To determine whether the 8-week Hopeful Outdoor Parkinson's Exercise (HOPE) Program would be effective in improving balance performance, physical functions, gait parameter, balance confidence, health-related quality-of-life, disease-specific motor performance and fall-related outcomes in Parkinson's disease (PD) non-fallers and single fallers.

Previous studies demonstrated that multi-modal balance training program was effective in improving balance performance in people with PD. However they did not include all the balance domains and outdoor fall-prone activities have been overlooked. We designed a task- and context-specific balance training program based on the framework of the Balance Evaluation Systems Test (BESTest) to target all six balance domains including biomechanical constraints, stability limits and verticality, anticipatory postural adjustments, reactive postural responses, sensori-motor integration and dynamic gait control.

Inclusion Criteria:

• diagnosed with PD by a neurologist (Fahn and Elton, 1987);
• aged 30 to 85 years;
• at modified Hoehn and Yahr (H&Y) stage 1.5 to 3 (Hoehn and Yahr ,1967; Goetz et al., 2004);
• able and willing to give written consent for participation in the study;
• living at home in the community;
• able to walk independently for 30 metres with or without an assistive device.

Exclusion Criteria:

• any neurological conditions other than PD;
• significant musculoskeletal or cardiopulmonary diseases;
• other disorders that may affect balance or locomotion;
• taken any structured behavioral or exercise programs in the past 3 months
• or they are receiving regular physical rehabilitation at present;
• unstable condition on anti-parkinsonian medications;
• surgical interventions for PD;
• communication or cognitive deficits with mini-mental state examination, (MMSE) <24/30 (Folstein et al., 1975);
• a history of more than two falls in the previous 12 months.