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McMahon L, McGrath D, Blake C, Lennon O. Responsiveness of respiratory function in Parkinson's Disease to an integrative exercise programme: A prospective cohort study. PLoS One 2024; 19:e0301433. [PMID: 38551984 PMCID: PMC10980210 DOI: 10.1371/journal.pone.0301433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 03/15/2024] [Indexed: 04/01/2024] Open
Abstract
INTRODUCTION Respiratory disorders are the most common cause of death in Parkinson's Disease (PD). Conflicting data exist on the aetiology of respiratory dysfunction in PD and few studies examine the effects of exercise-based interventions on respiratory measures. This study was conducted to better understand respiratory dysfunction in PD and to identify measures of dysfunction responsive to an integrative exercise programme. OBJECTIVES The objectives were to compare baseline respiratory measures with matched, published population norms and to examine immediate and longer-term effects of a 12-week integrated exercise programme on these measures. DESIGN Twenty-three people with mild PD (median Hoehn & Yahr = 2) self-selected to participate in this exploratory prospective cohort study. Evaluation of participants occurred at three time points: at baseline; following the 12-week exercise programme and at 4-month follow-up. OUTCOME MEASURES Outcome measures included: Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), FEV1/FVC ratio, Peak Expiratory Flow (PEF), Inspiratory Muscle Strength (MIP), Expiratory Muscle Strength (MEP), Peak Cough Flow (PCF), and Cardiovascular Fitness measures of estimated VO2 max and 6-Minute Walk Test (6MWT). RESULTS Compared to published norms, participants had impaired cough, reduced respiratory muscle strength, FEV, FVC, PEF and cardiovascular fitness. Post exercise intervention, statistically significant improvements were noted in MEP, cardiovascular fitness, and PEF. However only gains in PEF were maintained at 4-month follow-up. CONCLUSIONS Significant respiratory dysfunction exists, even in the early stages of PD. Metrics of respiratory muscle strength, peak expiratory flow and cardiovascular fitness appear responsive to an integrative exercise programme.
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Affiliation(s)
- Laura McMahon
- Health Sciences Centre, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Denise McGrath
- Health Sciences Centre, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Catherine Blake
- Health Sciences Centre, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Olive Lennon
- Health Sciences Centre, UCD School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
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Padilha C, Souza R, Grossl FS, Gauer APM, de Sá CA, Rodrigues-Junior SA. Physical exercise and its effects on people with Parkinson's disease: Umbrella review. PLoS One 2023; 18:e0293826. [PMID: 37917715 PMCID: PMC10621990 DOI: 10.1371/journal.pone.0293826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/20/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Parkinson's disease is neurodegenerative, complex and progressive, manifesting in a slow and irreversible way. Physical exercise has been proposed as therapeutic alternative to people with Parkinson´s disease. OBJECTIVE To synthesize knowledge about the effects of physical exercise on people with Parkinson´s Disease as presented by published systematic reviews. METHODS Nine electronic databases and two grey literature databases were searched for systematic reviews reporting the effects of physical exercises on people with Parkinson´s Disease. Searches involved a two-phase process, by, at least, two independent reviewers. Methodological quality of the included systematic reviews was assessed using AMSTAR-2. RESULTS From 2,122 systematic reviews, 139 were included. Motor outcomes were assessed in 91% of the studies, with balance being the most studied. Non-motor outcomes were assessed in 68% of the studies, with emphasis on quality of life. Physical exercises were classified into five categories: aerobic exercises, strength, combined, sensorimotor activities and other activity protocols. Findings of the systematic reviews suggest that all exercise categories can be prescribed to improve balance and mobility, while combined exercises, strength, and specific activities improve both motor and non-motor outcomes, and aerobic exercise and sensorimotor activities improve motor outcomes. CONCLUSION Current evidence from systematic reviews suggests that physical exercises impacts both motor and non-motor outcomes in people with Parkinson´s Disease. Limits in evidence provided by the systematic reviews were related to methodological issues and to the description of the interventions and must be considered to improve decision-making and clinical application.
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Affiliation(s)
- Cristiano Padilha
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Renan Souza
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Fernando Schorr Grossl
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Ana Paula Maihack Gauer
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
| | - Clodoaldo Antônio de Sá
- Health Sciences Post-Graduate Program, Universidade Comunitária da Região de Chapecó–Unochapecó, Chapecó, Santa Catarina, Brazil
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Rahmati Z, Behzadipour S, Taghizadeh G. Margins of postural stability in Parkinson's disease: an application of control theory. Front Bioeng Biotechnol 2023; 11:1226876. [PMID: 37781528 PMCID: PMC10539597 DOI: 10.3389/fbioe.2023.1226876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/28/2023] [Indexed: 10/03/2023] Open
Abstract
Introduction: Postural instability is a restrictive feature in Parkinson's disease (PD), usually assessed by clinical or laboratory tests. However, the exact quantification of postural stability, using stability theorems that take into account human dynamics, is still lacking. We investigated the feasibility of control theory and the Nyquist stability criterion-gain margin (GM) and phase margin (PM)-in discriminating postural instability in PD, as well as the effects of a balance-training program. Methods: Center-of-pressure (COP) data of 40 PD patients before and after a 4-week balance-training program, and 20 healthy control subjects (HCs) (Study1) as well as COP data of 20 other PD patients at four time points during a 6-week balance-training program (Study2), collected in two earlier studies, were used. COP was recorded in four tasks, two on a rigid surface and two on foam, both with eyes open and eyes closed. A postural control model (an inverted pendulum with a Proportional-integral-derivative (PID) controller and time delay) was fitted to the COP data to subject-specifically identify the model parameters thereby calculating |GM| and PM for each subject in each task. Results: PD patients had a smaller margin of stability (|GM| and PM) compared with HCs. Particularly, patients, unlike HCs, showed a drastic drop in PM on foam. Clinical outcomes and margins of stability improved in patients after balance training. |GM| improved early in week 4, followed by a plateau during the rest of the training. In contrast, PM improved late (week 6) in a relatively continuous-progression form. Conclusion: Using fundamental stability theorems is a promising technique for the standardized quantification of postural stability in various tasks.
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Affiliation(s)
- Zahra Rahmati
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
- Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Liu Z, Lemus J, Smirnova IV, Liu W. Rehabilitation for non-motor symptoms for patients with Parkinson's disease from an α-synuclein perspective: a narrative review. EXPLORATION OF NEUROPROTECTIVE THERAPY 2023; 3:235-257. [PMID: 37920444 PMCID: PMC10621781 DOI: 10.37349/ent.2023.00049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 06/22/2023] [Indexed: 11/04/2023]
Abstract
Parkinson's disease (PD) is a common neurodegenerative disorder affecting aged population around the world. PD is characterized by neuronal Lewy bodies present in the substantia nigra of the midbrain and the loss of dopaminergic neurons with various motor and non-motor symptoms associated with the disease. The protein α-synuclein has been extensively studied for its contribution to PD pathology, as α-synuclein aggregates form the major component of Lewy bodies, a hallmark of PD. In this narrative review, the authors first focus on a brief explanation of α-synuclein aggregation and circumstances under which aggregation can occur, then present a hypothesis for PD pathogenesis in the peripheral nervous system (PNS) and how PD can spread to the central nervous system from the PNS via the transport of α-synuclein aggregates. This article presents arguments both for and against this hypothesis. It also presents various non-pharmacological rehabilitation approaches and management techniques for both motor and non-motor symptoms of PD and the related pathology. This review seeks to examine a possible hypothesis of PD pathogenesis and points to a new research direction focus on rehabilitation therapy for patients with PD. As various non-motor symptoms of PD appear to occur earlier than motor symptoms, more focus on the treatment of non-motor symptoms as well as a better understanding of the biochemical mechanisms behind those non-motor symptoms may lead to better long-term outcomes for patients with PD.
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Affiliation(s)
- Zhaoyang Liu
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Jessica Lemus
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Irina V. Smirnova
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
| | - Wen Liu
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, KS 66160, USA
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Mobile health technology, exercise adherence and optimal nutrition post rehabilitation among people with Parkinson's Disease (mHEXANUT) - a randomized controlled trial protocol. BMC Neurol 2023; 23:93. [PMID: 36864377 PMCID: PMC9979434 DOI: 10.1186/s12883-023-03134-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/21/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Although it is well known that regular physical activity and exercise, as well as maintaining adequate nutritional status is important to delaying symptom development and maintaining physical capacity and function in people with Parkinson's Disease (PD), many are unable to follow self-management recommendations. Active interventions have shown short-term effects, but there is a need for interventions that facilitate self-management over the course of the disease. Until now, no studies have combined exercise and nutritional interventions with an individual self-management approach in PD. Thus, we aim to examine the effect of a six-month mobile health technology(m-health)-based follow-up programme, focusing on self-management in exercise and nutrition, after an in-service interdisciplinary rehabilitation programme. METHODS A single-blinded, two-group randomised controlled trial. Participants are Adults aged 40 or older, with idiopathic PD, Hoehn and Yahr 1-3, living at home. The intervention group receives a monthly, individualized, digital conversation with a PT, combined with use of an activity tracker. People at nutritional risk get additional digital-follow-up from a nutritional specialist. The control group receives usual care. The primary outcome is physical capacity, measured by 6-min walk test (6MWT). Secondary outcomes are nutritional status, Health related quality of life (HRQOL), physical function and exercise adherence. All measurements are performed at baseline, after 3 months and after 6 months. Sample size, based on primary outcome, is set at 100 participants randomized into the two arms, including an estimated 20% drop out. DISCUSSION The increasing prevalence of PD globally makes it even more important to develop evidence-based interventions that can increase motivation to stay active, promote adequate nutritional status and improve self-management in people with PD. The individually tailored digital follow-up programme, based on evidence-based practice, has the potential to promote evidence-based decision-making and to empower people with PD to implement exercise and optimal nutrition in their daily lives and, hopefully, increase adherence to exercise and nutritional recommendations. TRIAL REGISTRATION ClinicalTrials.gov (NCT04945876). First registration 01.03.2021.
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Muscle Strength and Power in People With Parkinson Disease: A Systematic Review and Meta-analysis. J Neurol Phys Ther 2023; 47:3-15. [PMID: 36318503 DOI: 10.1097/npt.0000000000000421] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE No studies have synthesized the literature regarding mechanical muscle function (ie, strength, power, rate of force development [RFD]) in people with Parkinson disease (PD). Here, we aimed to expand our understanding of mechanical muscle function in people with PD (PwPD) by systematically reviewing (1) the psychometric properties of isokinetic/isometric dynamometry in PD, (2) the literature comparing mechanical muscle function in PwPD with healthy controls (HC), and (3) reported associations between muscle mechanical muscle function and functional capacity and/or disease severity. METHODS Systematic literature search in 6 databases. Included studies had to (1) enroll and report data on PwPD, (2) include assessment(s) of psychometric properties (ie, validity, reliability, responsiveness) of isokinetic/isometric dynamometry in PD, and/or (3) assess mechanical muscle function in both PwPD and HC using isokinetic/isometric dynamometry. RESULTS A total of 40 studies were included. Aim 1 studies (n = 2) showed high reliability for isometric dynamometry (hip-abductor/dorsiflexor/trunk flexor-extensor/handgrip: intraclass correlations coefficients range = 0.92-0.98). Aim 2 studies (n = 40) showed impaired mechanical muscle function (ie, strength, power, RFD) in PwPD compared with HC (effect sizes range = 0.52-1.89). Aim 3 studies (n = 11) showed weak-to-strong associations between overall and lower extremities muscle strength and functional capacity and/or disease severity outcomes (ie, Unified Parkinson Disease Rating Scale). DISCUSSION AND CONCLUSIONS Sparse methodological evidence suggests high reliability when using dynamometry in PwPD. Muscle strength, power, and RFD are impaired in PwPD compared with HC. Muscle strength is associated with functional capacity and disease severity.Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A403 ).
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Salmon R, Preston E, Mahendran N, Ada L, Flynn A. People with mild Parkinson's disease have impaired force production in upper limb muscles: A cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e1976. [PMID: 36266769 PMCID: PMC10078520 DOI: 10.1002/pri.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/30/2022] [Accepted: 10/09/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND There has been little examination of force production of the upper limb in people with Parkinson's disease (PD), despite its impact on activities of daily living and clear evidence that force production is significantly reduced in lower limb muscle groups. The aim of this study was to determine the force production of the major muscle groups of the upper limb in people with PD during the "on" phase after medication, compared with aged-matched neurologically-normal controls. METHOD A cross-sectional study was carried out. PARTICIPANTS Thirty people with mild PD (Hoehn Yahr mean 1.1) and 24 age-matched neurologically-normal controls. OUTCOME MEASURES Maximum isometric force production of the shoulder flexors, extensors, abductors, adductors, internal rotators and external rotators, elbow flexors and extensors, wrist flexors and extensors and hand grip using dynamometry. RESULTS There was a significant impairment in force production in all upper limb muscle groups, compared with control participants, except in the wrist flexors. On average the deficit in force production was 22%, despite people with PD having mild disease, being physically active and being measured during the "on" phase of medication. The most severely affected muscle groups were the upper limb extensors. CONCLUSION People with PD have a significant deficit in force production of the upper limb muscle groups compared with age-matched neurologically normal controls. CLINICAL IMPLICATIONS Regular assessment of strength of the upper limb should be considered by clinicians and strengthening interventions could be implemented if a deficit is identified.
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Affiliation(s)
- Renee Salmon
- Faculty of Health, University of Canberra, Canberra, Australia
| | | | | | - Louise Ada
- Faculty of Health Sciences, University of Sydney, Lidcombe, Australia
| | - Allyson Flynn
- Faculty of Health, University of Canberra, Canberra, Australia
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Resistance Training Combined with Balance or Gait Training for Patients with Parkinson's Disease: A Randomized Controlled Pilot Study. PARKINSON'S DISEASE 2022; 2022:9574516. [PMID: 36247107 PMCID: PMC9568326 DOI: 10.1155/2022/9574516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 09/19/2022] [Indexed: 11/17/2022]
Abstract
Background Gait and balance disorders in patients with idiopathic Parkinson's disease (PD) lead to major mobility limitations. To counteract this, physical therapy such as gait, balance, or resistance training is applied. Integrative training methods, which combine these elements, could be particularly effective. Objective The objective of this study is to evaluate and compare the effects of two integrative interventions on gait and balance of patients with PD. Methods Twenty-six patients with PD received either resistance training in combination with gait training (gait resistance training, GRT) or resistance training in combination with balance training (stability resistance training, SRT) for six weeks. Gait and balance outcome parameters were assessed before, immediately after, and six weeks after the interventions. The primary outcome parameters were the functional reach test to evaluate balance and stride length to evaluate gait. Secondary outcomes included further gait analysis parameters, knee extension strength, the timed up and go test, and the six-minute walk test. Results The functional reach test results were significantly better after the intervention in both groups. Stride length increased significantly only in the GRT group. Several further gait parameters and the six-minute walk test improved in the GRT group, and the increase in gait speed was significantly higher than in the SRT group. The SRT group performed better after the intervention regarding the timed up and go test and knee extension strength, the latter being significantly more improved than in the SRT group. At six-week follow-up, the improvement in functional reach was maintained in the SRT group. Conclusions Integrative therapies, combining gait or balance training with resistance training, have specific positive effects in PD rehabilitation. More pronounced effects on gait parameters are achieved by GRT, while SRT has more impact on balance. Thus, the combination of both training methods might be particularly efficient in improving the mobility of PD patients.
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Karpodini CC, Dinas PC, Angelopoulou E, Wyon MA, Haas AN, Bougiesi M, Papageorgiou SG, Koutedakis Y. Rhythmic cueing, dance, resistance training, and Parkinson's disease: A systematic review and meta-analysis. Front Neurol 2022; 13:875178. [PMID: 36034281 PMCID: PMC9413961 DOI: 10.3389/fneur.2022.875178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/14/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives The aim of the present systematic review and meta-analysis was to synthesize evidence associated with the functional and clinical effectiveness of rhythmic cueing, dance, or resistance training (RT) on motor and non-motor parameters in Parkinson's Disease patients, and to provide a comparative perspective not offered by existing systematic reviews. Methodology Eligibility criteria for selecting studies retained no restrictions in methodological design and included interventions of rhythmic cueing, dance, RT, and measurements of motor and non-motor parameters. Animal studies, reviews, editorials, conferences, magazines, and gray literature articles were excluded. Two independent investigators searched Cochrane Library, Medline, PubMed, and SPORTDiscus from the date of their inception until 1 June 2021. The ROBINS-I tool was employed for the non-randomized controlled trials, and the updated for Risk of Bias 2 tool of Cochrane Library used for randomized controlled trials. For meta-analyses, the RevMan 5.4.13 software was used. For incompatible meta-analysis studies, a narrative data synthesis was conducted. Results A total of 49 studies included in the systematic review involving 3767 PD participants. Meta-analyses revealed that rhythmic cueing training assists gait velocity (p = 0.01), stride length (p = 0.01), and motor symptoms (p = 0.03). Similarly, dance training benefits stride length (p = 0.05), lower extremity function-TUG (p = 0.01), and motor symptoms (p = 0.01), whilst RT improves lower extremity function-TUG (p = 0.01), quality of life (p = 0.01), knee flexion (p = 0.02), and leg press (p = 0.01). Subgroup analyses have shown non-significant differences in gait velocity (p = 0.26), stride length (p = 0.80), functional mobility-TUG (p = 0.74), motor symptoms-UPDRS-III (p = 0.46), and quality of life-PDQ39 (p = 0.44). Conclusion Rhythmic cueing, dance, or RT positively affect the examined outcomes, with rhythmic cueing to be associated with three outcomes (Gait, Stride, and UPDRS-III), dance with three outcomes (TUG, Stride, and UPDRS-III), and RT with two outcomes (TUG and PDQ-39). Subgroup analyses confirmed the beneficial effects of these forms of exercise. Clinicians should entertain the idea of more holistic exercise protocols aiming at improving PD manifestations.International Prospective Register of systematic reviews (PROSPERO) (registration number: CRD42020212380).
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Affiliation(s)
- Claire Chrysanthi Karpodini
- Sport and Physical Activity Research Centre, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Petros C. Dinas
- Functional Architecture of Mammals in their Environment Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Volos, Greece
| | - Efthalia Angelopoulou
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition University Hospital, Athens, Greece
| | - Matthew A. Wyon
- Sport and Physical Activity Research Centre, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Aline Nogueira Haas
- School of Physical Education Physiotherapy and Dance, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Maria Bougiesi
- Functional Architecture of Mammals in their Environment Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Volos, Greece
| | - Sokratis G. Papageorgiou
- First Department of Neurology, Medical School, National and Kapodistrian University of Athens, Eginition University Hospital, Athens, Greece
| | - Yiannis Koutedakis
- Sport and Physical Activity Research Centre, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
- Functional Architecture of Mammals in their Environment Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Volos, Greece
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Hortobágyi T, Vetrovsky T, Balbim GM, Sorte Silva NCB, Manca A, Deriu F, Kolmos M, Kruuse C, Liu-Ambrose T, Radák Z, Váczi M, Johansson H, Dos Santos PCR, Franzén E, Granacher U. The impact of aerobic and resistance training intensity on markers of neuroplasticity in health and disease. Ageing Res Rev 2022; 80:101698. [PMID: 35853549 DOI: 10.1016/j.arr.2022.101698] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To determine the effects of low- vs. high-intensity aerobic and resistance training on motor and cognitive function, brain activation, brain structure, and neurochemical markers of neuroplasticity and the association thereof in healthy young and older adults and in patients with multiple sclerosis, Parkinson's disease, and stroke. DESIGN Systematic review and robust variance estimation meta-analysis with meta-regression. DATA SOURCES Systematic search of MEDLINE, Web of Science, and CINAHL databases. RESULTS Fifty studies with 60 intervention arms and 2283 in-analyses participants were included. Due to the low number of studies, the three patient groups were combined and analyzed as a single group. Overall, low- (g=0.19, p = 0.024) and high-intensity exercise (g=0.40, p = 0.001) improved neuroplasticity. Exercise intensity scaled with neuroplasticity only in healthy young adults but not in healthy older adults or patient groups. Exercise-induced improvements in neuroplasticity were associated with changes in motor but not cognitive outcomes. CONCLUSION Exercise intensity is an important variable to dose and individualize the exercise stimulus for healthy young individuals but not necessarily for healthy older adults and neurological patients. This conclusion warrants caution because studies are needed that directly compare the effects of low- vs. high-intensity exercise on neuroplasticity to determine if such changes are mechanistically and incrementally linked to improved cognition and motor function.
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Affiliation(s)
- Tibor Hortobágyi
- Center for Human Movement Sciences, University of Groningen Medical Center, Groningen, the Netherlands; Somogy County Kaposi Mór Teaching Hospital, Kaposvár, Hungary; Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Hungary; Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany; Hungarian University of Sports Science, Department of Kinesiology, Budapest, Hungary.
| | - Tomas Vetrovsky
- Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Guilherme Moraes Balbim
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Nárlon Cássio Boa Sorte Silva
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy; Unit of Endocrinology, Nutritional and Metabolic Disorders, AOU Sassari, Sassari, Italy
| | - Mia Kolmos
- Neurovascular Research Unit, Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Neurovascular Research Unit, Department of Neurology, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Teresa Liu-Ambrose
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
| | - Zsolt Radák
- Research Center of Molecular Exercise Science, Hungarian University of Sport Science, Budapest, Hungary
| | - Márk Váczi
- Department of Sport Biology, Institute of Sport Sciences and Physical Education, University of Pécs, Hungary
| | - Hanna Johansson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | | | - Erika Franzén
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden; Women's Health and Allied Health Professionals Theme, Medical Unit Occupational Therapy & Physiotherapy, Karolinska University Hospital, Stockholm, Sweden
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
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Gamborg M, Hvid LG, Dalgas U, Langeskov‐Christensen M. Parkinson's disease and intensive exercise therapy - An updated systematic review and meta-analysis. Acta Neurol Scand 2022; 145:504-528. [PMID: 34997759 DOI: 10.1111/ane.13579] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 12/08/2021] [Accepted: 12/21/2021] [Indexed: 01/01/2023]
Abstract
In 2015, Uhrbrand et al. published the first review on Parkinson´s disease (PD) and exercise entirely based on randomized controlled trials (RCT) applying strict exercise definitions. The present review aimed to update the PD literature by assessing the effects of different intensive exercise modalities: resistance training (RT), endurance training (ET), and other intensive exercise modalities (OITM). An updated systematic literature search identified 33 new RCTs. Qualitative and quantitative analyses were performed. A total of 18 RT, 14 ET, and 1 OITM studies were identified (adding to the 8 RT, 6 ET, and 4 OITM studies identified by Uhrbrand et al. in 2015). RT, ET, and OITM were feasible, safe, and did not worsen PD symptoms. Furthermore, RT, ET, and OITM may positively affect functional outcomes (e.g., balance) and depressive symptoms in PD but inconsistencies across these findings warrant cautious conclusions. Meta-analyses showed that RT had a positive impact on muscle strength (standardized mean difference (SMD) = 0.83 [95% CI;0.54, 1.12]), functional capacity (Timed Up and Go Test (TUG): SMD = -0.62 [-1.01, -0.24]), and quality of life (SMD = -0.41 [-0.72, -0.09]), while ET had a positive impact on cardiorespiratory fitness (SMD = 0.27 [0.07, 0.47]) and functional capacity (TUG: SMD = -0.21 [-0.46, 0.04], 6-Min Walk Test: SMD = 0.89 [0.17, 1.62]), and a potentially positive impact on "on-medication" UPDRS-III (SMD = -0.15 [-0.38, 0.09]) and "off-medication" UPDRS-III (SMD = -0.19 [-0.41, 0.04]). In conclusion, RT, ET, and OITM all represent safe, feasible, and beneficial adjunct rehabilitation strategies in PD, with particularly RT and ET showing solid effects.
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Affiliation(s)
- Mads Gamborg
- Exercise Biology Department of Public Health Aarhus University Aarhus Denmark
| | - Lars G. Hvid
- Exercise Biology Department of Public Health Aarhus University Aarhus Denmark
- The Danish MS Hospitals, Ry and Haslev Denmark
| | - Ulrik Dalgas
- Exercise Biology Department of Public Health Aarhus University Aarhus Denmark
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12
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Gollan R, Ernst M, Lieker E, Caro-Valenzuela J, Monsef I, Dresen A, Roheger M, Skoetz N, Kalbe E, Folkerts AK. Effects of Resistance Training on Motor- and Non-Motor Symptoms in Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis. JOURNAL OF PARKINSON'S DISEASE 2022; 12:1783-1806. [PMID: 35754291 DOI: 10.3233/jpd-223252] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Previous reviews indicated positive effects of resistance training (RT) on motor outcomes in Parkinson's disease (PD). However, inconsistencies between the included studies exist, and non-motor outcomes have only scarcely been considered in a review on RT in PD. OBJECTIVE To analyze the RT effects on motor- and non-motor outcomes in PD patients compared to passive and physically active control groups (i.e., other structured physical interventions). METHODS We searched CENTRAL, MEDLINE, EMBASE, and CINAHL for randomized controlled trials of RT in PD. After identifying 18 studies, a meta-analysis was conducted for the outcomes muscle strength, motor impairment, freezing of gait (FoG), mobility and balance, quality of life (QoL), depression, cognition, and adverse events. Meta-analyses with random models were calculated using mean differences (MD) or standardized mean differences (SMD) with 95% confidence intervals (CI). RESULTS When comparing RT with passive control groups, the meta-analyses showed significant large effects on muscle strength (SMD = -0.84, 95% CI -1.29--0.39, p = 0.0003), motor impairment (SMD = -0.81, 95% CI -1.34--0.27, p = 0.003), mobility and balance (MD = -1.81, 95% CI -3.13--0.49, p = 0.007), and small significant effects on QoL (SMD = -0.48, 95% CI -0.86--0.10, p = 0.01). RT compared with physically active control groups reached no significant results for any outcome. CONCLUSIONS RT improves muscle strength, motor impairment, mobility and balance, QoL, and depression in PD patients. However, it is not superior to other physically active interventions. Therefore, exercise is important for PD patients but according to this analysis, its type is of secondary interest.
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Affiliation(s)
- Romina Gollan
- Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Moritz Ernst
- Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Emma Lieker
- Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Julia Caro-Valenzuela
- Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ina Monsef
- Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Antje Dresen
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), Faculty of Human Sciences and Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Mandy Roheger
- Department of Neurology, Universitymedicine Greifswald, Greifswald, Germany
| | - Nicole Skoetz
- Evidence-based Oncology, Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology, Neuropsychology and Gender Studies & Center for Neuropsychological Diagnostics and Intervention (CeNDI), Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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13
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Merino-Andrés J, García de Mateos-López A, Damiano DL, Sánchez-Sierra A. Effect of muscle strength training in children and adolescents with spastic cerebral palsy: A systematic review and meta-analysis. Clin Rehabil 2021; 36:4-14. [PMID: 34407619 DOI: 10.1177/02692155211040199] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This systematic review and meta-analysis investigates the effects of strength training program in children and adolescents with cerebral palsy to improve function, activity, and participation. DATA SOURCES Five electronic databases (MEDLINE-Pubmed, Cochrane Library, PEDro, CINAHL, and SPORTDiscus) were systematically searched for full-text articles published from inception to 30 June 2021. REVIEW METHODS Randomized controlled trials were included, who compared: (i) child population with spastic cerebral palsy population between 0 and 22 years; (ii) studies in which a muscle strength training program was performed and included dosing information; (iii) studies comparing strength training with other physical therapy technique(s) or untreated control group. Studies with similar outcomes were pooled by calculating standardized mean differences. Risk of bias was assessed with Cochrane Collaboration's tool for assessing the risk of bias and PROSPERO's registration number ID: CRD42020193535. RESULTS Twenty-seven studies, comprising 847 participants with spastic cerebral palsy. The meta-analyses demonstrated significant standardized mean differences in favor of strength training program compared to other physical therapy technique(s) or untreated control group(s) for muscle strength at the knee flexors, at the knee extensor, at the plantarflexors, maximum resistance, balance, gait speed, GMFM (global, D and E dimension) and spasticity. CONCLUSION A strength training program has positive functional and activity effects on muscle strength, balance, gait speed, or gross motor function without increasing spasticity for children and adolescents with cerebral palsy in Gross Motor Function Classification System levels I, II, and III when adequate dosage and specific principles are utilized.
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Affiliation(s)
- Javier Merino-Andrés
- PedPT Research Lab, Toledo, Spain.,Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO), Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain
| | | | - Diane L Damiano
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD, USA
| | - Alberto Sánchez-Sierra
- Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain.,Toledo Physiotherapy Research Group (GIFTO), Department of Nursing, Physical Therapy and Occupational Therapy, Castilla-La Mancha University, Toledo, Spain.,Department of Physiotherapy, Camilo José Cela University, Madrid, Spain.,Department of Physiotherapy, European University, Madrid, Spain
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14
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Chen J, Chien HF, Francato DCV, Barbosa AF, Souza CDO, Voos MC, Greve JMD, Barbosa ER. Effects of resistance training on postural control in Parkinson's disease: a randomized controlled trial. ARQUIVOS DE NEURO-PSIQUIATRIA 2021; 79:S0004-282X2021005014102. [PMID: 34231653 PMCID: PMC9394568 DOI: 10.1590/0004-282x-anp-2020-0285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/23/2020] [Accepted: 09/17/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Postural instability affects Parkinson's disease (PD) patients' postural control right from the early stages of the disease. The benefits of resistance training (RT) for balance and functional capacity have been described in the literature, but few studies have been conducted showing its effects on PD patients' postural control. OBJECTIVE To investigate the effects of a three-month RT intervention on static posturography (SP) measurements and clinical functional balance assessment among PD patients. METHODS Seventy-four patients were randomly assigned to a three-month RT intervention consisting of using weightlifting machines at a gym (gym group) or RT consisting of using free weights and elastic bands (freew group), or to a control group. The participants were evaluated at baseline, three months and six months. We evaluated changes of SP measurements under eyes-open, eyes-closed and dual-task conditions (primary endpoint), along with motor performance and balance effects by means of clinical scales, dynamic posturography and perceptions of quality of life (secondary endpoints). RESULTS There were no significant interactions in SP measurements among the groups. Unified Parkinson Disease Rating Scale (UPDRS-III) motor scores decreased in both RT groups (p<0.05). Better perceived quality of life for the mobility domain was reported in the gym group while functional balance scores improved in the freew group, which were maintained at the six-month follow-up (p<0.05). CONCLUSIONS This study was not able to detect changes in SP measurements following a three-month RT intervention. Both RT groups of PD patients showed improved motor performance, with positive balance effects in the freew group and better perceived quality of life in the gym group.
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Affiliation(s)
- Janini Chen
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo SP, Brazil
| | - Hsin Fen Chien
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo SP, Brazil
| | - Debora Cristina Valente Francato
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
| | - Alessandra Ferreira Barbosa
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
- Universidade de São Paulo, Departamento de Fisioterapia, Terapia Ocupacional e Fonoaudiologia, São Paulo SP, Brazil
| | - Carolina de Oliveira Souza
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
| | - Mariana Callil Voos
- Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil
- Universidade de São Paulo, Departamento de Fisioterapia, Terapia Ocupacional e Fonoaudiologia, São Paulo SP, Brazil
| | - Julia Maria D'Andréa Greve
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, Laboratório de Estudo do Movimento, São Paulo SP, Brazil
| | - Egberto Reis Barbosa
- Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil
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15
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Siega J, Iucksch DD, Da Silva AZ, Zotz TGG, Israel VL. Parkinson's disease and multicomponent aquatic exercise: Effects on motor aspects, functional mobility, muscle function and aquatic motor skills. J Bodyw Mov Ther 2021; 27:314-321. [PMID: 34391251 DOI: 10.1016/j.jbmt.2021.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 03/10/2021] [Accepted: 03/29/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Analyze the effects of a multicomponent aquatic exercise program on motor aspects, functional mobility, muscle function and aquatic motor skills of people with PD. METHODS Eighteen people with a PD diagnosis were assessed before and after a 12-week multicomponent aquatic exercise program, twice a week, with each session lasting 50 min. The terrestrial variables analyzed were motor aspects, through the Unified Parkinson Disease Rating Scale (UPDRS); functional mobility, through the Five Times Sit to Stand Test (FTSST); Peak Torque (PT) and Mean Power (MP) of hip, knee and ankle flexors and extensors, assessed using an isokinetic dynamometer. In water, aquatic motor skill levels were assessed by means of the Aquatic Functional Assessment Scale (AFAS). RESULTS Significant improvements were found after the intervention in the following outcomes: motor aspects (p = 0.038, Δ = 5-61); MP of knee flexors at 90°/s on the most affected side (p = 0.026, Δ = 5.14), MP of knee extensors at 90°/s on the most affected side (p = 0.008, Δ = 8.69), MP of knee extensors at 120°/s on the most affected side (p = 0.005, Δ = 8.35), and AFAS in the domain of specialized therapeutic exercises (p = 0.014, Δ = 1.28). CONCLUSIONS The completed multicomponent aquatic exercise program promoted changes in muscle function and terrestrial and aquatic functional outcomes in people with PD.
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16
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Ellis TD, Colón-Semenza C, DeAngelis TR, Thomas CA, Hilaire MHS, Earhart GM, Dibble LE. Evidence for Early and Regular Physical Therapy and Exercise in Parkinson's Disease. Semin Neurol 2021; 41:189-205. [PMID: 33742432 DOI: 10.1055/s-0041-1725133] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Advances in medical management of Parkinson's disease (PD) have resulted in living longer with disability. Although disability worsens over the course of the disease, there are signs of disability even in the early stages. Several studies reveal an early decline in gait and balance and a high prevalence of nonmotor signs in the prodromal period that contribute to early disability. There is a growing body of evidence revealing the benefits of physical therapy and exercise to mitigate motor and nonmotor signs while improving physical function and reducing disability. The presence of early disability coupled with the benefits of exercise suggests that physical therapy should be initiated earlier in the disease. In this review, we present the evidence revealing early disability in PD and the effectiveness of physical therapy and exercise, followed by a discussion of a secondary prevention model of rehabilitation to reduce early disability and optimize long-term outcomes.
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Affiliation(s)
- Terry D Ellis
- Department of Physical Therapy and Athletic Training, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Cristina Colón-Semenza
- Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Tamara R DeAngelis
- Center for Neurorehabilitation, College of Health and Rehabilitation Sciences: Sargent College, Boston University, Boston, Massachusetts
| | - Cathi A Thomas
- Parkinson's Disease and Movement Disorders Center, Boston University Medical Campus, Boston, Massachusetts.,American Parkinson Disease Association Information and Referral Center at Boston University Medical Center, Boston, Massachusetts
| | - Marie-Hélène Saint Hilaire
- Parkinson's Disease and Movement Disorders Center, Boston University Medical Campus, Boston, Massachusetts.,Department of Neurology at Boston University School of Medicine, Boston, Massachusetts.,American Parkinson Disease Association Center for Advanced Research at Boston University Medical Center, Boston, Massachusetts
| | - Gammon M Earhart
- Program in Physical Therapy, Washington University School of Medicine in St. Louis, St. Louis, Missouri
| | - Leland E Dibble
- Department of Physical Therapy and Athletic Training, The University of Utah, Salt Lake City, Utah.,Health-Kinesiology-Recreation, The University of Utah, Salt Lake City, Utah
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17
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Braz de Oliveira MP, Maria Dos Reis L, Pereira ND. Effect of Resistance Exercise on Body Structure and Function, Activity, and Participation in Individuals With Parkinson Disease: A Systematic Review. Arch Phys Med Rehabil 2021; 102:1998-2011. [PMID: 33587899 DOI: 10.1016/j.apmr.2021.01.081] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To investigate the effects of resistance exercise (RE) on body structure and function, activity, and participation in individuals with Parkinson Disease (PD) in the mild to moderate stages. DATA SOURCES Medline, Embase, Web of Science, The Cochrane Library, Lilacs, and PEDro were searched from inception until June 2020 using the terms "Parkinson Disease," "Exercise," "Resistance Training," "Muscle Strength," "Cardiorespiratory Fitness," "Postural Balance," "Gait," and "Quality of Life." STUDY SELECTION We included studies conducted in individuals with PD involving RE compared with a control group. Two independent reviewers performed the selection process based on titles, abstracts, and full-text reading. In total, 270 individuals with PD were included from 10 selected studies. DATA EXTRACTION Two reviewers independently extracted characteristics related to participants, intervention and control types, and results. The PEDro scale was used to assess the methodological quality, and the level of evidence was analyzed and synthesized using the Grading of Recommendation, Assessment, Development, and Evaluations approach. DATA SYNTHESIS The level of evidence for body structure and function was low and without effect for lower limb muscle strength; very low and with effect for upper limb muscle strength, cardiorespiratory fitness, and postural balance; and very low and without effect for flexibility after RE training. For activity, the evidence was very low and with effect for gait and very low and without effect for mobility. For participation (ie, quality of life) the evidence was very low and without effect. CONCLUSIONS Although the level of evidence was low to very low, RE was shown to promote improvements in body structure and function (upper limb muscle strength, cardiovascular function, postural balance) and activity (gait). In contrast, RE did not significantly improve participation (quality of life). However, based on the present findings, the practice of RE can be recommended for individuals with PD in the mild to moderate stages.
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Affiliation(s)
- Marcos Paulo Braz de Oliveira
- Physiotherapy Department, Healthy Aging Research Laboratory, Federal University of São Carlos, São Carlos, SP, Brazil.
| | - Luciana Maria Dos Reis
- Physiotherapy Department, Neurofunctional Physiotherapy Laboratory, Federal University of Alfenas, Alfenas, MG, Brazil
| | - Natalia Duarte Pereira
- Physiotherapy Department, Research Group in Functionality and Technological Innovation in NeuroRehabilitation, Federal University of São Carlos, São Carlos, SP, Brazil
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18
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Renee S, Elisabeth P, Niruthikha M, Allyson F, Louise A. People with mild PD have impaired force production in all lower limb muscle groups: A cross-sectional study. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2021; 26:e1897. [PMID: 33464710 DOI: 10.1002/pri.1897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/15/2020] [Accepted: 12/25/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Power is reduced in people with Parkinson's disease as a consequence of bradykinesia, but it is not clear whether reduced power is also due to a deficit in force production. The aim of this study was to quantify force production in all major lower limb muscle groups in people with PD during the "on" phase after medication, compared with aged-matched neurologically normal control participants. METHOD Design: A cross-sectional study was undertaken. PARTICIPANTS Thirty ambulatory people with PD and 24 neurologically normal controls. OUTCOME MEASURES Isometric force production of the hip flexors and extensors, hip adductors and abductors, hip internal rotators and external rotators, knee flexors and extensors, ankle dorsiflexors and plantarflexors, ankle invertors and evertors using hand-held dynamometry. RESULTS There was a significant deficit in force production in participants with PD in all lower limb muscle groups tested, compared with control participants. On average, force production of participants with PD was 78% (range 67%-87%) of control participants, despite participants with PD regularly participating in exercise, being measured during their "on" phase after medication and having normal walking ability. The most severely affected muscle groups were the hip adductors (67%) and ankle plantarflexors (68%). CONCLUSION People with PD have a significant loss of force production in all lower limb muscle groups compared with age-matched neurologically-normal controls. IMPLICATIONS FOR PHYSIOTHERAPY PRACTICE Clinicians should regularly assess the strength of all lower limb muscle groups, regardless of participation in physical activity, responsiveness to levodopa medication and walking ability.
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Affiliation(s)
- Salmon Renee
- University of Canberra, Faculty of Health, Physiotherapy, Bruce, Australian Capital Territory, Australia
| | - Preston Elisabeth
- University of Canberra, Faculty of Health, Physiotherapy, Bruce, Australian Capital Territory, Australia
| | - Mahendran Niruthikha
- University of Canberra, Faculty of Health, Physiotherapy, Bruce, Australian Capital Territory, Australia
| | - Flynn Allyson
- University of Canberra, Faculty of Health, Physiotherapy, Bruce, Australian Capital Territory, Australia
| | - Ada Louise
- University of Sydney, Faculty of Health Sciences, Physiotherapy, Lidcombe, New South Wales, Australia
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19
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Chamberlain-Carter J, Jackson J. Does resistance training reduce falls and improve quality of life in people with Parkinson’s disease using strength training exercise programmes? PHYSICAL THERAPY REVIEWS 2021. [DOI: 10.1080/10833196.2020.1814123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - Jo Jackson
- School of Sport, Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
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20
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Hortobágyi T, Granacher U, Fernandez-Del-Olmo M, Howatson G, Manca A, Deriu F, Taube W, Gruber M, Márquez G, Lundbye-Jensen J, Colomer-Poveda D. Functional relevance of resistance training-induced neuroplasticity in health and disease. Neurosci Biobehav Rev 2020; 122:79-91. [PMID: 33383071 DOI: 10.1016/j.neubiorev.2020.12.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 01/13/2023]
Abstract
Repetitive, monotonic, and effortful voluntary muscle contractions performed for just a few weeks, i.e., resistance training, can substantially increase maximal voluntary force in the practiced task and can also increase gross motor performance. The increase in motor performance is often accompanied by neuroplastic adaptations in the central nervous system. While historical data assigned functional relevance to such adaptations induced by resistance training, this claim has not yet been systematically and critically examined in the context of motor performance across the lifespan in health and disease. A review of muscle activation, brain and peripheral nerve stimulation, and imaging data revealed that increases in motor performance and neuroplasticity tend to be uncoupled, making a mechanistic link between neuroplasticity and motor performance inconclusive. We recommend new approaches, including causal mediation analytical and hypothesis-driven models to substantiate the functional relevance of resistance training-induced neuroplasticity in the improvements of gross motor function across the lifespan in health and disease.
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Affiliation(s)
- Tibor Hortobágyi
- Center for Human Movement Sciences, University of Groningen, University Medical CenterGroningen, Groningen, Netherlands.
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany
| | - Miguel Fernandez-Del-Olmo
- Area of Sport Sciences, Faculty of Sports Sciences and Physical Education, Center for Sport Studies, King Juan Carlos University, Madrid, Spain
| | - Glyn Howatson
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK; Water Research Group, North West University, Potchefstroom, South Africa
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Wolfgang Taube
- Department of Neurosciences and Movement Sciences, University of Fribourg, Fribourg, Switzerland
| | - Markus Gruber
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
| | - Gonzalo Márquez
- Department of Physical Education and Sport, Faculty of Sports Sciences and Physical Education, University of A Coruña, A Coruña, Spain
| | - Jesper Lundbye-Jensen
- Movement & Neuroscience, Department of Nutrition, Exercise & Sports Department of Neuroscience, University of Copenhagenk, Faculty of Health Science, Universidad Isabel I, Burgos, Spain
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21
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McMahon L, Blake C, Lennon O. Nonpharmacological interventions for respiratory health in Parkinson's disease: A systematic review and meta-analysis. Eur J Neurol 2020; 28:1022-1040. [PMID: 33098349 DOI: 10.1111/ene.14605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/15/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Respiratory dysfunction in Parkinson's disease (PD) is often an underdiagnosed and untreated impairment associated with the disease. Clinically, a reactive approach to respiratory morbidity is taken, rather than preventative approaches that address underlying impairment/s. This systematic review identifies the current evidence to support nonpharmacological interventions to improve respiratory impairments in individuals with PD. METHODS The relevant literature was searched using a customised and systematic strategy. Randomised and nonrandomised control trials of nonpharmacological interventions targeting respiratory outcome measures in PD were included. Outcomes of interest were respiratory morbidity and mortality, respiratory muscle strength, spirometry measures, lung volumes, peak cough flow, and perception of dyspnoea. RESULTS Nonpharmacological interventions included: functional training, generalised strength training, respiratory muscle strength training, aerobic exercise, qigong, yoga, breath stacking, incentive spirometry and singing. Methodological quality of included studies varied. Meta-analyses of nonpharmacological interventions demonstrated significant effects for inspiratory muscle strength (mean difference [MD] 19.68; confidence interval [CI] 8.49, 30.87; z = 3.45; p = 0.0006; I2 = 2%), expiratory muscle strength (MD 18.97; CI 7.79, 30.14; z = 3.33; p = 0.0009; I2 = 23%) and peak expiratory flow (MD 72.21; CI 31.19, 113.24; z = 3.45; p = 0.0006; I2 = 0%). Best-evidence synthesis identified level 1 evidence supporting nonpharmacological interventions for improving peak cough flow and perceived dyspnoea. No studies were identified reporting outcomes of respiratory rate, inspiration:expiration ratio or respiratory morbidity or mortality in PD. CONCLUSIONS Nonpharmacological interventions improved respiratory muscle strength and peak expiratory flow in PD. Additional trials targeting respiratory dysfunction and longitudinal studies examining the relationship between respiratory dysfunction and morbidity and mortality rates in PD are required.
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Affiliation(s)
- L McMahon
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - C Blake
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
| | - O Lennon
- UCD School of Public Health, Physiotherapy and Population Science, Health Sciences Centre, University College Dublin, Dublin, Ireland
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Li X, He J, Yun J, Qin H. Lower Limb Resistance Training in Individuals With Parkinson's Disease: An Updated Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Neurol 2020; 11:591605. [PMID: 33281732 PMCID: PMC7691593 DOI: 10.3389/fneur.2020.591605] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/07/2020] [Indexed: 01/20/2023] Open
Abstract
Objective: Initial randomized controlled trials (RCTs) and recently released systematic reviews have identified resistance training (RT) as a modality to manage motor symptoms and improve physical functioning in individuals with Parkinson's disease (PD), although the effects are inconsistent. Therefore, we conducted an updated meta-analysis to reassess the evidence of the relationship. Methods: We performed a systematic search of studies reporting the effects of RT in PD available through major electronic databases (PubMed, Medline, Embase, Ovid, Cochrane Library, CNKI, Wanfang) through 20 July 2020. Eligible RCTs were screened based on established inclusion criteria. We extracted data on the indicators of leg strength, balance, gait capacity, and quality of life (QoL) of lower limbs. Random and fixed effects models were used for the analysis of standard mean differences (SMD) or mean differences (MD) with their 95% confidence intervals (CI). Results: Thirty-one papers from 25 independent trials compromising 1,239 subjects were selected for eligibility in this systematic review and meta-analysis. Summarized data indicated that the leg strength increased statistically significant in PD patients (SMD = 0.79, 95% CI 0.3, 1.27, P = 0.001), the balance capability was improved statistically significant in PD patients (SMD = 0.34, 95% CI 0.01, 0.66, P = 0.04), and QoL statistically significantly improved (MD = −7.22, 95% CI −12.05, −2.39, P = 0.003). For gait performance, four indicators were measured, the results as follows: fast gait velocity (MD = 0.14, 95% CI 0.06, 0.23, P = 0.001), Timed-up-and-go-test (TUG, MD = −1.17, 95% CI −2.27, −0.08, P = 0.04) and Freezing of Gait Questionnaire (FOG-Q, MD = −1.74, 95% CI −3.18, −0.3, P = 0.02) were improved statistically significant across trials, while there were no statistically significant improvement in stride length (MD = −0.05, 95% CI −0.12, 0.02, P = 0.15) in PD patients. Conclusions: Lower limb RT has positive effects during rehabilitation in individuals with PD in leg strength, QoL, and improve gait performance to a certain extent. RT also could improve balance capacity of patients, although a wide variety of tools were used, and further study is needed to confirm these findings.
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Affiliation(s)
- Xiaoyan Li
- Department of Endocrinology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jie He
- Department of Respiratory and Critical Care Medicine, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Jie Yun
- Nursing Department of Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hua Qin
- Department of Endocrinology, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
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Thijs Z, Watts CR. Perceptual Characterization of Voice Quality in Nonadvanced Stages of Parkinson's Disease. J Voice 2020; 36:293.e11-293.e18. [PMID: 32703725 DOI: 10.1016/j.jvoice.2020.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/17/2020] [Accepted: 05/04/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Parkinson's disease (PD) is a neurodegenerative disorder that impacts motor and nonmotor systems, and consequently influences voice. In later stages of the disease, people with PD develop salient hypokinetic dysarthria. However, it is unclear how extensive the voice impairment is in the nonadvanced stages of PD. Therefore, the aim of the current research was to investigate the auditory-perceptual characteristics of voice in people with Parkinson's disease (PWPD) in nonadvanced stages. METHODS 29 PWPD and 32 healthy older controls were recruited. For each participant, a recording of the sentence "We were away a year ago" was acquired. These recordings were evaluated by 2 licensed and experienced speech-language pathologists, who provided perceptual ratings of overall dysphonia severity, breathiness, roughness, and perceived age. RESULTS MANCOVA analysis showed that, when controlling for age and intensity, there was a significant effect of group (P = 0.001) on perceptual voice quality. PWPD were perceived to be significantly older, more breathy and more severely dysphonic than the older healthy controls. No differences were found for the perceived roughness. CONCLUSIONS The results suggest that perceptual features of hypokinetic dysarthria in voice, specifically breathiness, are present in nonadvanced stages of PWPD and may contribute to listener perceptions of speaker age. Moreover, the perceptual voice profiles in PWPD showed great variability, possibly reflecting the heterogeneity of disease impact on individuals. The results of this study may inform how research targets rehabilitation and maintenance of voice and laryngeal function in PWPD at nonadvanced stages.
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Affiliation(s)
- Zoë Thijs
- Texas Christian University, Fort Worth, Texas, USA.
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Evidence of Rehabilitative Impact of Progressive Resistance Training (PRT) Programs in Parkinson Disease: An Umbrella Review. PARKINSONS DISEASE 2020; 2020:9748091. [PMID: 32566123 PMCID: PMC7270996 DOI: 10.1155/2020/9748091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 04/09/2020] [Indexed: 11/26/2022]
Abstract
Parkinson disease (PD) is a chronic neurodegenerative condition that leads to progressive disability. PD-related reductions in muscle strength have been reported to be associated with lower functional performance and balance confidence with an increased risk of falls. Progressive resistance training (PRT) improves strength, balance, and functional abilities. This umbrella review examines the efficacy of PRT regarding muscular strength in PD patients. The PubMed, PEDro, Scopus, and Cochrane Library databases were searched from January 2009 to August 2019 for systematic reviews and meta-analyses conducted in English. The populations included had diagnoses of PD and consisted of males and females aged >18 years old. Outcomes measured were muscle strength and enhanced physical function. Eight papers (six systematic reviews and meta-analyses and two systematic reviews) were considered relevant for qualitative analysis. In six of the eight studies, the reported severity of PD was mild to moderate. Each study analyzed how PRT elicited positive effects on muscle strength in PD patients, suggesting 10 weeks on average of progressive resistance exercises for the upper and lower limbs two to three times per week. However, none of the studies considered the postworkout follow-up, and there was no detailed evidence about the value of PRT in preventing falls. The possibility of PRT exercises being effective for increasing muscle strength in patients with PD, but without comorbidities or severe disability, is discussed. Overall, this review suggests that PRT should be included in rehabilitation programs for PD patients, in combination with balance training for postural control and other types of exercise, in order to preserve cardiorespiratory fitness and improve endurance in daily life activities.
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Rahmati Z, Behzadipour S, Schouten AC, Taghizadeh G, Firoozbakhsh K. Postural control learning dynamics in Parkinson's disease: early improvement with plateau in stability, and continuous progression in flexibility and mobility. Biomed Eng Online 2020; 19:29. [PMID: 32393271 PMCID: PMC7216342 DOI: 10.1186/s12938-020-00776-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 04/28/2020] [Indexed: 12/17/2022] Open
Abstract
Background Balance training improves postural control in Parkinson’s disease (PD). However, a systematic approach for the development of individualized, optimal training programs is still lacking, as the learning dynamics of the postural control in PD, over a training program, are poorly understood. Objectives We investigated the learning dynamics of the postural control in PD, during a balance-training program, in terms of the clinical, posturographic, and novel model-based measures. Methods Twenty patients with PD participated in a balance-training program, 3 days a week, for 6 weeks. Clinical tests assessed functional balance and mobility pre-training, mid-training, and post-training. Center-of-pressure (COP) was recorded at four time-points during the training (pre-, week 2, week 4, and post-training). COP was used to calculate the sway measures and to identify the parameters of a patient-specific postural control model, at each time-point. The posturographic and model-based measures constituted the two sets of stability- and flexibility-related measures. Results Mobility- and flexibility-related measures showed a continuous improvement during the balance-training program. In particular, mobility improved at mid-training and continued to improve to the end of the training, whereas flexibility-related measures reached significance only at the end. The progression in the balance- and stability-related measures was characterized by early improvements over the first 3 to 4 weeks of training, and reached a plateau for the rest of the training. Conclusions The progression in balance and postural stability is achieved earlier and susceptible to plateau out, while mobility and flexibility continue to improve during the balance training.
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Affiliation(s)
- Zahra Rahmati
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran.,Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran
| | - Saeed Behzadipour
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran. .,Djawad Movafaghian Research Center in Neurorehab Technologies, Sharif University of Technology, Tehran, Iran.
| | - Alfred C Schouten
- Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands.,Department of Biomechanical Engineering, University of Twente, Enschede, The Netherlands
| | - Ghorban Taghizadeh
- Rehabilitation Research Center, Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
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Cherup NP, Buskard AN, Strand KL, Roberson KB, Michiels ER, Kuhn JE, Lopez FA, Signorile JF. Power vs strength training to improve muscular strength, power, balance and functional movement in individuals diagnosed with Parkinson's disease. Exp Gerontol 2019; 128:110740. [DOI: 10.1016/j.exger.2019.110740] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/13/2019] [Accepted: 09/16/2019] [Indexed: 10/25/2022]
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Alves WM, Alves TG, Ferreira RM, Lima TA, Pimentel CP, Sousa EC, Abrahin O, Alves EA. Strength training improves the respiratory muscle strength and quality of life of elderly with Parkinson disease. J Sports Med Phys Fitness 2019; 59:1756-1762. [PMID: 31113177 DOI: 10.23736/s0022-4707.19.09509-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The progression of Parkinson disease can lead to respiratory muscle weakness, reduced peak expiratory flow and quality of life (QoL). The aim was to evaluate the effects of strength training on levels of respiratory muscle strength, peak expiratory flow and QoL of elderly with Parkinson disease. METHODS A total of 28 patients were randomized into one of two groups: the control group (CG) comprised 16 participants, and the strength training group (STG) comprised 12 participants. All subjects maintained the standard pharmacological treatment for Parkinson disease, and the intervention group participated in a 16-week strength training program. The primary outcome was the measurement of respiratory muscle strength. RESULTS The STG showed improved values of maximum inspiratory pressures (36.11±11.82 to 52.94±24.17; P=0.01), maximum expiratory pressures (56.67±22.08 to 71.04±33.71; P=0.03) and QoL (41.75±20.33 to 34±20.92; P=0.0054); there was no significant difference in the peak expiratory flow (336.11±198.04 to 380±229.57; P=0.09). The CG showed significantly decreased values of peak expiratory flow (336.88±183.40 to 279.37±125.12, P=0.02) and non-significant changes in the other variables. CONCLUSIONS Sixteen weeks of strength training improves the inspiratory and expiratory muscle strength and QoL of elderly with Parkinson disease. These findings suggest that strength training could be considered an adjunct therapeutic intervention for elderly with Parkinson disease.
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Affiliation(s)
- Wilson M Alves
- Pará State University, Laboratório de Bioquímica do Exercício (LABEX), Belém, Brazil
| | - Thiago G Alves
- Pará State University, Laboratório de Bioquímica do Exercício (LABEX), Belém, Brazil
| | - Renilson M Ferreira
- Pará State University, Laboratório de Bioquímica do Exercício (LABEX), Belém, Brazil
| | - Tiago A Lima
- Pará State University, Laboratório de Bioquímica do Exercício (LABEX), Belém, Brazil
| | - Clebson P Pimentel
- Pará State University, Laboratório de Bioquímica do Exercício (LABEX), Belém, Brazil
| | - Evitom C Sousa
- Pará State University, Laboratório de Exercício Resistido e Saúde (LERES), Belém, Brazil
| | - Odilon Abrahin
- Pará State University, Laboratório de Exercício Resistido e Saúde (LERES), Belém, Brazil -
| | - Erik A Alves
- Pará State University, Laboratório de Bioquímica do Exercício (LABEX), Belém, Brazil
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Leal LC, Abrahin O, Rodrigues RP, da Silva MC, Araújo AP, de Sousa EC, Pimentel CP, Cortinhas-Alves EA. Low-volume resistance training improves the functional capacity of older individuals with Parkinson's disease. Geriatr Gerontol Int 2019; 19:635-640. [PMID: 31037806 DOI: 10.1111/ggi.13682] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 03/02/2019] [Accepted: 04/10/2019] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the effects of low-volume resistance training on the physical and functional capacity of older patients with Parkinson's disease. METHODS A total of 54 patients (aged ≥60 years) were randomly divided into two groups: (i) a control group comprising 13 men and 14 women; and (ii) a resistance training group with 14 men and 13 women. The resistance training group, in addition to maintaining their pharmacological treatments, carried out 6 months of resistance training twice a week, whereas the control group maintained their pharmacological treatments. Handgrip strength, flexibility, aerobic endurance, gait speed and balance were assessed in both groups. RESULTS After 6 months, patient functionality in the control group was reduced, whereas patients who carried out low training volumes showed significantly improved flexibility (Pre × Post: P = 0.008), aerobic resistance (Pre × Post: P = 0.006), gait speed (Pre × Post: P = 0.006) and balance (Pre × Post: P = 0.043). Significant improvement (P = 0.042) was also observed in right handgrip strength in the resistance training group. CONCLUSIONS The results of the present study showed that low-volume resistance training improves the physical capacity of older people with Parkinson's disease. Therefore, we suggest that resistance training be a central component in exercise programs for patients with Parkinson's disease. Geriatr Gerontol Int 2019; 19: 635-640.
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Affiliation(s)
- Leon Cp Leal
- Department of Physical Education, Exercise Biochemistry Laboratory, Pará State University, Belém, Brazil.,Department of Physical Education, Resistance Exercise and Health Laboratory, Pará State University, Belém, Brazil
| | - Odilon Abrahin
- Department of Physical Education, Resistance Exercise and Health Laboratory, Pará State University, Belém, Brazil
| | - Rejane P Rodrigues
- Department of Physical Education, Resistance Exercise and Health Laboratory, Pará State University, Belém, Brazil
| | - Maria Cr da Silva
- Department of Physical Education, Exercise Biochemistry Laboratory, Pará State University, Belém, Brazil
| | - Ana Pm Araújo
- Department of Physical Education, Exercise Biochemistry Laboratory, Pará State University, Belém, Brazil
| | - Evitom C de Sousa
- Department of Physical Education, Exercise Biochemistry Laboratory, Pará State University, Belém, Brazil.,Department of Physical Education, Resistance Exercise and Health Laboratory, Pará State University, Belém, Brazil
| | - Clebson P Pimentel
- Department of Physical Education, Exercise Biochemistry Laboratory, Pará State University, Belém, Brazil
| | - Erik A Cortinhas-Alves
- Department of Physical Education, Exercise Biochemistry Laboratory, Pará State University, Belém, Brazil.,Department of Physical Education, Resistance Exercise and Health Laboratory, Pará State University, Belém, Brazil
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Cugusi L, Manca A, Bergamin M, Di Blasio A, Monticone M, Deriu F, Mercuro G. Aquatic exercise improves motor impairments in people with Parkinson's disease, with similar or greater benefits than land-based exercise: a systematic review. J Physiother 2019; 65:65-74. [PMID: 30904467 DOI: 10.1016/j.jphys.2019.02.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 11/11/2018] [Accepted: 02/15/2019] [Indexed: 01/05/2023] Open
Abstract
QUESTIONS What are the effects of aquatic exercise on disease severity, (non-)motor impairments, activity performance, fear of falling, and quality of life in people with Parkinson's disease (PD)? Does aquatic exercise have greater effects on these outcomes than other forms of exercise in people with PD? DESIGN Systematic review and meta-analysis of randomised controlled trials. PARTICIPANTS People with idiopathic PD. INTERVENTION Supervised aquatic exercise programs ≥ 2 weeks. OUTCOMES MEASURES The primary outcomes were disease severity, motor impairments, activity performance, and fear of falling. The secondary outcomes were non-motor impairments and quality of life. RESULTS Of the 129 identified records, seven trials met the inclusion criteria and six were meta-analysed (159 participants). One trial assessed the effect of aquatic exercise compared with control and found a significant improvement in the Unified Parkinson's Disease Rating Scale Part III (MD -4.6, 95% CI -7.5 to -1.7) in favour of aquatic exercise. Six studies compared aquatic exercise with land-based exercise after intervention (mean 7.2 weeks of training (SD 2.2); 159 participants). The effect of aquatic exercise was superior to land-based exercise on the Berg Balance Scale (MD 2.7, 95% CI 1.6 to 3.9), the Falls Efficacy Scale (MD -4.0, 95% CI -6.1 to -1.8) and the 39-item Parkinson's Disease Questionnaire (MD -6.0, 95% CI -11.3 to -0.6), with no other significant effects identified. The significant benefit on the Berg Balance Scale was maintained at the follow-up assessment (MD 6.3, 95% CI 2.1 to 10.5, 54 participants). CONCLUSION Aquatic exercise improves motor impairments in people with PD significantly more than no intervention. It also has slightly to moderately greater benefits than land-based exercise on balance capacity, fear of falling, and health-related quality of life. On other outcomes, the benefits of aquatic exercise are similar to those of land-based exercise. TRIAL REGISTRATION PROSPERO CRD42017077370.
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Affiliation(s)
- Lucia Cugusi
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
| | - Andrea Manca
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Marco Bergamin
- Department of Medicine, Sport and Exercise Medicine Division, University of Padova, Italy
| | - Andrea Di Blasio
- Department of Medicine and Aging Sciences, Endocrine Section, 'G. d'Annunzio' University of Chieti - Pescara, Chieti, Italy
| | - Marco Monticone
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Franca Deriu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
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Physical Activity, Fatigue, and Sleep in People with Parkinson's Disease: A Secondary per Protocol Analysis from an Intervention Trial. PARKINSONS DISEASE 2018; 2018:1517807. [PMID: 30258564 PMCID: PMC6146558 DOI: 10.1155/2018/1517807] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/16/2018] [Accepted: 07/05/2018] [Indexed: 11/17/2022]
Abstract
Symptoms of Parkinson's can result in low physical activity and poor sleep patterns which can have a detrimental effect on a person's quality of life. To date, studies looking into exercise interventions for people with Parkinson's (PwP) for symptom management are promising but inconclusive. The aim of this study is to estimate the effect of a clearly defined exercise prescription on general physical activity levels, fatigue, sleep, and quality of life in PwP. Method. PwP randomised into either an exercise group (29; 16 males, 13 females; mean age 67 years (7.12)) or a control handwriting group (36; 19 males; 17 females; mean age 67 years (5.88)) as part of a larger trial were included in this substudy if they had completed a 6-month weekly exercise programme (intervention group) and had complete objective physical activity data (intervention and control group). Sleep and fatigue were recorded from self-reported measures, and physical activity levels measured through the use of accelerometers worn 24 hours/day over a seven-day testing period at baseline and following the 24-week intervention. A Wilcoxon's test followed by a Mann-Whitney post hoc analysis was used, and effect sizes were calculated. Results. Participants showed a significant increase in time spent in sedentary and light activities during the overnight period postintervention in both exercise and handwriting groups (p < 0.05) with a moderate effect found for the change in sedentary and light activities in the overnight hours for both groups, over time (0.32 and 0.37-0.38, resp.). There was no impact on self-reported fatigue or sleep. Conclusion. The observed moderate effect on sedentary and light activities overnight could suggest an objective improvement in sleep patterns for individuals participating in both exercise and handwriting interventions. This supports the need for further studies to investigate the role of behavioural interventions for nonmotor symptoms.
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Audet O, Bui HT, Allisse M, Comtois AS, Leone M. Assessment of the impact of an exercise program on the physical and functional capacity in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay: An exploratory study. Intractable Rare Dis Res 2018; 7:164-171. [PMID: 30181935 PMCID: PMC6119673 DOI: 10.5582/irdr.2018.01060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Autosomal recessive spastic ataxia of Charlevoix-Saguenay (ARSACS) is a neuromuscular disorder caused by the mutation of the SACS gene. Clinical symptoms of this disease include progressive ataxia, spasticity, and peripheral neuropathy. Similar to other neuromuscular disorders, these patients are prone to physical deconditioning which may lead to a loss of functional capacity. This paper aims to evaluate the impact of a training program on the physical fitness and the functional capacity of ARSACS patients. Twelve patients (age: 28.1 ± 8.2 years) participated in this study. They followed an eight-week training program including physical activities, strength-power and aerobic training. Compared to the initial evaluation, measures of physical fitness and functional capacity were significantly improved (p ≤ 0.05) for 11 of the 12 tests. Positive gains were also observed for fall frequency and for upper-limb incoordination. This paper supports the importance of a training program for ARSACS patients in order to improve their quality of life. Through these types of interventions, it may be possible to slow down the progression of the disease and help maintain functional capacity.
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Affiliation(s)
- Olivier Audet
- Deparment of Kinesiology, Université Laval, Québec, Canada
| | - Hung Tien Bui
- Department of Applied Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Maxime Allisse
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
| | - Alain-Steve Comtois
- Department of Exercise Sciences, Université du Québec à Montréal, Montréal, Canada
| | - Mario Leone
- Department of Health Sciences, Université du Québec à Chicoutimi, Saguenay, Canada
- Address correspondence to:Dr. Mario Leone, Department of Health, Kinesiology Division, Université du Québec à Chicoutimi, 555 boulevard de l'Université, Saguenay (Québec), G7H 2B1, Canada. E-mail:
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Joseph C, Leavy B, Mattsson S, Falk L, Franzén E. Implementation of the HiBalance training program for Parkinson's disease in clinical settings: A feasibility study. Brain Behav 2018; 8:e01021. [PMID: 29931778 PMCID: PMC6085912 DOI: 10.1002/brb3.1021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/24/2018] [Accepted: 05/09/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Translating evidence into practice requires adaptation to facilitate the implementation of efficacious interventions. A novel highly challenging balance training program (HiBalance) was found to improve gait, balance, and physical activity in persons with Parkinson's disease (PD) in an earlier randomized controlled trial. This study aimed to describe the adaptation process and feasibility of implementing the HiBalance program for PD within primary healthcare settings. METHOD Feasibility was assessed in terms of study processes and scientific evaluation. Nine persons with mild-moderate PD were enrolled in this pre-post feasibility study. The dose of the original program was adapted by reducing therapist-led training sessions from three to two times weekly. Outcome measures were substituted with ones more clinically feasible. One group (n = 5) received HiBalance training three times weekly for 10 weeks while another (n = 4) trained twice weekly plus a once weekly home exercise program (HEP). Balance performance was the primary outcome, while secondary outcomes (e.g., gait speed, physical activity level, concerns of falling, and health-related quality of life) were also evaluated. RESULTS Regarding process feasibility, attendance was high (approximately 90%) in both groups, and experiences of the group and home training were positive. Newly selected outcome measures were feasible. The scientific evaluation revealed few adverse events and no serious injuries occurred. Concerning outcomes per group, the average change in balance performance and gait speed was equal to, or exceeded, the minimally worthwhile treatment effect commonly used in PD. CONCLUSION The findings support the feasibility, in terms of process and scientific evaluation, of the adapted HiBalance program for implementation within clinical settings. A sufficiently powered study is required to ascertain whether the newly proposed program offers similar short and long-term effects as the original program.
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Affiliation(s)
- Conran Joseph
- Department of Neurobiology, Care Sciences and SocietyDivision of PhysiotherapyKarolinska InstitutetStockholmSweden
- Faculty of Community and Health SciencesPhysiotherapy DepartmentUniversity of the Western CapeCape TownSouth Africa
| | - Breiffni Leavy
- Department of Neurobiology, Care Sciences and SocietyDivision of PhysiotherapyKarolinska InstitutetStockholmSweden
- Unit of Research and DevelopmentStockholms Sjukhem FoundationStockholmSweden
| | - Sara Mattsson
- Rehabilitation and Primary careStockholms Sjukhem FoundationStockholmSweden
| | - Lynn Falk
- Rehabilitation and Primary careStockholms Sjukhem FoundationStockholmSweden
| | - Erika Franzén
- Department of Neurobiology, Care Sciences and SocietyDivision of PhysiotherapyKarolinska InstitutetStockholmSweden
- Unit of Research and DevelopmentStockholms Sjukhem FoundationStockholmSweden
- Allied Health Professionals FunctionKarolinska University HospitalStockholmSweden
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Audet O, Bui HT, Allisse M, Comtois AS, Leone M. WITHDRAWN: Assessment of the impact of an exercise program on the physical and functional capacity in patients with autosomal recessive spastic ataxia of Charlevoix-Saguenay: An exploratory study. Biosci Trends 2018. [PMID: 30012892 DOI: 10.5582/bst.2018.01060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Ahead of Print article withdrawn by publisher. This withdrawal is for above article due to the misoperation of advance online publication.
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Affiliation(s)
| | - Hung Tien Bui
- Department of Applied Sciences, Université du Québec à Chicoutimi
| | - Maxime Allisse
- Department of Health Sciences, Université du Québec à Chicoutimi
| | | | - Mario Leone
- Department of Health Sciences, Université du Québec à Chicoutimi
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Smaili SM, Bueno MEB, Barboza NM, Terra MB, Almeida IAD, Ferraz HB. Efficacy of neurofunctional versus resistance training in improving gait and quality of life among patients with Parkinson’s disease: a randomized clinical trial. MOTRIZ: REVISTA DE EDUCACAO FISICA 2018. [DOI: 10.1590/s1980-6574201800020004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Afra P, Bruggers CS, Sweney M, Fagatele L, Alavi F, Greenwald M, Huntsman M, Nguyen K, Jones JK, Shantz D, Bulaj G. Mobile Software as a Medical Device (SaMD) for the Treatment of Epilepsy: Development of Digital Therapeutics Comprising Behavioral and Music-Based Interventions for Neurological Disorders. Front Hum Neurosci 2018; 12:171. [PMID: 29780310 PMCID: PMC5946004 DOI: 10.3389/fnhum.2018.00171] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/12/2018] [Indexed: 12/29/2022] Open
Abstract
Digital health technologies for people with epilepsy (PWE) include internet-based resources and mobile apps for seizure management. Since non-pharmacological interventions, such as listening to specific Mozart's compositions, cognitive therapy, psychosocial and educational interventions were shown to reduce epileptic seizures, these modalities can be integrated into mobile software and delivered by mobile medical apps as digital therapeutics. Herein, we describe: (1) a survey study among PWE about preferences to use mobile software for seizure control, (2) a rationale for developing digital therapies for epilepsy, (3) creation of proof-of-concept mobile software intended for use as an adjunct digital therapeutic to reduce seizures, and (4) broader applications of digital therapeutics for the treatment of epilepsy and other chronic disorders. A questionnaire was used to survey PWE with respect to preferred features in a mobile app for seizure control. Results from the survey suggested that over 90% of responders would be interested in using a mobile app to manage their seizures, while 75% were interested in listening to specific music that can reduce seizures. To define digital therapeutic for the treatment of epilepsy, we designed and created a proof-of-concept mobile software providing digital content intended to reduce seizures. The rationale for all components of such digital therapeutic is described. The resulting web-based app delivered a combination of epilepsy self-care, behavioral interventions, medication reminders and the antiseizure music, such as the Mozart's sonata K.448. To improve long-term patient engagement, integration of mobile medical app with music and multimedia streaming via smartphones, tablets and computers is also discussed. This work aims toward development and regulatory clearance of software as medical device (SaMD) for seizure control, yielding the adjunct digital therapeutic for epilepsy, and subsequently a drug-device combination product together with specific antiseizure medications. Mobile medical apps, music, therapeutic video games and their combinations with prescription medications present new opportunities to integrate pharmacological and non-pharmacological interventions for PWE, as well as those living with other chronic disorders, including depression and pain.
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Affiliation(s)
- Pegah Afra
- Department of Neurology, University of Utah, Salt Lake City, UT, United States.,Department of Neurology, Weill Cornell Medicine, Cornell University, New York, NY, United States
| | - Carol S Bruggers
- Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Matthew Sweney
- Department of Neurology, University of Utah, Salt Lake City, UT, United States.,Department of Pediatrics, University of Utah, Salt Lake City, UT, United States
| | - Lilly Fagatele
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Fareeha Alavi
- Department of Neurology, University of Utah, Salt Lake City, UT, United States
| | - Michael Greenwald
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Merodean Huntsman
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Khanhly Nguyen
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
| | - Jeremiah K Jones
- Software Development Center, University of Utah, Salt Lake City, UT, United States
| | | | - Grzegorz Bulaj
- Department of Medicinal Chemistry, College of Pharmacy, University of Utah, Salt Lake City, UT, United States
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Silva-Batista C, Corcos DM, Kanegusuku H, Piemonte MEP, Gobbi LTB, de Lima-Pardini AC, de Mello MT, Forjaz CLM, Ugrinowitsch C. Balance and fear of falling in subjects with Parkinson's disease is improved after exercises with motor complexity. Gait Posture 2018; 61:90-97. [PMID: 29310015 DOI: 10.1016/j.gaitpost.2017.12.027] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Revised: 12/12/2017] [Accepted: 12/27/2017] [Indexed: 02/07/2023]
Abstract
Resistance training with instability (RTI) uses exercises with high motor complexity that impose high postural control and cognitive demands that may be important for improving postural instability and fear of falling in subjects with Parkinson's disease (PD). Here, we hypothesized that: 1) RTI will be more effective than resistance training (RT) in improving balance (Balance Evaluation Systems Test [BESTest] and overall stability index [Biodex Balance System®]) and fear of falling (Falls Efficacy Scale-International [FES-I] score) of subjects with Parkinson's disease (PD); and 2) changes in BESTest and FES-I after RTI will be associated with changes in cognitive function (Montreal Cognitive Assessment [MoCA] score - previously published) induced by RTI. Thirty-nine subjects with moderate PD were randomly assigned to a nonexercising control, RT, and RTI groups. While RT and RTI groups performed progressive RT twice a week for 12 weeks, the RTI group added progressive unstable devices to increase motor complexity of the resistance exercises. There were significant group × time interactions for BESTest, overall stability index, and FES-I scores (P < 0.05). Only RTI improved BESTest, overall stability index and FES-I scores, and RTI was more effective than RT in improving biomechanical constraints and stability in gait (BESTest sections) at post-training (P < 0.05). There were strong correlations between relative changes in BESTest and MoCA (r = 0.72, P = 0.005), and FES-I and MoCA (r = -0.75, P = 0.003) after RTI. Due to the increased motor complexity in RTI, RTI is recommended for improving balance and fear of falling, which are associated with improvement in cognitive function of PD.
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Affiliation(s)
- Carla Silva-Batista
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil; School of Arts, Sciences and Humanities, University of São Paulo, Brazil.
| | - Daniel M Corcos
- Department of Physical Therapy & Human Movement Sciences, Northwestern University, Chicago, Illinois, USA; Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
| | - Hélcio Kanegusuku
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil
| | | | | | - Andrea C de Lima-Pardini
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil; Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo, São Paulo, Brazil; LIM-44, Department of Radiology, University of São Paulo, São Paulo, Brazil
| | - Marco Túlio de Mello
- Department of Psychobiology, Center for Psychobiology and Exercise Studies University Federal de São Paulo, São Paulo, Brazil
| | - Claudia L M Forjaz
- Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil
| | - Carlos Ugrinowitsch
- Laboratory of Neuromuscular Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, Brazil
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Silva-Batista C, Corcos DM, Barroso R, David FJ, Kanegusuku H, Forjaz C, DE Mello MT, Roschel H, Tricoli V, Ugrinowitsch C. Instability Resistance Training Improves Neuromuscular Outcome in Parkinson's Disease. Med Sci Sports Exerc 2017; 49:652-660. [PMID: 27851668 DOI: 10.1249/mss.0000000000001159] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study compared the effects of resistance training (RT) and RT with instability (RTI) on neuromuscular and total training volume (TTV) outcomes obtained as part of the Instability Resistance Training Trial in Parkinson's disease. It also used a linear multiple regression (forward stepwise method) to identify the contribution of neuromuscular outcomes to previously published improvements in the timed-up-and-go test and the Unified Parkinson's Disease Rating Scale, motor subscale score. METHODS Thirty-nine patients with moderate to severe Parkinson's disease were randomly assigned to three groups: control (C), RT, and RTI. RT and RTI groups performed resistance exercises twice a week for 12 wk, and only the RTI group used unstable devices to perform resistance exercises. The following neuromuscular outcomes were assessed: quadriceps muscle cross-sectional area, root mean square and mean spike frequency of electromyographic signal, peak torque, rate of torque development, and half relaxation time of the knee extensors and plantarflexors during maximum ballistic voluntary isometric contractions. TTV was calculated for lower limb exercises. RESULTS From pre- to posttraining, RTI improved all of the neuromuscular outcomes (P < 0.05) except half relaxation time of the knee extensors (P = 0.068), despite the lower TTV than RT (P < 0.05). RTI was more effective than RT in increasing the root mean square values of vastus medialis, mean spike frequency of gastrocnemius medialis, and rate of torque development of plantarflexors (P < 0.05). Stepwise regression identified the changes in mean spike frequency of gastrocnemius medialis as the best predictor of improvements in timed-up-and-go test (R = 0.58, P = 0.002) and on-medication Unified Parkinson's Disease Rating Scale, motor subscale scores (R = 0.40, P = 0.020). CONCLUSION RTI optimizes neuromuscular adaptations, which partially explains mobility and motor sign improvements in patients with Parkinson's disease.
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Affiliation(s)
- Carla Silva-Batista
- 1Laboratory of Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo, São Paulo, BRAZIL; 2Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL; 3Department of Neurological Sciences, Rush University Medical Center, Chicago, IL; 4Department of Sport Sciences, State University of Campinas, Campinas, BRAZIL; 5Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, BRAZIL; and 6Center for Psychobiology and Exercise Studies, Federal University of São Paulo, São Paulo, BRAZIL
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Silva-Batista C, Corcos DM, Roschel H, Kanegusuku H, Gobbi LTB, Piemonte MEP, Mattos ECT, DE Mello MT, Forjaz CLM, Tricoli V, Ugrinowitsch C. Resistance Training with Instability for Patients with Parkinson's Disease. Med Sci Sports Exerc 2017; 48:1678-87. [PMID: 27054681 DOI: 10.1249/mss.0000000000000945] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE This randomized controlled trial compared the effects of resistance training (RT) and RT with instability (RTI) on the timed up and go test (TUG), on-medication Unified Parkinson's Disease Rating Scale part III motor subscale score (UPDRS-III), Montreal Cognitive Assessment (MoCA) score, Parkinson's Disease Questionnaire (PDQ-39) score, and muscle strength in the leg press exercise (one-repetition maximum) of patients with Parkinson's disease (PD). METHODS Thirty-nine patients with moderate to severe PD were randomly assigned to a nonexercising control group (C), RT group, and RTI group. The RT and RTI groups performed progressive RT twice a week for 12 wk. However, only the RTI group used high motor complexity exercises (i.e., progressive RT with unstable devices), for example, half squat exercise on the BOSU® device. The primary outcome was mobility (TUG). The secondary outcomes were on-medication motor signs (UPDRS-III), cognitive impairment (MoCA), quality of life (PDQ-39), and muscle strength (one-repetition maximum). RESULTS There were no differences between RTI and RT groups for any of the outcomes at posttraining (P > 0.05). However, there were differences between RTI and C groups in the TUG, MoCA, and muscle strength values at posttraining (P < 0.05). Only the RTI group improved the TUG (-1.9 s), UPDRS-III score (-4.5 score), MoCA score (6.0 score), and PDQ-39 score (-5.2 score) from pre- to posttraining (P < 0.001). Muscle strength improved for both training groups (P < 0.001). No adverse events were reported during the trial. CONCLUSIONS Both training protocols improved muscle strength, but only RTI improved the mobility, motor signs, cognitive impairment, and quality of life, likely because of the usage of high motor complexity exercises. Thus, RTI may be recommended as an innovative adjunct therapeutic intervention for patients with PD.
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Affiliation(s)
- Carla Silva-Batista
- 1Laboratory of Adaptations to Strength Training, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, BRAZIL; 2Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, IL; 3Department of Neurological Sciences, Rush University Medical Center, Chicago, IL; 4Exercise Hemodynamic Laboratory, School of Physical Education and Sport, University of São Paulo at São Paulo, São Paulo, BRAZIL; 5Posture and Gait Studies Lab, São Paulo State University at Rio Claro, Rio Claro, BRAZIL; 6Faculty of Medical Science, University of São Paulo, São Paulo, BRAZIL; 7Department of Psychobiology, Center for Psychobiology and Exercise Studies, University Federal de São Paulo, São Paulo, BRAZIL
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Cancela JM, Mollinedo Cardalda I, Ayán C, de Oliveira IM. Feasibility and Efficacy of Mat Pilates on People with Mild-to-Moderate Parkinson's Disease: A Preliminary Study. Rejuvenation Res 2017; 21:109-116. [PMID: 28712331 DOI: 10.1089/rej.2017.1969] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
This pilot study aimed at assessing the feasibility and efficacy of a Mat Pilates program in people with mild-to-moderate Parkinson's disease (PD). The participants carried out a Mat Pilates program twice a week for 12 weeks. The Senior Fitness Test battery and the 39-item PD Questionnaire were used to assess the effects of the program on the participants' fitness level and quality of life. A total of 16 patients with mild-to-moderate PD volunteered for and finished the study. The Mat Pilates program proved to be feasible. Adherence to the program was excellent, and no adverse effects were observed. The program had a positive effect on the participants' fitness levels, except for shoulder range of motion and dynamic balance, and on their quality of life. Assessments at follow-up indicated a regression in the improvements obtained by the end of the intervention, even though the sample still showed higher levels of fitness and quality of life than those tested at baseline. Mat Pilates is feasible and may be a beneficial rehabilitation strategy to improve fitness and quality of life in people with mild-to-moderate PD. Future randomized controlled trials might determine the extent of such benefits.
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Affiliation(s)
- Jose Maria Cancela
- 1 Department of Special Didactics, University of Vigo , Pontevedra, Spain .,2 HealthyFit Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur) , Sergas-UVIGO, Spain
| | - Irimia Mollinedo Cardalda
- 1 Department of Special Didactics, University of Vigo , Pontevedra, Spain .,3 Galician Government pre-doctoral fellow
| | - Carlos Ayán
- 1 Department of Special Didactics, University of Vigo , Pontevedra, Spain .,2 HealthyFit Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur) , Sergas-UVIGO, Spain
| | - Iris Machado de Oliveira
- 2 HealthyFit Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur) , Sergas-UVIGO, Spain .,4 Department of Functional Biology and Health Sciences, University of Vigo , Pontevedra, Spain
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Physiotherapy in Parkinson's Disease: Building ParkinsonNet in Czechia. PARKINSONS DISEASE 2017; 2017:8921932. [PMID: 28611932 PMCID: PMC5458379 DOI: 10.1155/2017/8921932] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 04/19/2017] [Indexed: 11/28/2022]
Abstract
Objective We conducted a questionnaire survey to investigate the availability and quality of physiotherapy (PT) for Parkinson's disease (PD). Background Despite evidence about the benefits of PT, there is no data regarding its use in Czechia. Methods Questionnaires were sent to 368 PD patients seen in a single movement disorders centre within two years (inclusion criteria: idiopathic PD, Hoehn and Yahr stage <5, and residence in Prague) and to 211 physical therapists (PTs) registered in Prague. The patient questionnaire evaluated limitations in 6 core areas and in activities of daily living and inquired about experience with PT. The PTs questionnaire evaluated knowledge about PD, number of PD patients treated yearly, and details of therapy. Results Questionnaires were returned by 248 patients and 157 PTs. PT was prescribed to 70/248 patients. The effects were satisfactory in 79% and lasted >3 months in 60/64. About half of the PTs have no experience with PD patients, 26% reported <3, and 5% see >10 yearly. The most widely used techniques were neurodevelopmental treatments. Conclusion Present PD healthcare model in Czechia is suboptimal (low PT prescription, non-evidence-based PT). Implementation of European PT Guidelines for PD and the introduction of an efficient model of care are needed.
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Collett J, Franssen M, Meaney A, Wade D, Izadi H, Tims M, Winward C, Bogdanovic M, Farmer A, Dawes H. Phase II randomised controlled trial of a 6-month self-managed community exercise programme for people with Parkinson's disease. J Neurol Neurosurg Psychiatry 2017; 88:204-211. [PMID: 27837101 DOI: 10.1136/jnnp-2016-314508] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/26/2016] [Accepted: 10/21/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Evidence for longer term exercise delivery for people with Parkinson's disease (PwP) is deficient. AIM Evaluate safety and adherence to a minimally supported community exercise intervention and estimate effect sizes (ES). METHODS 2-arm parallel phase II randomised controlled trial with blind assessment. PwP able to walk ≥100 m and with no contraindication to exercise were recruited from the Thames valley, UK, and randomised (1:1) to intervention (exercise) or control (handwriting) groups, via a concealed computer-generated list. Groups received a 6-month, twice weekly programme. Exercise was undertaken in community facilities (30 min aerobic and 30 min resistance) and handwriting at home, both were delivered through workbooks with monthly support visits. Primary outcome was a 2 min walk, with motor symptoms (Movement Disorder Society Unified Parkinson's Disease Rating Scale, MDS-UPDRS III), fitness, health and well-being measured. RESULTS Between December 2011 and August 2013, n=53 (n=54 analysed) were allocated to exercise and n=52 (n=51 analysed) to handwriting. N=37 adhered to the exercise, most attending ≥1 session/week. Aerobic exercise was performed in 99% of attended sessions and resistance in 95%. Attrition and adverse events (AEs) were similar between groups, no serious AEs (n=2 exercise, n=3 handwriting) were related, exercise group-related AEs (n=2) did not discontinue intervention. Largest effects were for motor symptoms (2 min walk ES=0.20 (95% CI -0.44 to 0.45) and MDS-UPDRS III ES=-0.30 (95% CI 0.07 to 0.54)) in favour of exercise over the 12-month follow-up period. Some small effects were observed in fitness and well-being measures (ES>0.1). CONCLUSIONS PwP exercised safely and the possible long-term benefits observed support a substantive evaluation of this community programme. TRIAL REGISTRATION NUMBER NCT01439022.
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Affiliation(s)
- Johnny Collett
- Movement Science Group, OxINAHR, Oxford Brookes University, Oxford, UK
| | - Marloes Franssen
- Movement Science Group, OxINAHR, Oxford Brookes University, Oxford, UK.,Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Andy Meaney
- Movement Science Group, OxINAHR, Oxford Brookes University, Oxford, UK
| | - Derick Wade
- Movement Science Group, OxINAHR, Oxford Brookes University, Oxford, UK.,Oxford Centre for Enablement, Oxford University Hospitals, Oxford, UK
| | - Hooshang Izadi
- Movement Science Group, OxINAHR, Oxford Brookes University, Oxford, UK.,Department of Mechanical Engineering and Mathematical Sciences, Oxford Brookes University, Oxford, UK
| | - Martin Tims
- Movement Science Group, OxINAHR, Oxford Brookes University, Oxford, UK
| | - Charlotte Winward
- Movement Science Group, OxINAHR, Oxford Brookes University, Oxford, UK.,Department of Infectious Disease, Churchill Hospital, Oxford University Hospitals, Oxford, UK
| | | | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Helen Dawes
- Movement Science Group, OxINAHR, Oxford Brookes University, Oxford, UK.,Department of Clinical Neurology, University of Oxford, Oxford, UK
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Radder DL, Sturkenboom IH, van Nimwegen M, Keus SH, Bloem BR, de Vries NM. Physical therapy and occupational therapy in Parkinson's disease. Int J Neurosci 2017; 127:930-943. [DOI: 10.1080/00207454.2016.1275617] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Danique L.M. Radder
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ingrid H. Sturkenboom
- Department of Rehabilitation-Occupational Therapy, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marlies van Nimwegen
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Samyra H. Keus
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nienke M. de Vries
- Department of Neurology, Radboud University Medical Center, Nijmegen, the Netherlands
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Ni M, Signorile JF, Balachandran A, Potiaumpai M. Power training induced change in bradykinesia and muscle power in Parkinson's disease. Parkinsonism Relat Disord 2016; 23:37-44. [DOI: 10.1016/j.parkreldis.2015.11.028] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/06/2015] [Accepted: 11/23/2015] [Indexed: 11/24/2022]
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