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Banks HC, Lemos T, Oliveira LAS, Ferreira AS. Short-term effects of Pilates-based exercise on upper limb strength and function in people with Parkinson's disease. J Bodyw Mov Ther 2024; 39:237-242. [PMID: 38876632 DOI: 10.1016/j.jbmt.2024.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 11/27/2023] [Accepted: 02/25/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND People with Parkinson's disease (PD) have impaired upper limb motor coordination, limiting the execution of activities of daily living. This study investigated the feasibility and safety of a short-term Pilates-based exercise program in the treatment of upper limb motor coordination for people with PD. METHODS Fifteen patients - n (%) 4 women/11 men (27/73), median [interquartile range] age 66 [9] years - participated in this quasi-experimental (before-and-after) clinical trial. Patients underwent a 6-week (30 min/day, 3 days/week) Pilates exercise program using Reformer, Cadillac, Chair, and Barrel equipment. Feasibility was evaluated by adherence to the program and the ability to perform the exercises including progressions on difficulty. Safety was evaluated based on self-reported adverse events. Clinical and functional trends before and after the intervention were also computed regarding handgrip strength (HGS), fine motor coordination (9 Hole Peg Test; 9HPT), bradykinesia (Movement Disorder Society - Unified Parkinson's disease Rating Scale; MDS-UPDRS), and upper limb functionality (Test D'évaluation des Membres Supérieurs des Personnes Âgées, TEMPA). RESULTS Of the 18 Pilates sessions, exercise adherence was 100%. The only adverse event observed was mild muscle pain. Pre-post differences were observed only for body bradykinesia and hypokinesia (1.0 [0.0] vs. 0.0 [1.0] s, adjusted p = 0.048). CONCLUSIONS A short-term Pilates-based exercise program in the treatment of upper limb muscle strength, manual dexterity, bradykinesia, and functionality is feasible and safe for people with PD. Changes in upper limb bradykinesia encourage randomized clinical trials.
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Affiliation(s)
- Helen Cristian Banks
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil
| | - Thiago Lemos
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil.
| | - Laura Alice Santos Oliveira
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil.
| | - Arthur Sá Ferreira
- Postgraduate Program of Rehabilitation Sciences, Centro Universitário Augusto Motta/UNISUAM, Rio de Janeiro, RJ, Brazil.
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Singer T, Fahey P, Liu KPY. Effectiveness of Motor Imagery in the Rehabilitation of People With Parkinson's Disease: A Systematic Review and Meta-Analysis. Neurorehabil Neural Repair 2024; 38:460-475. [PMID: 38686907 DOI: 10.1177/15459683241246493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
BACKGROUND AND OBJECTIVE With more research completed using Motor imagery (MI) in people with Parkinson's disease, this study gathered and synthesized evidence on the use of MI for Parkinson's disease in improving rehabilitation outcomes. METHODS Medical Literature Analysis and Retrieval System Online, Embase, Web of Science, The Cochrane Library, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Scopus were searched from inception to May 2023. We included randomized controlled trials that examine the effects of MI on individuals with Parkinson's disease. Two reviewers selected articles and extracted study characteristics and results independently. The Physiotherapy Evidence Database scale was used to assess the methodological quality. Mean differences and 95% confidence intervals were calculated. Heterogeneity was assessed using the I2 statistic. RESULTS Thirteen articles with 12 studies were included, involving 320 individuals with Parkinson's disease, with moderate to high methodological quality (mean = 6.62/10). Compared with the control group, 3 articles reported significant greater improvements in cognitive function, 7 reported significant greater improvement in motor function, 1 article reported significant greater improvement in quality of life, and 1 reported significant greater confidence in daily task performance. No statistically significant effects were found in the meta-analyses. Conclusion. Results of individual articles were in favor of the MI intervention. No statistically significant results were found in the meta-analyses. This might be due to the small number of studies and the heterogeneity of interventions and outcome measures used. MI may be effective in improving some rehabilitation outcomes, but meta-analytic evidence is lacking. More research with larger sample size and less heterogeneous samples, interventions, and outcome measures, is warranted. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number CRD42021230556.
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Affiliation(s)
- Tabitha Singer
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Brain Injury Rehabilitation Unit, Liverpool Hospital, South Western Sydney Local Health District, NSW, Australia
| | - Paul Fahey
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Karen P Y Liu
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
- South Western Sydney Local Health District, NSW, Australia
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Miri A, Araújo H, Gil A, de Oliveira M, Volpe R, Angelo E, Mahmoud Smaili S. Analysis of handgrip strength, pulling force using the upper limbs, and ground reaction forces in the task of boarding a bus between healthy elderly individuals and those with Parkinson's disease. Physiother Theory Pract 2024; 40:909-918. [PMID: 36377318 DOI: 10.1080/09593985.2022.2144781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 10/27/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Elderly individuals with neurodegenerative diseases, such as Parkinson's disease (PD), may experience difficulties when performing functional tasks. OBJECTIVE To analyze the handgrip strength, pulling force, and ground reaction forces (GRF) of individuals with and without PD when boarding a bus while performing both simple (ST) and dual tasks (DT). METHOD This case-control study addressed 31 individuals with PD (GPD) and 30 healthy individuals (GHI). Assessments were performed in ST and DT situations using a bus model (prototype). Handgrip strength and pulling force were measured in both upper limbs using a dynamometer, and GRF was measured using a force platform. The GPD's and GHI's performances were compared in both ST and DT, and the individuals were classified as fallers according to the Falls Efficacy Scale. RESULTS In the inter-group comparison, the GPD presented significantly lower maximum force using their right hand, in handgrip strength (30.43 vs. 36.62, P = .022), and pulling force (10.77 vs 12.81, P = .037). The left hand's pulling force proved to be the most demanding for the GPD, during ST (6.35 vs. 4.76, P = .006) and DT (6.32 vs 4.74, P = .008). The GPD also took longer to perform ST (6.14 vs. 4.67, P < .001) and DT (6.08 vs. 4.81, P = .002). Additionally, the GPD was more afraid of falling compared to the GHI (34.74 vs. 24.77, P < .001). CONCLUSION Boarding a bus is a complex task for individuals with PD because they present lower maximum strength in the upper limbs and more significant functional expenditure than their healthy counterparts.
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Affiliation(s)
- Andressa Miri
- Post-Graduation Program in Rehabilitation Sciences, State University of Londrina (UEL), Avenida Robert Koch, n 60, Vila Operária, Londrina, Brazil
| | - Hayslenne Araújo
- Post-Graduation Program in Rehabilitation Sciences, State University of Londrina (UEL), Avenida Robert Koch, n 60, Vila Operária, Londrina, Brazil
| | - André Gil
- Post-Graduation Program in Rehabilitation Sciences, Northern Paraná University (UNOPAR), Londrina, Brazil
| | - Marcio de Oliveira
- Post-Graduation Program in Rehabilitation Sciences, Northern Paraná University (UNOPAR), Londrina, Brazil
| | - Renata Volpe
- Post-Graduation Program in Rehabilitation Sciences, State University of Londrina (UEL), Avenida Robert Koch, n 60, Vila Operária, Londrina, Brazil
| | - Edylaine Angelo
- Undergraduate Student at the Physiotherapy Program, State University of Londrina (UEL), Londrina, Brazil
| | - Suhaila Mahmoud Smaili
- Post-Graduation Program in Rehabilitation Sciences, Physiotherapy Department, State University of Londrina (UEL), Londrina, Brazil
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Magris R, Nardello F, Bombieri F, Monte A, Zamparo P. Characterization of the vastus lateralis torque-length, and knee extensors torque-velocity and power-velocity relationships in people with Parkinson's disease. Front Sports Act Living 2024; 6:1380864. [PMID: 38725475 PMCID: PMC11079174 DOI: 10.3389/fspor.2024.1380864] [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: 02/02/2024] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Introduction Parkinson's disease (PD) is a prevalent neurodegenerative condition observed primarily in the elderly population that gives rise to motor and non-motor symptoms, one of which is muscle weakness. The aim of this study was to characterize the vastus lateralis torque-fascicle length (T-L) and the knee extensors torque-angular velocity (T-V) and power-angular velocity (P-V) relationships in PD patients and to investigate the influence of muscle geometry on muscle mechanics. Methods Participants (11 PD: patients, 9 CR: age matched healthy controls; 10 CY: young healthy controls) performed: (i) isometric contractions (e.g., MVC) to obtain the torque-angle and T-L relationships; (ii) isokinetic (e.g., iso-velocity) contractions to obtain the T-V and P-V relationships. During the experiments, the architecture of vastus lateralis (pennation angle, fascicle length, muscle thickness) was also determined by using an ultrasound apparatus. Results Significant differences were observed between PD patients and physically matched control groups (CR and CY) in terms of maximum isometric force (calculated as the apex of the T-L curve) and maximum mechanical power (apex of the P-V curve), but not in maximum shortening velocity. Among the mechanical variables investigated, mechanical power was able to identify differences between the less and the more affected side in PD patients, suggesting that this parameter could be useful for clinical evaluation in this population. Conclusions The observed results cannot be explained by differences in muscle geometry at rest (similar in the three cohorts), but rather by the muscle capacity to change in shape during contraction, that is impaired in PD patients.
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Affiliation(s)
- Riccardo Magris
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
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Mey R, Calatayud J, Casaña J, Núñez-Cortés R, Suso-Martí L, Andersen LL, López-Gil JF, López-Bueno R. Is Handgrip Strength Associated With Parkinson's Disease? Longitudinal Study of 71 702 Older Adults. Neurorehabil Neural Repair 2023; 37:727-733. [PMID: 38116602 DOI: 10.1177/15459683231207359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
BACKGROUND To date, no study has longitudinally assessed the dose-response association between handgrip strength and incidence of Parkinson's Disease (PD). OBJECTIVES to investigate the longitudinal association between handgrip strength and the development of PD within a representative European population of older adults. METHODS Individuals aged 50 years and older from 27 European countries and Israel participated. We retrieved data from the Survey of Health, Ageing and Retirement in Europe waves 1, 2, 4, 5, 6, 7, and 8. Handgrip strength was measured using a hand dynamometer and participants reported whether they had a medical PD diagnosis. Time-varying exposure and covariates were modeled using both Cox regression and restricted cubic splines. RESULTS A total of 71 702 participants (mean age 65.2 years) were followed over a median period of 5.0 years. Among them, 314 participants developed PD. In the fully adjusted model, we observed a higher risk (hazard ratio [HR]: 2.50; 95% CI:1.92-3.32) of PD for participants with lower handgrip strength (third 1) and a lower risk of PD for participants in the second third (HR: 1.41; 95% CI: 1.06-1.87). In dose-response analyses, men showed lower risk of PD from 27 kg (HR:0.94; 95% CI: 0.91-0.97) to 59 kg (HR:0.10; 95% CI: 0.04-0.22), whereas women showed significant reductions from 24 kg (HR:0.68; 95% CI: 0.46-0.99) to 38 kg (HR:0.44; 95% CI: 0.22-0.88). CONCLUSIONS Handgrip strength ought to be incorporated as one of the measures in the prognostic toolbox for the screening of older adults who are possibly at risk of developing PD.
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Affiliation(s)
- Rochelle Mey
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Rodrigo Núñez-Cortés
- Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Lars Louis Andersen
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | - Rubén López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
- National Research Centre for the Working Environment, Copenhagen, Denmark
- Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain
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Tharwat EK, Abdelaty AO, Abdelrahman AI, Elsaeed H, Elgohary A, El-Feky AS, Ebrahim YM, Sakraan A, Ismail HA, Khadrawy YA, Aboul Ezz HS, Noor NA, Fahmy HM, Mohammed HS, Mohammed FF, Radwan NM, Ahmed NA. Evaluation of the therapeutic potential of cerebrolysin and/or lithium in the male Wistar rat model of Parkinson's disease induced by reserpine. Metab Brain Dis 2023; 38:1513-1529. [PMID: 36847968 DOI: 10.1007/s11011-023-01189-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 02/13/2023] [Indexed: 03/01/2023]
Abstract
Parkinson's disease (PD) is the second most prevalent neurodegenerative disease worldwide and represents a challenge for clinicians. The present study aims to investigate the effects of cerebrolysin and/or lithium on the behavioral, neurochemical and histopathological alterations induced by reserpine as a model of PD. The rats were divided into control and reserpine-induced PD model groups. The model animals were further divided into four subgroups: rat PD model, rat PD model treated with cerebrolysin, rat PD model treated with lithium and rat PD model treated with a combination of cerebrolysin and lithium. Treatment with cerebrolysin and/or lithium ameliorated most of the alterations in oxidative stress parameters, acetylcholinesterase and monoamines in the striatum and midbrain of reserpine-induced PD model. It also ameliorated the changes in nuclear factor-kappa and improved the histopathological picture induced by reserpine. It could be suggested that cerebrolysin and/or lithium showed promising therapeutic potential against the variations induced in the reserpine model of PD. However, the ameliorating effects of lithium on the neurochemical, histopathological and behavioral alterations induced by reserpine were more prominent than those of cerebrolysin alone or combined with lithium. It can be concluded that the antioxidant and anti-inflammatory effects of both drugs played a significant role in their therapeutic potency.
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Affiliation(s)
- Engy K Tharwat
- Biotechnology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Ahmed O Abdelaty
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | | | | | - Ayatallah Elgohary
- School of Biotechnology, Badr University in Cairo, Badr City, Cairo, Egypt
| | - Amena S El-Feky
- School of Biotechnology, Badr University in Cairo, Badr City, Cairo, Egypt
| | - Yasmina M Ebrahim
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Cairo University, Cairo, Egypt
| | - Alaa Sakraan
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Hossam A Ismail
- Biophysics Department, Faculty of Science, Tanta University, Tanta, Egypt
| | - Yasser A Khadrawy
- Medical Physiology Department, Medical Division, National Research Center, Dokki, Egypt
| | - Heba S Aboul Ezz
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Neveen A Noor
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt.
- Department of Zoology, Faculty of Science, Cairo University, Giza, Egypt.
| | - Heba M Fahmy
- Biophysics Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Haitham S Mohammed
- Biophysics Department, Faculty of Science, Cairo University, Cairo, Egypt
| | | | - Nasr M Radwan
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
| | - Nawal A Ahmed
- Zoology Department, Faculty of Science, Cairo University, Cairo, Egypt
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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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Mollà-Casanova S, Pedrero-Sánchez J, Inglés M, López-Pascual J, Muñoz-Gómez E, Aguilar-Rodríguez M, Sempere-Rubio N, Serra-Añó P. Impact of Parkinson’s Disease on Functional Mobility at Different Stages. Front Aging Neurosci 2022; 14:935841. [PMID: 35783141 PMCID: PMC9249436 DOI: 10.3389/fnagi.2022.935841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 05/23/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Specific functional assessments to determine the progression of Parkinson’s Disease (PD) are important to slow down such progression and better plan rehabilitation. This study aimed to explore possible differences in the performance of different functional tasks included in a mobility test using sensors embedded in an Android device, in people at different PD stages. Materials and Methods Eighty-seven participants with PD agreed to participate in this cross-sectional study. They were assessed once using an inertial sensor and variables related to functional status were recorded (i.e., MLDisp, APDisp, DispA, Vrange, MLRange, PTurnSit, PStand, TTime, and RTime). Results There was significant impairment of the vertical range during gait between stages I and II. Further, when stages II and III were compared, the sit-to-stand power was significantly impaired, and the total time required to complete the test increased significantly (p < 0.05). Even more significant differences were obtained when stages I and III were compared, in particular, dysfunction in postural control, vertical range, sit to stand power and total time. Finally, there were no significant differences between stages in the medial-lateral displacements and reaction time (p > 0.05). Conclusion Functional mobility becomes more significantly impaired in the PD population as the PD stages progress. This implies impaired postural control, decreased ability to sit down or stand up from a chair, increased metabolic cost during walking, and overall slowing-down of motor function.
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Affiliation(s)
- Sara Mollà-Casanova
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de Valéncia, Valencia, Spain
| | - Jose Pedrero-Sánchez
- Instituto de Biomecánica de Valencia, Universidad Politécnica de Valencia, Valencia, Spain
| | - Marta Inglés
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de Valéncia, Valencia, Spain
| | - Juan López-Pascual
- Instituto de Biomecánica de Valencia, Universidad Politécnica de Valencia, Valencia, Spain
| | - Elena Muñoz-Gómez
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de Valéncia, Valencia, Spain
| | - Marta Aguilar-Rodríguez
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de Valéncia, Valencia, Spain
| | - Nuria Sempere-Rubio
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de Valéncia, Valencia, Spain
- *Correspondence: Nuria Sempere-Rubio,
| | - Pilar Serra-Añó
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de Valéncia, Valencia, Spain
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Polinski NK, Martinez TN, Ramboz S, Sasner M, Herberth M, Switzer R, Ahmad SO, Pelligrino LJ, Clark SW, Marcus JN, Smith SM, Dave KD, Frasier MA. The GBA1 D409V mutation exacerbates synuclein pathology to differing extents in two alpha-synuclein models. Dis Model Mech 2022; 15:dmm049192. [PMID: 35419585 PMCID: PMC9150115 DOI: 10.1242/dmm.049192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 04/11/2022] [Indexed: 11/28/2022] Open
Abstract
Heterozygous mutations in the GBA1 gene - encoding lysosomal glucocerebrosidase (GCase) - are the most common genetic risk factors for Parkinson's disease (PD). Experimental evidence suggests a correlation between decreased GCase activity and accumulation of alpha-synuclein (aSyn). To enable a better understanding of the relationship between aSyn and GCase activity, we developed and characterized two mouse models that investigate aSyn pathology in the context of reduced GCase activity. The first model used constitutive overexpression of wild-type human aSyn in the context of the homozygous GCase activity-reducing D409V mutant form of GBA1. Although increased aSyn pathology and grip strength reductions were observed in this model, the nigrostriatal system remained largely intact. The second model involved injection of aSyn preformed fibrils (PFFs) into the striatum of the homozygous GBA1 D409V knock-in mouse model. The GBA1 D409V mutation did not exacerbate the pathology induced by aSyn PFF injection. This study sheds light on the relationship between aSyn and GCase in mouse models, highlighting the impact of model design on the ability to model a relationship between these proteins in PD-related pathology.
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Affiliation(s)
- Nicole K. Polinski
- The Michael J. Fox Foundation for Parkinson's Research, Grand Central Station PO Box 4777, New York, NY 10163, USA
| | - Terina N. Martinez
- The Michael J. Fox Foundation for Parkinson's Research, Grand Central Station PO Box 4777, New York, NY 10163, USA
| | - Sylvie Ramboz
- PsychoGenics, Inc, 215 College Road, Paramus, NJ 07652, USA
| | - Michael Sasner
- The Jackson Laboratory, 600 Main Street, Bar Harbor, ME 04609, USA
| | - Mark Herberth
- Charles River Laboratories, 1407 George Road, Ashland, OH 44805, USA
| | - Robert Switzer
- NeuroScience Associates, 10915 Lake Ridge Drive, Knoxville, TN 37934, USA
| | - Syed O. Ahmad
- Saint Louis University, 3437 Caroline Street, St. Louis, MO 63104, USA
| | | | - Sean W. Clark
- Amicus Therapeutics, 1 Cedarbrook Dr, Cranbury, NJ 08512, USA
| | - Jacob N. Marcus
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Sean M. Smith
- Merck & Co., Inc., 2000 Galloping Hill Road, Kenilworth, NJ 07033, USA
| | - Kuldip D. Dave
- The Michael J. Fox Foundation for Parkinson's Research, Grand Central Station PO Box 4777, New York, NY 10163, USA
| | - Mark A. Frasier
- The Michael J. Fox Foundation for Parkinson's Research, Grand Central Station PO Box 4777, New York, NY 10163, USA
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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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11
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Yokote A, Hayashi Y, Yanamoto S, Fujioka S, Higa K, Tsuboi Y. Leg Muscle Strength Correlates with Gait Performance in Advanced Parkinson Disease. Intern Med 2022; 61:633-638. [PMID: 34393165 PMCID: PMC8943390 DOI: 10.2169/internalmedicine.7646-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective Leg muscle strength (LMS) is decreased in early-stage Parkinson disease (PD) patients and is associated with slower walking and falls. However, LMS in advanced PD has not been well investigated. The purpose of this study was to evaluate LMS in advanced PD patients and its effects on gait performance, activities of daily living, and the cognitive function. Methods The medical records of 132 patients with idiopathic advanced PD [Hoehn and Yahr (H&Y) stages 3 and 4] with a mean disease duration of 9.6 years were retrospectively reviewed. Leg extensor muscle strength of the patients was measured using a Strength Ergo 240. The associations between the LMS and gait performance, Barthel index, H&Y stage, and Mini-Mental State Examination (MMSE) score were analyzed. Results A Spearman's correlation analysis showed that LMS was correlated with the sex, age, age of disease onset, H&Y stage, Barthel index, MMSE score, and gait parameters. A multivariable linear regression analysis for identifying predictors of LMS showed that the gait velocity (β=0.377), Barthel index (β=0.281), sex (β=-0.187), and disease duration (β=-0.155) were significant. A receiver operating characteristic curve analysis for discriminating between H&Y stage 3 and 4 was performed for LMS; the area under the curve was 0.774 (95% confidence interval=0.696-0.851). Conclusions LMS was strongly associated with multiple domains of clinical characteristics, especially gait velocity and the Barthel index. Our study also suggested that LMS can be a predictor of PD progression.
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Affiliation(s)
- Akira Yokote
- Department of Neurology, Fukuseikai Minami Hospital, Japan
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | - Yuka Hayashi
- Department of Neurology, Fukuseikai Minami Hospital, Japan
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | - Shozaburo Yanamoto
- Department of Neurology, Fukuseikai Minami Hospital, Japan
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | - Shinsuke Fujioka
- Department of Neurology, Fukuoka University School of Medicine, Japan
| | - Kazuo Higa
- Department of Anesthesiology, Fukuseikai Minami Hospital, Japan
| | - Yoshio Tsuboi
- Department of Neurology, Fukuoka University School of Medicine, Japan
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12
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Bliss RR, Church FC. Golf as a Physical Activity to Potentially Reduce the Risk of Falls in Older Adults with Parkinson's Disease. Sports (Basel) 2021; 9:sports9060072. [PMID: 34070988 PMCID: PMC8224548 DOI: 10.3390/sports9060072] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 12/11/2022] Open
Abstract
Advanced age is associated with an increased risk for falls in aging adults. Older adults are also more likely to be diagnosed with Parkinson’s disease (PD), with advanced age as the most significant risk factor. PD is a neurodegenerative disorder with four Cardinal motor symptoms: rigidity, bradykinesia, postural instability, and tremor. Thus, people (person)-with-Parkinson’s disease (PwP) have an even greater risk of falling than non-disorder age-matched peers. Exercise is an activity requiring physical effort, typically carried out to sustain or improve overall health and fitness, and it lowers the risk of falls in the general population. The sport of golf provides a low-impact all-around workout promoting a range of motion, activation of muscles in the upper and lower body, flexibility, and balance. Swinging a golf club offers a unique combination of high amplitude axial rotation, strengthening postural musculature, coordination, and stabilization, demonstrating the potential to impact PD symptoms positively. Golf may be a novel exercise treatment regimen for PD to use in conjunction with traditional medical therapy. We completed a literature review to determine the relationship between the game of golf, PD, and the risk of falls. We concluded that regularly playing golf can lower the risk for falls in community ambulating older adults with PD and demonstrates the potential to improve quality of life for PwP.
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Affiliation(s)
| | - Frank C. Church
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC 27599, USA
- Correspondence:
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13
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Treatment Options for Motor and Non-Motor Symptoms of Parkinson's Disease. Biomolecules 2021; 11:biom11040612. [PMID: 33924103 PMCID: PMC8074325 DOI: 10.3390/biom11040612] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 03/29/2021] [Accepted: 04/15/2021] [Indexed: 12/11/2022] Open
Abstract
Parkinson’s disease (PD) usually presents in older adults and typically has both motor and non-motor dysfunctions. PD is a progressive neurodegenerative disorder resulting from dopaminergic neuronal cell loss in the mid-brain substantia nigra pars compacta region. Outlined here is an integrative medicine and health strategy that highlights five treatment options for people with Parkinson’s (PwP): rehabilitate, therapy, restorative, maintenance, and surgery. Rehabilitating begins following the diagnosis and throughout any additional treatment processes, especially vis-à-vis consulting with physical, occupational, and/or speech pathology therapist(s). Therapy uses daily administration of either the dopamine precursor levodopa (with carbidopa) or a dopamine agonist, compounds that preserve residual dopamine, and other specific motor/non-motor-related compounds. Restorative uses strenuous aerobic exercise programs that can be neuroprotective. Maintenance uses complementary and alternative medicine substances that potentially support and protect the brain microenvironment. Finally, surgery, including deep brain stimulation, is pursued when PwP fail to respond positively to other treatment options. There is currently no cure for PD. In conclusion, the best strategy for treating PD is to hope to slow disorder progression and strive to achieve stability with neuroprotection. The ultimate goal of any management program is to improve the quality-of-life for a person with Parkinson’s disease.
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Kanegusuku H, Peçanha T, Silva-Batista C, Miyasato RS, Silva Júnior NDD, Mello MTD, Piemonte MEP, Ugrinowitsch C, Forjaz CLDM. Effects of resistance training on metabolic and cardiovascular responses to a maximal cardiopulmonary exercise test in Parkinson`s disease. EINSTEIN-SAO PAULO 2021; 19:eAO5940. [PMID: 33886934 PMCID: PMC8051939 DOI: 10.31744/einstein_journal/2021ao5940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 12/05/2020] [Indexed: 11/16/2022] Open
Abstract
Objective: To evaluate the effects of resistance training on metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson’s disease. Methods: Twenty-four patients with Parkinson’s disease (modified Hoehn and Yahr stages 2 to 3) were randomly assigned to one of two groups: Control or Resistance Training. Patients in the Resistance Training Group completed an exercise program consisting of five resistance exercises (two to four sets of six to 12 repetitions maximum per set) twice a week. Patients in the Control Group maintained their usual lifestyle. Oxygen uptake, systolic blood pressure and heart rate were assessed at rest and during cycle ergometer-based maximal cardiopulmonary exercise testing at baseline and at 12 weeks. Assessments during exercise were conducted at absolute submaximal intensity (slope of the linear regression line between physiological variables and absolute workloads), at relative submaximal intensity (anaerobic threshold and respiratory compensation point) and at maximal intensity (maximal exercise). Muscle strength was also evaluated. Results: Both groups had similar increase in peak oxygen uptake after 12 weeks of training. Heart rate and systolic blood pressure measured at absolute and relative submaximal intensities and at maximal exercise intensity did not change in any of the groups. Muscle strength increased in the Resistance Training but not in the Control Group after 12 weeks. Conclusion: Resistance training increases muscle strength but does not change metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson’s disease without cardiovascular comorbidities.
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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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16
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Lima DP, de Almeida SB, Bonfadini JDC, Sobreira EST, Damasceno PG, Viana Júnior AB, de Alencar MS, de Luna JRG, Rodrigues PGB, Pereira IDS, Gadelha ALDC, de Oliveira LM, Chaves ÉCB, Carneiro VG, Monteiro RR, Costa TADM, Helal L, Signorile J, Lima LAO, Sobreira-Neto MA, Braga-Neto P. Effects of a power strength training using elastic resistance exercises on the motor and non-motor symptoms in patients with Parkinson's disease H&Y 1-3: study protocol for a randomised controlled trial (PARK-BAND Study). BMJ Open 2020; 10:e039941. [PMID: 33046475 PMCID: PMC7552828 DOI: 10.1136/bmjopen-2020-039941] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/02/2020] [Accepted: 09/09/2020] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Parkinson's disease (PD) is the second most common neurodegenerative disorder in Brazil. Physical activity is a complementary intervention in managing inherent declines associated with the disease like strength, balance, gait, and functionality and benefit health-related outcomes. Here, we report the PARK-BAND Study protocol, which aims to investigate potential benefits of power training using elastic devices in participants with PD. Our intervention will be provided in patients with PD using elastic devices like elastic bands and tubes. Therefore, we used the term Park from Parkinson's disease and band from elastic bands. METHODS AND ANALYSIS This randomised single-blind single-centre two-arm parallel, superiority trial will include 50 participants with PD attending the clinical setting. Those who meet the eligibility criteria and provide consent to participate will be randomised in a 1:1 ratio to either the exercise group, which will receive power training programme or the health education group, which will receive the education programme. Randomisation will be performed by permuted block randomisation with a block size of eight. Both groups will receive a 12-week intervention. The exercise group will have two sessions per week and the health education group will have one session per week. Changes from baseline in bradykinesia, as assessed by the Unified Parkinson's Disease Rating Scale motor examination subscore and physical functional performance, will be the primary outcomes. Secondary outcomes include other neurological, neurophysiological and physical variables, as well as the quality of life, depression, cognition, sleep quality and disturbances, assessed before and after interventions. We hypothesise that the exercise group will have greater improvement in primary and secondary outcomes than the health education group. ETHICS AND DISSEMINATION The study is approved by the Research Ethics Committee of Hospital Universitário Walter Cantidio and all participants will provide their written informed consent (register number 91075318.1.0000.5045).Trial results will be disseminated via peer reviewed journal articles and conference presentations, reports for organisations involved with PD and for participants. TRIAL REGISTRATION NUMBER Registro Brasileiro de Ensaios Clínicos Registry (RBR-5w2sqt); Pre-results.
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Affiliation(s)
- Danielle Pessoa Lima
- Geriatric Division, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
- Medical School, Universidade de Fortaleza, Fortaleza, Brazil
| | - Samuel Brito de Almeida
- Clinical Research Unit, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - Janine de Carvalho Bonfadini
- Clinical Research Unit, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | | | - Patrícia Gomes Damasceno
- Division of Neurology, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - Antonio Brazil Viana Júnior
- Clinical Research Unit, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - Madeleine Sales de Alencar
- Geriatric Division, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - João Rafael Gomes de Luna
- Geriatric Division, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | | | - Isabelle de Sousa Pereira
- Medical School, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | | | - Liliane Maria de Oliveira
- School of Kinesiology, Universidade Estácio de Sá Sistema Integrado de Bibliotecas do Centro Universitário Estácio do Ceará, Fortaleza, Ceará, Brazil
| | - Érica Carneiro Barbosa Chaves
- School of Kinesiology, Universidade Estácio de Sá Sistema Integrado de Bibliotecas do Centro Universitário Estácio do Ceará, Fortaleza, Ceará, Brazil
| | | | - Rayane Rodrigues Monteiro
- School of Kinesiology, Universidade Estácio de Sá Sistema Integrado de Bibliotecas do Centro Universitário Estácio do Ceará, Fortaleza, Ceará, Brazil
| | - Thatyara Almeida de Macedo Costa
- School of Nutrition, Universidade Estácio de Sá Sistema Integrado de Bibliotecas do Centro Universitário Estácio do Ceará, Fortaleza, Ceará, Brazil
| | - Lucas Helal
- School of Kinesiology, Universidade do Extremo Sul Catarinense, Criciuma, Brazil
| | - Joseph Signorile
- Kinesiology and Sport Sciences, University of Miami, Coral Gables, Florida, USA
| | | | - Manoel Alves Sobreira-Neto
- Division of Neurology, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
| | - Pedro Braga-Neto
- Division of Neurology, Universidade Federal do Ceará, Hospital Universitário Walter Cantídio, Fortaleza, Brazil
- Medical School, Universidade Estadual do Ceará, Curso de Medicina, Fortaleza, Brazil
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17
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Hall MFE, Church FC. Exercise for Older Adults Improves the Quality of Life in Parkinson's Disease and Potentially Enhances the Immune Response to COVID-19. Brain Sci 2020; 10:E612. [PMID: 32899958 PMCID: PMC7563553 DOI: 10.3390/brainsci10090612] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 08/26/2020] [Accepted: 09/03/2020] [Indexed: 12/21/2022] Open
Abstract
Parkinson's disease (PD) is a progressive neurodegenerative disorder brought about due to dopaminergic neuronal cell loss in the midbrain substantia nigra pars compacta region. PD presents most commonly in older adults and is a disorder of both motor and nonmotor dysfunction. The novel SARS-CoV-2 virus is responsible for the recent COVID-19 pandemic, and older individuals, those with preexisting medical conditions, or both have an increased risk of developing COVID-19 with more severe outcomes. People-with-Parkinson's (PwP) of advanced age can have both immune and autonomic nervous problems that potentially lead to pre-existing pulmonary dysfunction and higher infection risk, increasing the probability of contracting COVID-19. A lifestyle change involving moderate-intensity exercise has the potential to protect against SARS-CoV-2 through strengthening the immune system. In addition to a potential protective measure against SARS-CoV-2, exercise has been shown to improve quality-of-life (QoL) in PD patients. Recent studies provide evidence of exercise as both neuroprotective and neuroplastic. This article is a literature review investigating the role exercise plays in modifying the immune system, improving health outcomes in PwP, and potentially acting as a protective measure against SARS-Cov-2 infection. We conclude that exercise, when correctly performed, improves QoL and outcomes in PwP, and that the enhanced immune response from moderate-intensity exercise could potentially offer additional protection against COVID-19.
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Affiliation(s)
| | - Frank C. Church
- Department of Pathology and Laboratory Medicine, The University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC 27599, USA;
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18
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Helgerud J, Thomsen SN, Hoff J, Strandbråten A, Leivseth G, Unhjem R, Wang E. Maximal strength training in patients with Parkinson's disease: impact on efferent neural drive, force-generating capacity, and functional performance. J Appl Physiol (1985) 2020; 129:683-690. [PMID: 32790593 DOI: 10.1152/japplphysiol.00208.2020] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Parkinson's disease (PD) is characterized by progressive neurological deterioration, typically accompanied by reductions in skeletal muscle force-generating capacity (FGC) and functional performance. Physical activity has the potential to counteract this debilitating outcome, however, it is elusive if high-intensity strength training included in conventional treatment may improve results. Therefore, we randomly assigned 22 PD patients (74 ± 9 yr) to conventional rehabilitation with or without maximal strength training (MST) performed as leg press and chest press at ~90% of one repetition maximum (1RM), five times per week for 4 wk. FGC, physical performance, and efferent neural drive assessed as evoked potentials (V-wave normalized to M-wave in m. soleus) were measured following training. Results revealed that only MST improved 1RM leg press (101 ± 23 to 118 ± 18 kg) and chest press (36 ± 15 to 41 ± 15 kg), plantar flexion maximal voluntary contraction (235 ± 125 to 293 ± 158 N·m), and rate of force development (373 ± 345 to 495 ± 446 N·m·s-1; all P < 0.05; different from controls P < 0.05). FGC improvements were accompanied by an increased efferent neural drive to maximally contracting musculature (V-to-M ratio: 0.17 ± 0.12 to 0.24 ± 0.15; P < 0.05; different from controls P < 0.05), improved physical performance (stair climbing: 21.0 ± 9.2 to 14.4 ± 5.2 s; timed up and go: 7.8 ± 3.3 to 6.2 ± 2.5 s; both P < 0.05), and self-perceived improvement in health (3.1 ± 0.5 to 2.6 ± 0.9) and social activities functioning (2.2 ± 1.0 to 1.5 ± 1.1; both P < 0.05). No changes were observed in the control group. In conclusion, this study shows that MST improves FGC, neuromuscular function, and functional performance and advocates that high-intensity strength training should be implemented as an adjunct therapy in the treatment of PD patients.NEW & NOTEWORTHY This randomized, controlled trial documents that supervised high-intensity strength training improves efferent neural drive, maximal muscle strength, rate of force development, and functional performance in patients with Parkinson's disease (PD). In contrast, no differences were observed in these outcome variables in patients receiving conventional treatment consisting of recreational physical activity with low-to-medium intensity. Consequently, this study advocates that high-intensity strength training should be implemented in the clinical treatment of PD patients.
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Affiliation(s)
- J Helgerud
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Myworkout, Medical Rehabilitation Clinic, Trondheim, Norway
| | - S N Thomsen
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - J Hoff
- Myworkout, Medical Rehabilitation Clinic, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs University Hospital, Trondheim, Norway
| | - A Strandbråten
- Hokksund Medical Rehabilitation Center, Hokksund, Norway
| | - G Leivseth
- Department of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
| | - R Unhjem
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
| | - E Wang
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.,Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.,Department of Internal Medicine, University of Utah, Salt Lake City, Utah.,Department of Rehabilitation, Rīga Stradiņš University, Riga, Latvia
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Youm C, Kim Y, Noh B, Lee M, Kim J, Cheon SM. Impact of Trunk Resistance and Stretching Exercise on Fall-Related Factors in Patients with Parkinson's Disease: A Randomized Controlled Pilot Study. SENSORS (BASEL, SWITZERLAND) 2020; 20:E4106. [PMID: 32717956 PMCID: PMC7435366 DOI: 10.3390/s20154106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/10/2020] [Accepted: 07/21/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND This study aimed to examine the effect of a 12-week progressive trunk resistance and stretching exercise program on fall-related factors in patients with Parkinson's disease (PD). METHODS A randomized study assessed a progressive trunk resistance and stretching exercise program over a 12-week period. A total of 17 patients with PD participated and wererandomly allocated into an exercise group (n = 10) or a control group (n = 7). Participants in the exercise group completed the exercise program in 60- to 90-min sessions for three days per week. Primary and secondary outcome measures included the trunk mobility scale, functional fitness test, standing balance, and sit-to-walk test. RESULTS The exercise group showed improvements in functional fitness, trunk mobility, standing balance, and dynamic stability compared with the control group (all p < 0.05). The 2.44 m timed up and go test (odds ratio (OR): 0.125) and the 2 min step test (OR: 10.584) of the functional fitness test, and the first-step length (OR: 3.558) and first-toe clearance height (OR: 4.777) of the sit-to-walk test, were different between the groups following the exercise program. CONCLUSION This 12-week exercise program improved fall-related factors in patients with PD and may lead to prevention of fall-related injuries.
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Affiliation(s)
- Changhong Youm
- Department of Health Care and Science, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea;
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea; (Y.K.); (M.L.); (J.K.)
| | - Youkyung Kim
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea; (Y.K.); (M.L.); (J.K.)
| | - Byungjoo Noh
- Department of Health Care and Science, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea;
| | - Myeounggon Lee
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea; (Y.K.); (M.L.); (J.K.)
| | - Jinhee Kim
- Biomechanics Laboratory, College of Health Sciences, Dong-A University, Saha-gu, Busan 49315, Korea; (Y.K.); (M.L.); (J.K.)
| | - Sang-Myung Cheon
- Department of Neurology, School of Medicine, Dong-A University, Dongdaesin-dong 3-ga, Seo-gu, Busan 49201, Korea;
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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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21
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Douris PC, D'Agostino N, Werner WG, Petrizzo J, DiFrancisco-Donoghue J. Blood flow restriction resistance training in a recreationally active person with Parkinson's disease. Physiother Theory Pract 2020; 38:422-430. [PMID: 32400274 DOI: 10.1080/09593985.2020.1762812] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background: Blood flow restriction (BFR) applied during low intensity resistance training (LIRT) exercise produces hypertrophy and strength gains equivalent to traditional training. The effectiveness of BFR-LIRT on persons with Parkinson Disease (PD) has not been investigated.Objective: To determine the effects of BFR-LIRT on a recreationally active person with PD in regards to function, strength, Restless Leg Syndrome (RLS) and safety. Methods: A single subject, A-B-A design was utilized. Each phase lasted 6 weeks. Outcome measures included: 30-second sit-to-stand; Timed Up and Go (TUG); RLS Questionnaire; 3-RM of Cybex Leg Press (LP); Leg Curl (LC); and Leg Extension (LE) measured every 3 weeks for 18 weeks. The intervention phase (B, weeks 6-12) included four lower extremity resistance exercises (LP, LC, LE, calf presses on the LP) with the addition of BFR. The two standard deviation band method was used to determine significance.Results: All outcome measures except the TUG improved significantly by the end of intervention phase.Conclusion: The combination of BFR with LIRT safely lead to an increase in lower extremity strength and function in a person with PD, while decreasing their RLS (improvement from moderate to mild symptoms) resulting in a better quality of life for the participant.
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Affiliation(s)
- Peter C Douris
- Department of Physical Therapy, New York Institute of Technology (NYIT), Old Westbury, NY, USA
| | - Nick D'Agostino
- Department of Physical Therapy, New York Institute of Technology (NYIT), Old Westbury, NY, USA
| | - William G Werner
- Department of Physical Therapy, New York Institute of Technology (NYIT), Old Westbury, NY, USA
| | - John Petrizzo
- Department of Exercise Science, Health Studies, Physical Education and Sport Management, Adelphi University, Garden City, NY, USA
| | - Joanne DiFrancisco-Donoghue
- NYIT College of Osteopathic Medicine, Department of Osteopathic Medicine, NYIT Center for Sports Medicine, Old Westbury, NY, USA
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22
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Vieira de Moraes Filho A, Chaves SN, Martins WR, Tolentino GP, de Cássia Pereira Pinto Homem R, Landim de Farias G, Fischer BL, Oliveira JA, Pereira SKA, Vidal SE, Mota MR, Moreno Lima R, Jacó de Oliveira R. Progressive Resistance Training Improves Bradykinesia, Motor Symptoms and Functional Performance in Patients with Parkinson's Disease. Clin Interv Aging 2020; 15:87-95. [PMID: 32158202 PMCID: PMC6986410 DOI: 10.2147/cia.s231359] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 12/13/2019] [Indexed: 01/08/2023] Open
Abstract
Purpose Bradykinesia and muscle weaknesses are common symptoms of Parkinson’s Disease (PD) and are associated with impaired functional performance, increased risk of falls, and reduced quality of life. Recent studies have pointed to progressive resistance training (PRT) as an effective method to control and reduce these symptoms, increasing possibilities to treat the disease. However, few studies have focused on assessing the PRT effects in the short-term. Therefore, the present study aimed to assess the short-term PRT effects on people with PD, in order to offer new parameters for a better understanding of its effects, so as an adequation and PRT use as a complementary therapy. Patients and Methods Forty individuals diagnosed with PD from stage 1 to 3 on the Hoehn and Yahr scale took part on the study and were allocated into 2 groups; Training Group (TG) performed a 9-week RT program twice a week, and the Control Group (CG) attended disease lectures. Bradykinesia UPDRS subscale (BSS), knee extensors isokinetic strength, Ten Meters Walk Test (TMW), Timed Up&Go Test (TUG) and 30-Second Chair Stand (T30) were measured before and after the intervention period. Statistical significance was set at p ≤ 0.05. Results Significant time was noted by the group interaction for all functional tests (TUG, T30, and TWM; all p < 0.01) and BSS (p < 0.01). Post hoc analyses revealed that these differences were driven by significant improvements in these dependent variables (all p < 0.01) while the CG remained unchanged (all p > 0.05). Moreover, TUG, T30, TWM, and BSS were significantly different between TG and CG in the post-training assessments (all p < 0.01). Isokinetic muscle strength was slightly increased in the TG (2.4%) and decreased in the CG (−2.2%), but statistical analyses did not reach significance for interaction but only a trend (p = 0.12). Conclusion The results indicate that 9 weeks of PRT reduces bradykinesia and improves functional performance in patients with mild to moderate PD. These findings reinforce this mode of exercise as an important component of public health promotion programs for PD.
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Affiliation(s)
| | - Sandro Nobre Chaves
- College of Physical Education, University of Brasilia, Brasilia, Brazil.,Integrated Colleges IESGO, Formosa, Goias, Brazil
| | | | | | | | | | | | | | | | | | | | | | - Ricardo Jacó de Oliveira
- College of Health Sciences, University of Brasilia, Brasilia, Brazil.,College of Physical Education, University of Brasilia, Brasilia, Brazil
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23
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Messa LV, Ginanneschi F, Momi D, Monti L, Battisti C, Cioncoloni D, Pucci B, Santarnecchi E, Rossi A. Functional and Brain Activation Changes Following Specialized Upper-Limb Exercise in Parkinson's Disease. Front Hum Neurosci 2019; 13:350. [PMID: 31749690 PMCID: PMC6843060 DOI: 10.3389/fnhum.2019.00350] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Accepted: 09/23/2019] [Indexed: 12/29/2022] Open
Abstract
For the management of Parkinson's disease (PD), the concept of forced exercise (FE) has drawn interest. In PD subjects, the FE executed with lower limbs has been shown to lessen symptoms and to promote brain adaptive changes. Our study is aimed to investigate the effect of an upper-limb exercise, conceptually comparable with the FE, in PD. Upper-limb exercise was achieved in a sitting position by using a specially designed device (Angel's Wings®). Clinical data, computerized dynamic posturography, magnetic resonance imaging (MRI) (resting-state MRI and arterial spin labeling), and neuropsychological tests were used before and after 2 months' exercise training. We found a significant long-lasting improvement in Unified Parkinson Disease Rating Scale (UPDRS)-III and cognitive scales, along with improvement in balance and postural control (better alignment of the gravity center and improvement in weight symmetry and in anticipatory motor strategies). Computerized dynamic posturography pointed out an enhanced central ability to integrate the vestibular signals with afferents from other sensory systems. Neuroimaging analyses after 2 months' exercise training showed, with respect to pretraining condition, many changes. An increase of the cerebral blood flow was evident in the left primary motor cortex (M1), left supplementary motor cortical area, and left cerebellar cortex. The bilateral globus pallidus showed an increased functional connectivity to the right central operculum, right posterior cingulate gyrus, and left sensorimotor cortex. Seed-to-voxel analysis demonstrated a functional connectivity between M1 and the left superior frontal gyrus. Left crus II showed strengthened connections with the left pre-rolandic area, left post-rolandic area, and left supramarginal area. These findings likely reflect compensatory mechanisms to the neuropathological hallmark of PD. Overall, our results show that this upper-limb exercise model, conceptually comparable with the FE already tested in the lower limbs, leads to a global improvement (involving non-exercised limbs) likely consistent with the functional changes observed in the central nervous system.
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Affiliation(s)
- Luca Valerio Messa
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Davide Momi
- Siena Brain Investigation and Neuromodulation Lab, Department of Medicine, Surgery and Neurological Sciences, University of Siena, Siena, Italy.,Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Lucia Monti
- Unit of Neuroimaging and Neurointervention, Department of Neurological and Neurosensorial Sciences, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Carla Battisti
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - David Cioncoloni
- U.O.P. Professioni della Riabilitazione, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Barbara Pucci
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
| | - Emiliano Santarnecchi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy.,Berenson-Allen Center for Non-Invasive Brain Stimulation, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States.,The Center for Complex Network Research, Department of Physics, Northeastern University, Boston, MA, United States
| | - Alessandro Rossi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, Siena, Italy
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24
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Yang CY, Chen RS, Huang YZ. Analysis and Discrimination of Surface Electromyographic Features for Parkinson's Disease during Elbow Flexion Movements. J Mot Behav 2019; 52:625-633. [PMID: 31538541 DOI: 10.1080/00222895.2019.1666081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Parkinson's disease (PD) is the second most common neurodegenerative disorder. Early intervention/treatment relies on early diagnosis of PD. There is increasing interest in methods based on electromyography measurements of PD patients because of its noninvasiveness. Thus, this study was to investigate electromyographic (EMG) characteristics of the upper limb between PD patients and healthy control subjects using EMG, and to distinguish PD patients from healthy control subjects according to the EMG information using a support vector machine (SVM) classifier. Sixteen right-handed PD patients and 25 right-handed healthy subjects participated in experiments involving elbow flexion movement. The frequency power, duration, skewness, recurrence rate, and correlation dimension of EMG signals and success rate for the right hand and the skewness of EMG signals for the left hand were found to be significantly different between the two groups. This information was subsequently used to distinguish PD patients from healthy control subjects using the SVM classifier to obtain a mean accuracy of 87.02%. Although the results may not be immediately available to use in clinical applications, the safety, simplicity and speed of the system still merits further consideration. Enhancing performance accuracy and examining PD patients in different stages of disease are anticipated in future investigations.
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Affiliation(s)
- Chia-Yen Yang
- Department of Biomedical Engineering, Ming-Chuan University, Taoyuan, Taiwan
| | - Rou-Shayn Chen
- Division of Movement Disorders, Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan1
| | - Ying-Zu Huang
- Neuroscience Research Center and Department of Neurology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan.,Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Institute of Cognitive Neuroscience, National Central University, Taoyuan, Taiwan
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25
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Abstract
Parkinson's disease is the second most common neurodegenerative disease with a prevalence rate of 1-2 per 1000 of the population worldwide. Pharmacological management is the mainstay of treatment. Despite optimal medication, motor impairment particularly balance and gait impairment persist leading to various degree of disability and reduced quality-of-life. The present review describes motor impairment including postural impairment, gait dysfunction, reduced muscle strength and aerobic capacity and falls. Physical therapy and complementary exercises have been proven to improve motor performance and functional mobility. Evidence on the efficacy of physical therapy and complementary exercises is presented in this review. These exercises include gait training with cues, gait training with treadmill, Nordic walking, brisk walking, balance training, virtual reality interventions, Tai Chi and dance. All these treatment interventions produce short-term beneficial effects and some interventions demonstrate long-term benefit. Gait training with treadmill enhance walking performance and the effects sustain for 3-6 months. Balance training improves balance, function and reduces fall rate, and these effects carry over to at least 12 months after training ended. Sustained Tai Chi for 6 months, dance therapy for 12 months, progressive resistive training for 24 months alleviates the PD motor symptoms, suggesting that they could slow down PD progression. Based on this evidence, individuals with PD are encouraged to sustain their training in order to improve/maintain their physical ability and to combat the progression of PD.
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Affiliation(s)
- Margaret K Y Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China.
| | - Irene S K Wong-Yu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
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26
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Al-Jarrah MD, Erekat NS. Treadmill exercise training could attenuate the upregulation of Interleukin-1 beta and tumor necrosis factor alpha in the skeletal muscle of mouse model of chronic/progressive Parkinson disease. NeuroRehabilitation 2019; 43:501-507. [DOI: 10.3233/nre-182492] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Muhammed D. Al-Jarrah
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan
| | - Nour S. Erekat
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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27
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Douris PC, Cogen ZS, Fields HT, Greco LC, Hasley MR, Machado CM, Romagnuolo PM, Stamboulis G, DiFrancisco-Donoghue J. THE EFFECTS OF BLOOD FLOW RESTRICTION TRAINING ON FUNCTIONAL IMPROVEMENTS IN AN ACTIVE SINGLE SUBJECT WITH PARKINSON DISEASE. Int J Sports Phys Ther 2018; 13:247-254. [PMID: 30090683 PMCID: PMC6063055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
BACKGROUND Blood flow restriction (BFR) applied during low intensity exercise produces hypertrophy and strength gains equivalent to traditional training. Previous research has shown the positive effects of BFR on younger and older adults. However, the effectiveness of BFR on subjects with Parkinson Disease (PD) has not been investigated. HYPOTHESES/PURPOSE The purpose of the study was to determine the effects of BFR on a recreationally active person with PD in regards to functional improvements and safety. The hypothesis was that BFR training will demonstrate improvements in motor function, gait and endurance, while decreasing symptoms associated with Restless Leg Syndrome (RLS) in a subject with PD. STUDY DESIGN A single subject, B-A design was used. METHODS The subject was an active 65-year-old male recreational boxer diagnosed with PD. Baseline data were measured on day one. The intervention (Phase B) consisted of five, two-minute bouts of walking on treadmill with lower extremity BFR cuffs interspersed with 1 minute rest, three times a week for six weeks, at 0 grade incline, and speed of 50 meters/min. The pressure increased from the initial 120 to 160 mmHg at the end of the phase B as per the subject's tolerance. A four-week baseline phase (A) without the BFR intervention followed phase B. The outcome measures which were measured every two weeks over the 10 weeks included: Timed Up and Go Test, 6-Minute Walk Test, 30-Second Chair Stand Test, and the RLS Questionnaire. RESULTS All outcome measures steadily improved every two weeks during the six week intervention phase and steadily declined when the intervention was removed during the second four week baseline phase according to visual inspection of the graphed data points. CONCLUSION The subject enjoyed and tolerated the intervention well without any adverse effects. The results were that BFR training can produce functional improvements, reduce restless leg syndrome symptoms and can be safely utilized with a subject with PD who wishes to maintain his ability to remain recreationally active.
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Affiliation(s)
- Peter C Douris
- New York Institute of Technology (NYIT), Department of Physical Therapy, Old Westbury, NY, USA
| | - Zachary S Cogen
- New York Institute of Technology (NYIT), Department of Physical Therapy, Old Westbury, NY, USA
| | - Helen T Fields
- New York Institute of Technology (NYIT), Department of Physical Therapy, Old Westbury, NY, USA
| | - Lauren C Greco
- New York Institute of Technology (NYIT), Department of Physical Therapy, Old Westbury, NY, USA
| | - Matthew R Hasley
- New York Institute of Technology (NYIT), Department of Physical Therapy, Old Westbury, NY, USA
| | - Christina M Machado
- New York Institute of Technology (NYIT), Department of Physical Therapy, Old Westbury, NY, USA
| | - Peter M Romagnuolo
- New York Institute of Technology (NYIT), Department of Physical Therapy, Old Westbury, NY, USA
| | - George Stamboulis
- New York Institute of Technology (NYIT), Department of Physical Therapy, Old Westbury, NY, USA
| | - Joanne DiFrancisco-Donoghue
- NYIT College of Osteopathic Medicine, Department of Osteopathic Medicine, NYIT Center for Sports Medicine, Old Westbury, NY, USA
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28
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Krumpolec P, Vallova S, Slobodova L, Tirpakova V, Vajda M, Schon M, Klepochova R, Janakova Z, Straka I, Sutovsky S, Turcani P, Cvecka J, Valkovic L, Tsai CL, Krssak M, Valkovic P, Sedliak M, Ukropcova B, Ukropec J. Aerobic-Strength Exercise Improves Metabolism and Clinical State in Parkinson's Disease Patients. Front Neurol 2017; 8:698. [PMID: 29312123 PMCID: PMC5743754 DOI: 10.3389/fneur.2017.00698] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 12/05/2017] [Indexed: 12/27/2022] Open
Abstract
Regular exercise ameliorates motor symptoms in Parkinson’s disease (PD). Here, we aimed to provide evidence that exercise brings additional benefits to the whole-body metabolism and skeletal muscle molecular and functional characteristics, which might help to explain exercise-induced improvements in the clinical state. 3-months supervised endurance/strength training was performed in early/mid-stage PD patients and age/gender-matched individuals (n = 11/11). The effects of exercise on resting energy expenditure (REE), glucose metabolism, adiposity, and muscle energy metabolism (31P-MRS) were evaluated and compared to non-exercising PD patients. Two muscle biopsies were taken to determine intervention-induced changes in fiber type, mitochondrial content, and expression of genes related to muscle energy metabolism, as well as proliferative and regenerative capacity. Exercise improved the clinical disability score (MDS-UPDRS), bradykinesia, balance, walking speed, REE, and glucose metabolism and increased muscle expression of energy sensors (AMPK). However, the exercise-induced increase in muscle mass/strength, mitochondrial content, type II fiber size, and postexercise phosphocreatine (PCr) recovery (31P-MRS) were found only in controls. Nevertheless, MDS-UPDRS was associated with muscle AMPK and mechano-growth factor (MGF) expression. Improvements in fasting glycemia were positively associated with muscle function and the expression of Sirt1 and Cox7a1, and the parameters of fitness/strength were positively associated with the expression of MyHC2, MyHC7, and MGF. Moreover, reduced bradykinesia was associated with better muscle metabolism (maximal oxidative capacity and postexercise PCr recovery; 31P-MRS). Exercise training improved the clinical state in early/mid-stage Parkinson’s disease patients, including motor functions and whole-body metabolism. Although the adaptive response to exercise in PD was different from that of controls, exercise-induced improvements in the PD clinical state were associated with specific adaptive changes in muscle functional, metabolic, and molecular characteristics.
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Affiliation(s)
- Patrik Krumpolec
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Silvia Vallova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Lucia Slobodova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Veronika Tirpakova
- Institute of Sports Medicine and Physical Education, Faculty of Medicine, Slovak Medical University in Bratislava, Bratislava, Slovakia
| | - Matej Vajda
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Martin Schon
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Radka Klepochova
- High Field MR Centre, Department of Biomedical Imaging and Imaged-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Clinical Molecular Imaging, MOLIMA, Medical University of Vienna, Vienna, Austria
| | - Zuzana Janakova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Igor Straka
- 2nd Neurology Department, Faculty of Medicine, Comenius University & University Hospital Bratislava, Bratislava, Slovakia
| | - Stanislav Sutovsky
- 1st Neurology Department, Faculty of Medicine, Comenius University & University Hospital Bratislava, Bratislava, Slovakia
| | - Peter Turcani
- 1st Neurology Department, Faculty of Medicine, Comenius University & University Hospital Bratislava, Bratislava, Slovakia
| | - Jan Cvecka
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Ladislav Valkovic
- High Field MR Centre, Department of Biomedical Imaging and Imaged-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Oxford Centre for Clinical Magnetic Resonance Research (OCMR), BHF Centre of Research Excellence, University of Oxford, Oxford, United Kingdom
| | | | - Martin Krssak
- High Field MR Centre, Department of Biomedical Imaging and Imaged-Guided Therapy, Medical University of Vienna, Vienna, Austria.,Christian Doppler Laboratory for Clinical Molecular Imaging, MOLIMA, Medical University of Vienna, Vienna, Austria.,Division of Endocrinology and Metabolism, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Peter Valkovic
- 2nd Neurology Department, Faculty of Medicine, Comenius University & University Hospital Bratislava, Bratislava, Slovakia
| | - Milan Sedliak
- Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Barbara Ukropcova
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia.,Institute of Pathological Physiology, Faculty of Medicine, Comenius University, Bratislava, Slovakia.,Faculty of Physical Education and Sports, Comenius University, Bratislava, Slovakia
| | - Jozef Ukropec
- Institute of Experimental Endocrinology, Biomedical Research Center, Slovak Academy of Sciences, Bratislava, Slovakia
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29
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David FJ, Robichaud JA, Vaillancourt DE, Poon C, Kohrt WM, Comella CL, Corcos DM. Progressive resistance exercise restores some properties of the triphasic EMG pattern and improves bradykinesia: the PRET-PD randomized clinical trial. J Neurophysiol 2016; 116:2298-2311. [PMID: 27582297 DOI: 10.1152/jn.01067.2015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 08/31/2016] [Indexed: 01/05/2023] Open
Abstract
In Parkinson's disease (PD), the characteristic triphasic agonist and antagonist muscle activation pattern during ballistic movement is impaired: the number of agonist muscle bursts is increased, and the amplitudes of the agonist and antagonist bursts are reduced. The breakdown of the triphasic electromyographic (EMG) pattern has been hypothesized to underlie bradykinesia in PD. Progressive resistance exercise has been shown to improve clinical measures of bradykinesia, but it is not clear whether the benefits for bradykinesia are accompanied by changes in agonist and antagonist muscle activity. This study examined the spatiotemporal changes in agonist and antagonist muscle activity following 24 mo of progressive resistance exercise and the combined relationship between spatiotemporal muscle activity and strength measures and upper limb bradykinesia. We compared the effects of progressive resistance exercise training (PRET) with a nonprogressive exercise intervention, modified Fitness Counts (mFC), in patients with PD. We randomized 48 participants with mild-to-moderate PD to mFC or PRET. At the study endpoint of 24 mo, participants randomized to PRET compared with mFC had significantly faster movement velocity, accompanied by significant increases in the duration, magnitude, and magnitude normalized to duration of the 1st agonist burst and fewer number of agonist bursts before peak velocity. The antagonist muscle activity was increased relative to baseline but did not differ between groups. Spatiotemporal EMG muscle activity and muscle strength were significantly associated with upper limb bradykinesia. These findings demonstrate that progressive resistance exercise improves upper limb movement velocity and restores some aspects of the triphasic EMG pattern.
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Affiliation(s)
- Fabian J David
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois;
| | - Julie A Robichaud
- Physical Therapy Department, University of Illinois at Chicago, Chicago, Illinois
| | - David E Vaillancourt
- Departments of Applied Physiology and Kinesiology, Biomedical Engineering, and Neurology, University of Florida, Gainesville, Florida
| | - Cynthia Poon
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois
| | - Wendy M Kohrt
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, Colorado; and
| | - Cynthia L Comella
- Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, Illinois
| | - Daniel M Corcos
- Department of Physical Therapy and Human Movement Sciences, Northwestern University, Chicago, Illinois.,Department of Neurological Sciences, Section of Parkinson Disease and Movement Disorders, Rush University Medical Center, Chicago, Illinois
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30
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Saltychev M, Bärlund E, Paltamaa J, Katajapuu N, Laimi K. Progressive resistance training in Parkinson's disease: a systematic review and meta-analysis. BMJ Open 2016; 6:e008756. [PMID: 26743698 PMCID: PMC4716165 DOI: 10.1136/bmjopen-2015-008756] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate if there is evidence on effectiveness of progressive resistance training in rehabilitation of Parkinson disease. DESIGN Systematic review and meta-analysis. DATA SOURCES Central, Medline, Embase, Cinahl, Web of Science, Pedro until May 2014. Randomised controlled or controlled clinical trials. The methodological quality of studies was assessed according to the Cochrane Collaboration's domain-based evaluation framework. DATA SYNTHESIS random effects meta-analysis with test for heterogeneity using the I² and pooled estimate as the raw mean difference. PARTICIPANTS Adults with primary/idiopathic Parkinson's disease of any severity, excluding other concurrent neurological condition. INTERVENTIONS Progressive resistance training defined as training consisting of a small number of repetitions until fatigue, allowing sufficient rest between exercises for recovery, and increasing the resistance as the ability to generate force improves. COMPARISON Progressive resistance training versus no treatment, placebo or other treatment in randomised controlled or controlled clinical trials. PRIMARY AND SECONDARY OUTCOME MEASURES Any outcome. RESULTS Of 516 records, 12 were considered relevant. Nine of them had low risk of bias. All studies were randomised controlled trials conducted on small samples with none or 1 month follow-up after the end of intervention. Of them, six were included in quantitative analysis. Pooled effect sizes of meta-analyses on fast and comfortable walking speed, the 6 min walking test, Timed Up and Go test and maximal oxygen consumption were below the level of minimal clinical significance. CONCLUSIONS There is so far no evidence on the superiority of progressive resistance training compared with other physical training to support the use of this technique in rehabilitation of Parkinson's disease. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO 2014:CRD42014009844.
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Affiliation(s)
- Mikhail Saltychev
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - Esa Bärlund
- Satakunta University of Applied Sciences, Pori, Finland
| | - Jaana Paltamaa
- School of Health and Social Studies, JAMK University of Applied Sciences, Jyväskylä, Finland
| | | | - Katri Laimi
- Department of Physical and Rehabilitation Medicine, Turku University Hospital and University of Turku, Turku, Finland
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31
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Reynolds GO, Otto MW, Ellis TD, Cronin-Golomb A. The Therapeutic Potential of Exercise to Improve Mood, Cognition, and Sleep in Parkinson's Disease. Mov Disord 2016; 31:23-38. [PMID: 26715466 PMCID: PMC4724300 DOI: 10.1002/mds.26484] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/11/2015] [Accepted: 10/15/2015] [Indexed: 01/15/2023] Open
Abstract
In addition to the classic motor symptoms, Parkinson's disease (PD) is associated with a variety of nonmotor symptoms that significantly reduce quality of life, even in the early stages of the disease. There is an urgent need to develop evidence-based treatments for these symptoms, which include mood disturbances, cognitive dysfunction, and sleep disruption. We focus here on exercise interventions, which have been used to improve mood, cognition, and sleep in healthy older adults and clinical populations, but to date have primarily targeted motor symptoms in PD. We synthesize the existing literature on the benefits of aerobic exercise and strength training on mood, sleep, and cognition as demonstrated in healthy older adults and adults with PD, and suggest that these types of exercise offer a feasible and promising adjunct treatment for mood, cognition, and sleep difficulties in PD. Across stages of the disease, exercise interventions represent a treatment strategy with the unique ability to improve a range of nonmotor symptoms while also alleviating the classic motor symptoms of the disease. Future research in PD should include nonmotor outcomes in exercise trials with the goal of developing evidence-based exercise interventions as a safe, broad-spectrum treatment approach to improve mood, cognition, and sleep for individuals with PD.
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Affiliation(s)
| | - Michael W. Otto
- Boston University, Department of Psychological and Brain Sciences
| | - Terry D. Ellis
- Boston University College of Health and Rehabilitation Sciences: Sargent College, Department of Physical Therapy & Athletic Training and Center for Neurorehabilitation
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Exercise and medication effects on persons with Parkinson disease across the domains of disability: a randomized clinical trial. J Neurol Phys Ther 2015; 39:85-92. [PMID: 25742370 DOI: 10.1097/npt.0000000000000086] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Hypokinesia and bradykinesia as movement deficits of Parkinson disease are thought to be mediated by both basal ganglia dysfunction and a loss of muscle mass and strength commensurate with aging and decreased levels of physical activity. For these reasons, we sought to utilize resistance training as a means to increase muscle force and minimize hypokinesia and bradykinesia in persons with Parkinson disease and examine the effects of exercise and medication on Body Structure and Function (muscle force production and muscle cross-sectional area), Activity (mobility), and Participation (Health Status) outcomes. METHODS Forty-two participants were enrolled in a 12-week randomized clinical trial that compared 2 active exercise interventions: a standard care control group (Active Control) and an experimental group that underwent Resistance Exercise via Negative Eccentric Work (RENEW). RESULTS Participants in both groups improved in muscle force production and mobility as a result of exercise and medication (P < 0.02). There were no significant interaction or between-group differences and no significant changes in muscle cross-sectional area or health status were observed. Effect sizes for exercise and medication combined exceeded the effect sizes of either intervention in isolation. DISCUSSION AND CONCLUSIONS Taken together, these results point to the complementary effects of exercise and medication on the Body Structure and Function and Activity outcomes but little effect on Participation outcomes.Video Abstract available for more insights from the authors (see Supplemental Digital Content 1, http://links.lww.com/JNPT/A92).
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Roeder L, Costello JT, Smith SS, Stewart IB, Kerr GK. Effects of Resistance Training on Measures of Muscular Strength in People with Parkinson's Disease: A Systematic Review and Meta-Analysis. PLoS One 2015; 10:e0132135. [PMID: 26146840 PMCID: PMC4492705 DOI: 10.1371/journal.pone.0132135] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 06/10/2015] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to determine the overall effect of resistance training (RT) on measures of muscular strength in people with Parkinson's disease (PD). METHODS Controlled trials with parallel-group-design were identified from computerized literature searching and citation tracking performed until August 2014. Two reviewers independently screened for eligibility and assessed the quality of the studies using the Cochrane risk-of-bias-tool. For each study, mean differences (MD) or standardized mean differences (SMD) and 95% confidence intervals (CI) were calculated for continuous outcomes based on between-group comparisons using post-intervention data. Subgroup analysis was conducted based on differences in study design. RESULTS Nine studies met the inclusion criteria; all had a moderate to high risk of bias. Pooled data showed that knee extension, knee flexion and leg press strength were significantly greater in PD patients who undertook RT compared to control groups with or without interventions. Subgroups were: RT vs. control-without-intervention, RT vs. control-with-intervention, RT-with-other-form-of-exercise vs. control-without-intervention, RT-with-other-form-of-exercise vs. control-with-intervention. Pooled subgroup analysis showed that RT combined with aerobic/balance/stretching exercise resulted in significantly greater knee extension, knee flexion and leg press strength compared with no-intervention. Compared to treadmill or balance exercise it resulted in greater knee flexion, but not knee extension or leg press strength. RT alone resulted in greater knee extension and flexion strength compared to stretching, but not in greater leg press strength compared to no-intervention. DISCUSSION Overall, the current evidence suggests that exercise interventions that contain RT may be effective in improving muscular strength in people with PD compared with no exercise. However, depending on muscle group and/or training dose, RT may not be superior to other exercise types. Interventions which combine RT with other exercise may be most effective. Findings should be interpreted with caution due to the relatively high risk of bias of most studies.
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Affiliation(s)
- Luisa Roeder
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Movement Neuroscience Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Injury Prevention Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Joseph T. Costello
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
- Extreme Environments Laboratory (EEL), Department of Sport and Exercise Science, Spinnaker Building, Cambridge Road, University of Portsmouth, Portsmouth, PO1 2ER, United Kingdom
| | - Simon S. Smith
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Injury Prevention Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- CARRS-Q, School of Psychology and Counselling, Queensland University of Technology, Brisbane, Australia
| | - Ian B. Stewart
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Graham K. Kerr
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Movement Neuroscience Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- Injury Prevention Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
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Goodwin VA, Pickering R, Ballinger C, Roberts H, McIntosh E, Lamb S, Nieuwboer A, Rochester L, Ashburn A. A multi-centre, randomised controlled trial of the effectiveness of PDSAFE to prevent falls among people with Parkinson's: study protocol. BMC Neurol 2015; 15:81. [PMID: 25971244 PMCID: PMC4431174 DOI: 10.1186/s12883-015-0332-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/30/2015] [Indexed: 03/24/2023] Open
Abstract
Background Falls amongst people with Parkinson’s (PwP) result in significant disability and reduced quality of life. There is emerging evidence that exercise-based and physiotherapeutic interventions are of benefit for improving fall risk factors, such as balance. However, the benefit, in terms of preventing falls, is mixed. The development of effective interventions has been identified as the highest research priority for this population. The aim of this trial is to establish the effectiveness and cost-effectiveness of a novel, home-based physiotherapy programme, compared with usual care, on falls amongst PwP. Methods/Design A UK multi-centre, community-based, single blind, randomised controlled trial with twelve month follow-up, and nested economic evaluation and qualitative studies will be undertaken. Six hundred PwP who live in their own home, have had one or more falls in the previous year and an MMSE score of ≥24 will be recruited. Those living in care homes and those needing assistance from another person to walk indoors will not be eligible. The intervention is a physiotherapist delivered, individually tailored and progressive, home-based programme (PDSAFE) comprising task orientated movement strategy training, functional lower limb strengthening and balance training, of six months duration. Unsupervised daily home exercises and strategies will be practised and supported using technology. Control participants will receive usual care. Data collection will include falls, cognitive state, balance and mobility, fear of falling, freezing of gait, mood, quality of life, carer quality of life and resource use. Data will be collected at baseline, three, six and twelve months. Longitudinal semi-structured interviews will be undertaken with forty participants to explore the expectations and experiences of participants. The primary outcome is risk of repeat falling at six months post-randomisation. Discussion The aims of this trial are to establish the effectiveness and cost-effectiveness of a novel, home-delivered physiotherapy intervention (PDSAFE) compared with usual care on risk of falling for PwP who have a history of falling. PDSAFE is a novel intervention that builds upon the existing literature and targeting known risk factors, being the first study that uses a novel delivery modus (technology) in conjunction with traditional physiotherapeutic approaches. Trial registration Current Controlled Trials ISRCTN48152791
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Borrione P, Tranchita E, Sansone P, Parisi A. Effects of physical activity in Parkinson's disease: A new tool for rehabilitation. World J Methodol 2014; 4:133-143. [PMID: 25332912 PMCID: PMC4202452 DOI: 10.5662/wjm.v4.i3.133] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 05/28/2014] [Accepted: 07/29/2014] [Indexed: 02/06/2023] Open
Abstract
Parkinson’s disease (PD) is a common neurodegenerative disease characterized by bradykinesia, tremor, rigidity, and postural instability. Motor disorders are composite and combined, adversely affecting the patient’s health. Tremor and rigidity are correlated with worsening manual dexterity as well as postural changes such as akinesia and camptocormia. Moreover, gait alteration as well as postural instability, with consequent impairment in balance, increase the risk of falls. It is well known that these symptoms respond poorly to pharmacologic therapy in PD patients. Physical therapy is the most effective non-pharmacological aid to PD patients. Available data in the literature indicate that any rehabilitation protocol has to focus on: cognitive movement strategies, cueing strategies, and improved physical capacity and balance. Different training programs for PD patients have been designed and evaluated but only specific training strategies, tailored and individualized for each patient, may produce improvements in gait speed and stride length, decrease motor and balance symptoms and improve quality of life. Furthermore, aerobic training may improve muscle trophism, strength and mobility. It seems reasonable to state that tailored physical activity is a valid tool to be included in the therapeutic program of PD patients, considering that this approach may ameliorate the symptoms as well as the overall physical incapacity, reduce the risk of falls and injuries, and ultimately improve quality of life.
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Erekat N, Al-Khatib A, Al-Jarrah M. Heat shock protein 90 is a potential therapeutic target for ameliorating skeletal muscle abnormalities in Parkinson's disease. Neural Regen Res 2014; 9:616-21. [PMID: 25206864 PMCID: PMC4146229 DOI: 10.4103/1673-5374.130105] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2014] [Indexed: 11/25/2022] Open
Abstract
Previous studies have confirmed that heat shock protein 90 overexpression can lead to dopaminergic neuronal death. This study was designed to further investigate what effects are produced by heat shock protein 90 after endurance exercise training. Immunohistochemistry results showed that exercise training significantly inhibited heat shock protein 90 overexpression in the soleus and gastrocnemius in Parkinson's disease rats, which is a potential therapeutic target for ameliorating skeletal muscle abnormalities in Parkinson's disease.
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Affiliation(s)
- Nour Erekat
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Ahed Al-Khatib
- Department of Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Muhammed Al-Jarrah
- Department of Rehabilitation Sciences, Faculty of Applied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan (Current address: Fatima College of Health Sciences (FCHS). Abu Dhabi, UAE)
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Prodoehl J, Rafferty MR, David FJ, Poon C, Vaillancourt DE, Comella CL, Leurgans SE, Kohrt WM, Corcos DM, Robichaud JA. Two-year exercise program improves physical function in Parkinson's disease: the PRET-PD randomized clinical trial. Neurorehabil Neural Repair 2014; 29:112-22. [PMID: 24961994 DOI: 10.1177/1545968314539732] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. The progressive resistance exercise (PRE) in Parkinson's disease trial (PRET-PD) showed that PRE improved the motor signs of PD compared to a modified Fitness Counts (mFC) program. It is unclear how long-term exercise affects physical function in these individuals. Objective. To examine the effects of long-term PRE and mFC on physical function outcome measures in individuals with PD. Methods. A preplanned secondary analysis was conducted using data from the 38 patients with idiopathic PD who completed the PRET-PD trial. Participants were randomized into PRE or mFC groups and exercised 2 days/week up to 24 months. Blinded assessors obtained functional outcomes on and off medication at baseline, 6 and 24 months with the Modified Physical Performance Test, 5 times sit to stand test, Functional Reach Test, Timed Up and Go, Berg Balance Scale, 6 minute walk test (6MWT), and 50-ft walking speed (walk speed). Results. The groups did not differ on any physical function measure at 6 or 24 months (Ps > .1). Across time, all physical function measures improved from baseline to 24 months when tested on medication (Ps < .0001), except for 6MWT (P = .068). Off medication results were similar except that the 6MWT was now significant. Conclusions. Twenty-four months of supervised and structured exercise (either PRE or mFC) is effective at improving functional performance outcomes in individuals with moderate PD. Clinicians should strive to include structured and supervised exercise in the long-term plan of care for individuals with PD.
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Affiliation(s)
| | | | | | | | | | | | | | - Wendy M Kohrt
- University of Colorado School of Medicine, Aurora, CO, USA
| | - Daniel M Corcos
- Rush University Medical Center, Chicago, IL, USA Northwestern University, Chicago, IL, USA
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Kelly NA, Ford MP, Standaert DG, Watts RL, Bickel CS, Moellering DR, Tuggle SC, Williams JY, Lieb L, Windham ST, Bamman MM. Novel, high-intensity exercise prescription improves muscle mass, mitochondrial function, and physical capacity in individuals with Parkinson's disease. J Appl Physiol (1985) 2014; 116:582-92. [PMID: 24408997 DOI: 10.1152/japplphysiol.01277.2013] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
We conducted, in persons with Parkinson's disease (PD), a thorough assessment of neuromotor function and performance in conjunction with phenotypic analyses of skeletal muscle tissue, and further tested the adaptability of PD muscle to high-intensity exercise training. Fifteen participants with PD (Hoehn and Yahr stage 2-3) completed 16 wk of high-intensity exercise training designed to simultaneously challenge strength, power, endurance, balance, and mobility function. Skeletal muscle adaptations (P < 0.05) to exercise training in PD included myofiber hypertrophy (type I: +14%, type II: +36%), shift to less fatigable myofiber type profile, and increased mitochondrial complex activity in both subsarcolemmal and intermyofibrillar fractions (I: +45-56%, IV: +39-54%). These adaptations were accompanied by a host of functional and clinical improvements (P < 0.05): total body strength (+30-56%); leg power (+42%); single leg balance (+34%); sit-to-stand motor unit activation requirement (-30%); 6-min walk (+43 m), Parkinson's Disease Quality of Life Scale (PDQ-39, -7.8pts); Unified Parkinson's Disease Rating Scale (UPDRS) total (-5.7 pts) and motor (-2.7 pts); and fatigue severity (-17%). Additionally, PD subjects in the pretraining state were compared with a group of matched, non-PD controls (CON; did not exercise). A combined assessment of muscle tissue phenotype and neuromuscular function revealed a higher distribution and larger cross-sectional area of type I myofibers and greater type II myofiber size heterogeneity in PD vs. CON (P < 0.05). In conclusion, persons with moderately advanced PD adapt to high-intensity exercise training with favorable changes in skeletal muscle at the cellular and subcellular levels that are associated with improvements in motor function, physical capacity, and fatigue perception.
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Affiliation(s)
- Neil A Kelly
- UAB Center for Exercise Medicine, University of Alabama at Birmingham, Birmingham, Alabama
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Parkinson’s disease and sex-related differences in electromyography during daily life. J Electromyogr Kinesiol 2013; 23:958-65. [DOI: 10.1016/j.jelekin.2013.03.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 03/18/2013] [Accepted: 03/19/2013] [Indexed: 11/19/2022] Open
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Corcos DM, Robichaud JA, David FJ, Leurgans SE, Vaillancourt DE, Poon C, Rafferty MR, Kohrt WM, Comella CL. A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease. Mov Disord 2013; 28:1230-40. [PMID: 23536417 DOI: 10.1002/mds.25380] [Citation(s) in RCA: 195] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 12/22/2012] [Accepted: 01/03/2013] [Indexed: 11/08/2022] Open
Abstract
The effects of progressive resistance exercise (PRE) on the motor signs of Parkinson's disease have not been studied in controlled trials. The objective of the current trial was to compare 6-, 12-, 18-, and 24-month outcomes of patients with Parkinson's disease who received PRE with a stretching, balance, and strengthening exercise program. The authors conducted a randomized controlled trial between September 2007 and July 2011. Pairs of patients matched by sex and off-medication scores on the Unified Parkinson's Disease Rating Scale, motor subscale (UPDRS-III), were randomly assigned to the interventions with a 1:1 allocation ratio. The PRE group performed a weight-lifting program. The modified fitness counts (mFC) group performed a stretching, balance, and strengthening exercise program. Patients exercised 2 days per week for 24 months at a gym. A personal trainer directed both weekly sessions for the first 6 months and 1 weekly session after 6 months. The primary outcome was the off-medication UPDRS-III score. Patients were followed for 24 months at 6-month intervals. Of 51 patients, 20 in the PRE group and 18 in the mFC group completed the trial. At 24 months, the mean off-medication UPDRS-III score decreased more with PRE than with mFC (mean difference, -7.3 points; 95% confidence interval, -11.3 to -3.6; P<0.001). The PRE group had 10 adverse events, and the mFC group had 7 adverse events. PRE demonstrated a statistically and clinically significant reduction in UPDRS-III scores compared with mFC and is recommended as a useful adjunct therapy to improve Parkinsonian motor signs. © 2013 Movement Disorder Society.
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Affiliation(s)
- Daniel M Corcos
- Department of Kinesiology and Nutrition, University of Illinois, Chicago, IL, USA.
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Lima LO, Scianni A, Rodrigues-de-Paula F. Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson's disease: a systematic review. J Physiother 2013; 59:7-13. [PMID: 23419910 DOI: 10.1016/s1836-9553(13)70141-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
QUESTION Does progressive resistance exercise improve strength and measures of physical performance in people with Parkinson's disease? DESIGN Systematic review with meta-analysis of randomised and quasi-randomised controlled trials. PARTICIPANTS People with Parkinson's disease, regardless of gender or level of disability. INTERVENTION Progressive resistance exercise, defined as involving repetitive, strong, or effortful muscle contractions and progression of load as the participant's abilities changed. OUTCOME MEASURES Measures of muscle strength (maximum voluntary force production) - either continuous (force, torque, work, EMG) or ordinal (manual muscle test) - and physical performance measures: sit-to-stand time, fast and comfortable walking speeds, 6-min walk test, stair descent and ascent, the Activities-specific Balance Confidence scale, Timed Up and Go test, and the Short Physical Performance Battery. RESULTS Four (quasi-) randomised trials were included, three of which reported data that could be pooled in a meta-analysis. Progressive resistance exercise increased strength, with a standardised mean difference 0.50 (95% CI 0.05 to 0.95), and had a clinically worthwhile effect on walking capacity, with a mean difference of 96 metres (95% CI 40 to 152) among people with mild to moderate Parkinson's disease. However, most physical performance outcomes did not show clinically worthwhile improvement after progressive resistance exercise. CONCLUSION This review suggests that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson's disease, but carryover of benefit does not occur for all measures of physical performance. The current evidence suggests that progressive resistance training should be implemented in Parkinson's disease rehabilitation, particularly when the aim is to improve walking capacity.
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