The effects of mountain exercise in Parkinsonian persons - a preliminary study

Acute and cumulative effects of hypoxia exposure in people with Parkinson's disease: A scoping review and evidence map

Hypoxia exposure may promote neuroprotection for people with Parkinson's disease (PwPD). However, to implement hypoxia in practical settings and direct future research, it is necessary to organize the current knowledge about hypoxia responses/effects in PwPD. Thus, the present scoping review elucidates the evidence about hypoxia exposure applied to PwPD. Following the PRISMA Extension for Scoping Reviews, papers were searched in PubMed/NCBI, Web of Science, and Scopus (descriptors: Parkinson and hypoxia, mountain, or altitude). We included original articles published in English until August 12, 2023. Eight studies enrolled participants with early to moderate stages of disease. Acute responses demonstrated that PwPD exposed to normobaric hypoxia presented lower hypoxia ventilatory responses (HVR), perceptions of dyspnea, and sympathetic activations. Cumulative exposure to hypobaric hypoxia (living high; 7 days; altitude not reported) induced positive effects on motor symptoms (hypokinesia) and perceptions of PwPD (quality of life and living with illness). Normobaric hypoxia (isocapnic rebreathe, 14 days, three times/day of 5-7 min at 8-10 % of O2) improved HVR. The included studies reported no harmful effects. Although these results demonstrate the effectiveness and safety of hypoxia exposure applied to PwPD, we also discuss the methodological limitations of the selected experimental design (no randomized controlled trials), the characterization of the hypoxia doses, and the range of symptoms investigated. Thus, despite the safety of both normobaric hypoxia and hypobaric hypoxia for early to moderate levels of disease, the current literature is still incipient, limiting the use of hypoxia exposure in practical settings.

Recommendations for traveling to altitude with neurological disorders

BACKGROUND

Several neurological conditions might worsen with the exposure to high altitude (HA). The aim of this review was to summarize the available knowledge on the neurological HA illnesses and the risk for people with neurological disorders to attend HA locations.

METHODS

A search of literature was conducted for several neurological disorders in PubMed and other databases since 1970. The neurological conditions searched were migraine, different cerebrovascular disease, intracranial space occupying mass, multiple sclerosis, peripheral neuropathies, neuromuscular disorders, epileptic seizures, delirium, dementia, and Parkinson's disease (PD).

RESULTS

Attempts were made to classify the risk posed by each condition and to provide recommendations regarding medical evaluation and advice for or against traveling to altitude. Individual cases should be advised after careful examination and risk evaluation performed either in an outpatient mountain medicine service or by a physician with knowledge of HA risks. Preliminary diagnostic methods and anticipation of neurological complications are needed.

CONCLUSIONS

Our recommendations suggest absolute contraindications to HA exposure for the following neurological conditions: (1) Unstable conditions-such as recent strokes, (2) Diabetic neuropathy, (3) Transient ischemic attack in the last month, (4) Brain tumors, and 5. Neuromuscular disorders with a decrease of forced vital capacity >60%. We consider the following relative contraindications where decision has to be made case by case: (1) Epilepsy based on recurrence of seizure and stabilization with the therapy, (2) PD (± obstructive sleep apnea syndrome-OSAS), (3) Mild Cognitive Impairment (± OSAS), and (4) Patent foramen ovale and migraine have to be considered risk factors for acute mountain sickness.

The effects of arm crank training on aerobic capacity, physical performance, quality of life, and health-related disability in patients with Parkinson's disease

BACKGROUND

Aerobic exercise training contributes to improvement of cardiopulmonary capacity, mobility, neurological function, and quality of life.

AIMS

To investigate the effects of arm crank ergometer training on aerobic capacity, quality of life, and Parkinson's disease (PD)-related disability METHODS: Seventeen patients with PD were recruited to study. Assessments were performed at baseline and at the end of an 8-week arm crank ergometer (ACE) training program (3 days/week; 1 h per session, 50-70% VO_2peak) with patients acting as their own control. Outcome measures included aerobic capacity assessment, 6-min walk test (6MWT), timed up and go test (TUG), Unified Parkinson's Disease Rating Scale (UPDRS), Parkinson's Disease Questionnaire-39 (PDQ-39), Beck Depression Index (BDI), the Falls Efficacy Scale (FES), and Montreal Cognitive Assessment (MoCA).

RESULTS

At the end of the study, an increase of 30.49% in aerobic capacity was observed. Statistically significant improvements were found for the 6MWT (p = 0.001), TUG test (p = 0.001), UPDRS total score (p = 0.002), quality of life assessed with PDQ-39 (p = 0.006), BDI (p = 0.001), and FES scores (p = 0.002) after an 8-week ACE training. No significant effect on MoCA was found (p = 0.264).

CONCLUSION

An 8-week ACE training led to significant improvement in aerobic capacity, physical performance, and PD-related disabilities.

Auditing the Physical Activity and Parkinson Disease Literature Using the Behavioral Epidemiologic Framework

Motor and nonmotor symptoms associated with Parkinson disease place individuals at greater risk of sedentary behaviors and comorbidities. Physical activity is one modifiable means of improving health and reducing the risk of morbidity. We applied a behavioral framework to classify existing research on physical activity and Parkinson disease to describe the current evolution and inform knowledge gaps in this area. Research placed in phase 1 establishes links between physical activity and health-related outcomes; phase 2 develops approaches to quantify physical activity behavior; phase 3 identifies factors associated with implementation of physical activity behaviors; phase 4 assesses the effectiveness of interventions to promote activity; and phase 5 disseminates evidence-based recommendations. Peer-reviewed literature was identified by searching PubMed, Google Scholar, and EBSCO-host. We initially identified 287 potential articles. After further review, we excluded 109 articles, leaving 178 included articles. Of these, 75.84% were categorized into phase 1 (n = 135), 10.11% in phase 2 (n = 18), 9.55% into phase 3 (n = 17), 3.37% into phase 4 (n = 6), and 1.12% into phase 5 (n = 2). By applying the behavioral framework to the physical activity literature for people with Parkinson disease, we suggest this area of research is nascent with more than 75% of the literature in phase 1.

LEVEL OF EVIDENCE

III.

Effects of a Nordic Walking program on motor and non-motor symptoms, functional performance and body composition in patients with Parkinson's disease

BACKGROUND

Several studies have clearly shown that physical exercise can reduce the progression of motor symptoms in Parkinson's Disease (PD). However, little is known about the effects of a Nordic Walking (NW) program in PD patients.

OBJECTIVE

To determine the effects of a NW program on motor and non-motor symptoms, functional performances and body composition in PD patients.

METHODS

Twenty PD patients (16M, 4F, 67.3±7.8 years) were enrolled and randomly assigned to NW group (NWg, n = 10) and Control group (Cg, n = 10). The training consisted in 2 sessions per week for 12 weeks. Training effects were assessed by functional and instrumental tests and motor and non-motor symptoms were assessed by UPDRS-III, Hoehn and Yahr scale, PD Fatigue Scale, Beck Depression Inventory-II, Starkstein Apathy Scale, and Non-Motor Symptoms Scale.

RESULTS

Significant changes in resting HR, in walked distance (p <  0.05), and in lower limbs muscles strength (p <  0.005) were observed in NWg. Both balance abilities and safety with mobility were increased (p <  0.005). Significant variations in some circumferences and body composition were registered. Finally, a significant improvement in motor and non-motor symptoms was detected: UPDRS-III, HY scale, PFS-16, BDI-II, SAS, NMSS.

CONCLUSIONS

A tailored exercise program including NW proved to be an effective way to improve daily activities and both motor and non-motor symptoms in PD patients.

Comparison of exercise strategies for motor symptom improvement in Parkinson’s disease

SUMMARY Aims: To evaluate the effectiveness of four exercise interventions on motor symptoms of Parkinson’s disease (PD). Materials and methods: This was a quasi-experimental trial with 89 participants assigned to one of four exercise programs (aquatic, aerobic, strength and sensory attention-focused exercise) or a control group. All groups were assessed by a blinded evaluator with the Unified Parkinson’s Disease Rating Scale (UPDRS III) motor section before exercises began (pre-test), immediately following exercise (post-test) and a subgroup was followed for a 6-week nonexercise washout period (washout). Results: Only sensory attention-focused exercise resulted in significant symptomatic improvement relative to nonexercising control participants. The sensory (6.7 points) and strength training (5.5 points) groups also had significant UPDRS III reductions from pre- to post-exercise. These benefits were not maintained after the washout period. Conclusion: Of the exercise modalities tested, sensory attention-focused exercise and strength training were the most effective strategies for individuals with PD. Future randomized trials are needed to confirm these results and compare other promising strategies aimed at specific pathophysiological deficits of PD.

Rehabilitation interventions in Parkinson disease

OBJECTIVE

This self-directed learning module provides an evidence-based update of exercise-based rehabilitation interventions to treat Parkinson disease (PD). It is part of the study guide on stroke and neurodegenerative disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This focused review emphasizes treatment of locomotion deficits, upper limb motor control deficits, and hypokinetic dysarthria. New dopaminergic agents and deep brain stimulation are facilitating longer periods of functional stability for patients with PD. Adjunctive exercise-based treatments can therefore be applied over longer periods of time to optimize function before inevitable decline from this neurodegenerative disease. As function deteriorates in patients with PD, the role of caregivers becomes more critical, thus training caregivers is of paramount importance to help maintain a safe environment and limit caregiver anxiety and depression. The overall goal of this article is to enhance the learner's existing practice techniques used to treat PD through exercise-based intervention methods.

Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme on quality of life in patients with Parkinson’s disease

Objectives: To compare the effects of a physiotherapist-supervised exercise programme in an exercise unit and self-supervised home exercise programme on quality of life in patients with Parkinson’s disease.

Design: Assessor-blinded, quasi-randomized trial (alternate allocation).

Setting: An outpatient exercise unit; home settings.

Participants: Thirty patients with idiopathic Parkinson’s disease, Hoehn & Yahr I—III, stable medication use.

Interventions: Patients were included in the physiotherapist-supervised or home group. The exercise programme was performed for 10 weeks, three times/week either under the supervision of a physiotherapist or at home without supervision.

Main outcome measures: Parkinson’s Disease Quality of Life Questionnaire (PDQLQ), Nottingham Health Profile (NHP), Unified Parkinson’s Disease Rating Scale (UPDRS), Beck Depression Inventory (BDI).

Results: Patients in the supervised physiotherapy group improved more than the home exercise group in Parkinson’s Disease Quality of Life Questionnaire (total score, Parkinson’s symptoms, emotional function), Nottingham Health Profile total, Unified Parkinson’s Disease Rating Scale (all domains) and Beck Depression Inventory scores.

Conclusions: The exercise programme under physiotherapist supervision was found to be more effective at improving activities of daily living, motor, mental, emotional functions and general health quality in patients with Parkinson’s disease compared with a self-supervised home programme.

Voluntary exercise and tail shock have differential effects on amphetamine-induced dopaminergic toxicity in adult BALB/c mice

Exercise exerts neuroprotective effects and facilitates neural recovery in animal models of Parkinson's disease. In the present studies, effects of exercise on amphetamine-induced dopaminergic toxicity were assessed in mice housed individually either with or without access to run wheels. Mice in run wheel cages ran approximately 20 000 revolutions/day (over 10 km/day). Some mice received amphetamine (18.5 mg/kg x 4 injections) whereas controls received saline. Amphetamine caused a 90% dopamine depletion in mice housed either with or without run wheels. A precipitous drop was seen in run wheel activity following amphetamine, lasting at least 7 days. A significant decrease in food intake, water intake and body weight also occurred. The opportunity to exercise did not facilitate behavioral or neurochemical recovery at 1, 2 or 3 days, or 2 weeks after injections. Therefore, shock stress, a component of some forced exercise studies, was evaluated to determine whether stress without exercise provided neuroprotection against amphetamine. Results indicate that shock stress exerted neuroprotective effects, reducing the amphetamine-induced dopamine depletion. It is concluded that voluntary running does not afford either behavioral or neuroprotection nor facilitate recovery from amphetamine-induced dopaminergic toxicity; rather, elevated glucocorticoid levels following shock stress were associated with a reduction in the dopamine depletion.

The clinical approach to gait disturbances in Parkinson's disease; maintaining independent mobility

Gait is affected in all stages of Parkinson's disease (PD) and is one of the hallmarks for disease progression. The fear of getting into the wheel chair is one of the first thoughts many patients ask about when the diagnosis of PD is given. At the early stages of the disease gait disturbances are present and can be measured but in most patients it does not cause significant functional disturbances. In contrast, as the disease progress, gait disturbances and postural control abnormalities are becoming major causes for lost of mobility and falls. These unfortunate consequences should be forecasted at the early stages of the disease and a preventive approach should be taken. Treatment of gait disturbances at the early stages of the disease is mainly to encourage patients to exercise and walk daily and by drugs in those with disabling symptoms. At the advanced stages, treatment should be aggressive in order to keep the patient walking safely. Drugs, physiotherapy and functional neurosurgery should be used wisely for best outcomes and least side effects. When time comes and the risk of falls is very significant, walking aids should be suggested and if no other option is left, wheel chair is a very reasonable option to maintain mobility out of home, preserving quality of life and avoiding falls with all it severe consequences.

Music improves dopaminergic neurotransmission: demonstration based on the effect of music on blood pressure regulation

The mechanism by which music modifies brain function is not clear. Clinical findings indicate that music reduces blood pressure in various patients. We investigated the effect of music on blood pressure in spontaneously hypertensive rats (SHR). Previous studies indicated that calcium increases brain dopamine (DA) synthesis through a calmodulin (CaM)-dependent system. Increased DA levels reduce blood pressure in SHR. In this study, we examined the effects of music on this pathway. Systolic blood pressure in SHR was reduced by exposure to Mozart's music (K.205), and the effect vanished when this pathway was inhibited. Exposure to music also significantly increased serum calcium levels and neostriatal DA levels. These results suggest that music leads to increased calcium/CaM-dependent DA synthesis in the brain, thus causing a reduction in blood pressure. Music might regulate and/or affect various brain functions through dopaminergic neurotransmission, and might therefore be effective for rectification of symptoms in various diseases that involve DA dysfunction.

Regulation of brain function by exercise

The effect of excercise on brain function was investigated through animal experiments. Exercise leads to increased serum calcium levels, and the calcium is transported to the brain. This in turn enhances brain dopamine synthesis through a calmodulin-dependent system, and increased dopamine levels regulate various brain functions. There are abnormally low levels of dopamine in the neostriatum and nucleus accumbens of epileptic mice (El mice strain) and spontaneously hypertensive rats (SHR). The low dopamine levels in those animals were improved following intracerebroventricular administration of calcium chloride. Dopamine levels and blood pressure in SHR were also normalized by exercise. In epileptic El mice, convulsions normalized dopamine levels and physiologic function. These findings suggest that exercise or convulsions affect brain function through calcium/calmodulin-dependent dopamine synthesis. This leads to the possibility that some symptoms of Parkinson's disease or senile dementia might be improved by exercise.