubMed, Embase, Latin American and Caribbean Health Sciences Literature, Cumulative Index to Nursing and Allied Health Literature, and SpringerLink) were searched for full-text, peer-reviewed articles (2010-2023) on exercise or physical therapy for individuals with iNPH, with all types of study design. Two reviewers independently screened, extracted, and tabulated the search results. Research quality was assessed using the Joanna Briggs Institute critical appraisal checklist. The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews and the Template for Intervention Description and Replication checklists were used as reporting guidelines.

Results:

Six articles met the criteria, covering exercise interventions such as the Lee Silverman Voice Treatment-BIG exercise program, Dynamic Equilibrium Gait Training, High-Intensity Functional Exercise, Action Observation, and home-based physical exercise program (stretching exercises for back, gluteal, and trunk; strengthening exercise for shoulder, arm, and leg; and balance training). These exercises indicated positive effects on gait, sit-to-stand, mobility, balance, balance confidence, and disability, but did not significantly improve quality of life. All six articles provided sufficient details for replication; however, two were based on the same study project, leaving five unique studies included.

Conclusion:

Exercise interventions, when carefully prescribed by physical therapists, represent a promising approach for improving gait and balance in individuals with iNPH. However, the current paucity of well-powered randomized controlled trials highlights the urgent need for further research to identify the most effective exercise protocol. Future studies should focus on specific exercise modalities and their long-term impact to improve management and rehabilitation of individuals with iNPH.