Biomechanical responses of Nordic walking in people with Parkinson's disease

Can walking capacity predict respiratory functions of people with Parkinson's disease?

Introduction

People with Parkinson's Disease (PwPD) and an impaired respiratory profile show a lower walking ability. Still, it is unknown if there is a relationship between walking ability and respiratory function that can be used to predict the latter. This cross-sectional study evaluated the relationship between walking ability and respiratory function in PwPD.

Methods

Seventeen older PwPD, between 60 and 80 years old were asked to perform a 10-m walking test at self-selected, fast speed, and respiratory tests and these variables analyzed by an multiple linear regression.

Results

The respiratory profile revealed that 44% of the patients were restrictive, 33% were obstructive, and 22% were mixed. 73% of the PwPD presented a low lung capacity, as demonstrated by the forced expiratory volume in 1 s divided by the forced vital capacity (FEV1/FVC). Multiple linear regression demonstrated that self-selected walking speed explained 53 and 58% (p = 0.027 and p = 0.016) of the variation in maximal inspiratory and expiratory pressures, respectively. The fast walking speed explained 62 and 66% (p = 0.008 and p = 0.005) of the maximal inspiratory and expiratory pressure variation, respectively. Furthermore, the locomotor rehabilitation index explained 39% (p = 0.022) of the variance in the FEV1/FVC.

Conclusion

These results suggest that walking ability, particularly at self-selected and fast speeds, is a suitable screening parameter for pulmonary impairments in PwPD. Furthermore, the locomotor rehabilitation index indicates the ability to expire rapidly as a proportion of forced vital capacity in PwPD. Thus, the walking ability test can be an easily applicable and low-cost biomarker for assessing respiratory changes in PwPD.

The effects of Brazilian dance, deep-water exercise and nordic walking, pre- and post-12 weeks, on functional-motor and non-motor symptoms in trained PwPD

BACKGROUND

Motor and non-motor symptoms affect functional autonomy, mobility and daily life activities in People with Parkinson's Disease (PwPD). Brazilian Dance (BD), Deep-water exercise (DWE), and Nordic Walking (NW) are well-accepted, low-cost, and safe non-pharmacological strategies for untrained PwPD. However, no previous studies have investigated and compared the effects of these interventions on trained PwPD.

OBJECTIVE

To describe and compare the effects of BD, DWE and NW, pre- and post-12 weeks, on functional-motor and non-motor symptoms in trained PwPD.

METHODS

Eighty-three trained PwPD were randomly assigned into three groups: BD (n = 31), DWE (n = 21) and NW (n = 31), that participated in one of the interventions for 12 weeks. We applied Timed up and go at two speeds (self-selected and fast); 6-min and 10-meter walk test; Sit-to-Stand and handgrip test; Unified Parkinson Disease Rating Scale - III; Falls Efficacy Scale; Montreal Cognitive Assessment questionnaire; and Parkinson's Disease Questionnaire-39. The main (group and time) and interaction effects were analyzed using GEE analysis (p<0.05).

RESULTS

Statistical differences were found between groups in the handgrip test (p<0.01), the time (p = 0.04), and interaction group*time (p< 0.01) in the Sit-to-stand test. While BD improved the Sit-to-stand test performance (ES=1.00; large effect size), DWE and NW remained unchanged (ES=0.16 and ES=0.14; low effect size).

CONCLUSION

BD, DWE, and NW maintained most of the functional-motor and non-motor symptoms in trained PwPD. BD was shown to be more effective at improving strength in the lower limbs, when compared to NW and DWE.

Effects of nordic walking exercise on gait, motor/non-motor symptoms, and serum brain-derived neurotrophic factor in individuals with Parkinson's disease

Objective

The primary purpose of this study was to investigate the immediate and long-term effects of Nordic Walking (NW) exercise on walking function, motor/non-motor Parkinson's Disease (PD) symptoms, and serum brain-derived neurotrophic factor (BDNF) in persons with idiopathic PD.

Methods

Twelve community-dwelling participants with mild to moderate idiopathic PD and varied degrees of gait dysfunction were recruited for this prospective, repeated measures design that examined clinical measures and BDNF levels at baseline (T0), post-intervention (T1) and 3-month follow-up (T2). Participants engaged in 6 weeks of supervised NW exercise training with individualized instruction, followed by 14 weeks of independent NW exercise with remote coaching. Outcome measurements included daily step counts, 6-Minute Walk Test (6-MinWT), 10-Meter Walk Test (10MWT), spatiotemporalparameters, Timed Up and Go Test (TUG), dual-task TUG, Revised-Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS), Revised-Freezing of Gait Questionnaire, MDS-Nonmotor Symptom scale (NMS), Parkinson's Fatigue Scale, and serum BDNF levels. The Friedman test with post hoc Wilcoxon sign-ranked pairwise comparisons were used to compare baseline to T1, baseline to T2, and T1 to T2 timepoints with a Benjamini-Hockberg correction applied.

Results

Statistically significant improvements found post-training and retained at 3-month follow-up included 6-MinWT, daily step count, 10mWT, MDS-UPDRS, and TUG with effect sizes of 0.57 to 1.03. Serum BDNF at T2 was significantly greater than T0 and T1. Although no statistically significant improvements were observed in the MDS-NMS, 9 of 12 participants had improved non-motor symptoms. There was good adherence, sustained independent exercise engagement, and no adverse events over the 5-month study duration.

Conclusions

This study demonstrated that NW exercise was a safe, feasible, and sustainable mode of aerobic exercise for this sample of participants with varied Parkinson's disease duration and severity. Following an individualized and progressive NW training intervention, significant improvements in walking function, daily activity level, and motor function were observed. Following the supervised NW training phase, independent three-month engagement in NW exercise was sustained with long-term retention of these clinical improvements and an increase in serum BDNF levels over this five-month NW exercise trial.

Impact

Nordic walking exercise may be a safe, feasible and sustainable mode of independent exercise for improving daily ambulatory activity, gait and motor function, and serum BDNF in individuals with mild to moderate PD with varied gait abilities.

Clinical Trials Registry ID

20-101-H.

Structure of the Motor Descending Pathways Correlates with the Temporal Kinematics of Hand Movements

Simple Summary

How hand motor behavior relates to the microstructure of the underlying subcortical white matter pathways is yet to be fully understood. Here we consider two well-known examples of our everyday motor repertoire, reaching and reach-to-grasp, by looking at their temporal unfolding and at the microstructure of descending projection pathways, conveying motor information from the motor cortices towards the more ventral regions of the nervous system. We combine three-dimensional kinematics, describing the temporal profile of hand movements, with diffusion imaging tractography, exploring the microstructure of specific segments of the projection pathways (internal capsule, corticospinal and hand motor tracts). The results indicate that the level of anisotropy characterizing these white matter tracts can influence the temporal unfolding of reaching and reach-to-grasp movements.

Abstract

The projection system, a complex organization of ascending and descending white matter pathways, is the principal system for conveying sensory and motor information, connecting frontal and sensorimotor regions with ventral regions of the central nervous system. The corticospinal tract (CST), one of the principal projection pathways, carries distal movement-related information from the cortex to the spinal cord, and whether its microstructure is linked to the kinematics of hand movements is still an open question. The aim of the present study was to explore how microstructure of descending branches of the projection system, namely the hand motor tract (HMT), the corticospinal tract (CST) and its sector within the internal capsule (IC), can relate to the temporal profile of reaching and reach-to-grasp movements. Projection pathways of 31 healthy subjects were virtually dissected by means of diffusion tractography and the kinematics of reaching and reach-to-grasp movements were also analyzed. A positive association between Hindrance Modulated Orientation Anisotropy (HMOA) and kinematics was observed, suggesting that anisotropy of the considered tract can influence the temporal unfolding of motor performance. We highlight, for the first time, that hand kinematics and the visuomotor transformation processes underlying reaching and reach-to-grasp movements relate to the microstructure of specific projection fibers subserving these movements.

The Influence of the Relative Timing between Pole and Heel Strike on Lower Limb Loading among Young and Older Naïve Pole Walkers

Current research is unclear with respect to whether pole walking (PW) reduces lower limb loading when compared to regular walking (RW). Contradictory findings in the literature may be related to the relative timing between pole and foot contact events, which were examined in the current study among naïve pole walkers. Fourteen young (4 F; 25.3 ± 5.4 years) and 8 older adults (4 F; 68.5 ± 3.2 years) performed PW and RW trials along a force plate embedded walkway at two different visits. The time difference between pole and foot contact during both the onset of ground contact and the peak force application was calculated. Several kinetic measures were calculated for the lower limbs and poles. A significant decrease during PW, compared to RW, was found for foot impulse (2.1%; p < 0.01), peak vertical ground reaction force (vGRF) (3.4%; p < 0.01), rate of loading (5.2%; p=0.02), and peak push-off vGRF (2.1%; p=0.01). No difference in pole loading was found between age groups and visits. No significant correlations were found between the relative timing and foot loading measures. Significant low-to-moderate negative correlations were found between peak foot and pole vGRFs (p=0.04), peak foot vGRF and pole strike impulse (p=0.01), peak foot vGRF and pole impulse (p=0.02), and peak foot push-off vGRF and pole impulse (p=0.01), suggesting that as pole loading increased, foot loading decreased. Findings suggest timing between pole and heel contact may not be related to unloading the lower limbs but may be related to other aspects of pole use since PW reduced lower limb loading.