1
|
Miller SA, Mayol M, Moore ES, Heron A, Nicholos V, Ragano B. Rate of Progression in Activity and Participation Outcomes in Exercisers with Parkinson's Disease: A Five-Year Prospective Longitudinal Study. PARKINSON'S DISEASE 2019; 2019:5679187. [PMID: 31662843 PMCID: PMC6778930 DOI: 10.1155/2019/5679187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/12/2019] [Accepted: 07/02/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rates of progression of motor symptoms and physical performance show declines between 2% and 7% annually in community samples with Parkinson's disease (PD). However, the effects of ongoing exercise behaviors on progression rates have not been considered. OBJECTIVE The primary purpose of this prospective, longitudinal study was to examine the annual rates of progression in activity and participation measures over five years in community-based exercisers with PD. METHODS A cohort of 55 regular exercisers with idiopathic PD was assessed at baseline and 1, 2, and 5 years. Regular exercise was defined as scores of 4-5 on the Stages for Readiness to Exercise Scale and a self-reported average of at least 60 minutes of exercise/week within six months of each testing session. Unadjusted and adjusted annual progression rates for activity and participation measures were calculated with a standardized equation of change from baseline. A linear mixed model with covariates of age at PD diagnosis and PD subtype was used to determine adjusted change scores. RESULTS Annual progression rates for unadjusted and adjusted variables were similar, and none exceeded 1.7% across time points for this group of exercisers with PD. Older age at PD diagnosis significantly contributed to faster progression of walking and balance functions. A nonlinear trajectory of the PD progression was demonstrated across most activity and participation outcomes. CONCLUSIONS Annual progression rates demonstrated by this sample of exercisers were lower than those previously reported for motor decline in general samples with PD. Assessing activity and participation outcomes longitudinally at interim time points was important for understanding the trajectory of change over time. The lower rates of progression in this study warrant further investigation into the long-term effects of exercise in PD.
Collapse
Affiliation(s)
- Stephanie A. Miller
- University of Indianapolis, Krannert School of Physical Therapy, 1400 E. Hanna Ave., Indianapolis, IN 46227, USA
- University of Indianapolis, Interprofessional Health and Aging Studies, 1400 E. Hanna Ave., Indianapolis, IN 46227, USA
| | - Mindy Mayol
- University of Indianapolis, Exercise Science, Department of Kinesiology, Health and Sport Sciences, 1400 E. Hanna Ave., Indianapolis, IN 46227, USA
| | - Elizabeth S. Moore
- University of Indianapolis, Interprofessional Health and Aging Studies, 1400 E. Hanna Ave., Indianapolis, IN 46227, USA
| | - Audra Heron
- University of Indianapolis, Krannert School of Physical Therapy, 1400 E. Hanna Ave., Indianapolis, IN 46227, USA
| | - Victoria Nicholos
- University of Indianapolis, Krannert School of Physical Therapy, 1400 E. Hanna Ave., Indianapolis, IN 46227, USA
| | - Brian Ragano
- University of Indianapolis, Krannert School of Physical Therapy, 1400 E. Hanna Ave., Indianapolis, IN 46227, USA
| |
Collapse
|
2
|
Vila-Chã N, Cavaco S, Mendes A, Gonçalves A, Moreira I, Fernandes J, Damásio J, Azevedo LF, Castro-Lopes J. Unveiling the relationship between central parkinsonian pain and motor symptoms in Parkinson's disease. Eur J Pain 2019; 23:1475-1485. [PMID: 31070825 DOI: 10.1002/ejp.1413] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 04/30/2019] [Accepted: 05/05/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pain in Parkinson's disease (PD) is a common and heterogeneous non-motor symptom. Although the characteristics and predictors of pain in general and of central pain in particular are still largely unknown. METHODS A semi-structured interview, the Brief Pain Inventory and the Pain Disability Index were used to identify and characterize pain in a consecutive series of 292 PD patients. Unified PD Rating Scale-III, Hoehn & Yahr, Schwab and England Independence Scale and Freezing of Gait Questionnaire were applied to assess motor symptoms and functional independence in off and on conditions. Hospital Anxiety and Depression Scale and Questionnaire of Impulsive-Compulsive Control Disorders were used to screen for anxiety, depression and impulse control disorders. RESULTS Two hundred and twelve patients (73%) reported pain, which was classified as: musculoskeletal (63%), dystonia-related (27%), central parkinsonian (22%) and/or radicular or neuropathic (9%). Patients with pain had more comorbidities and more severe motor symptoms. Patients with central parkinsonian pain were significantly younger, had earlier disease onset, fewer comorbidities, greater non-axial motor symptom severity in on, more pain-related disability and more relief of pain with antiparkinsonian medication than patients with non-central parkinsonian pain. CONCLUSIONS PD patients with central parkinsonian pain have some distinctive demographic and clinical features, including lower levodopa responsiveness of motor appendicular/limb symptoms to levodopa, associated with greater responsiveness of pain symptoms to these same medications. These findings suggest the need for a more integrated approach to motor and non-motor symptoms in these patients' clinical care. SIGNIFICANCE In a consecutive series of 292 patients with PD, almost three quarters of patients with PD reported pain. The study results revealed that pain was related to more severe motor symptoms, anxiety symptoms and comorbidities. Among patients with pain, those with central parkinsonian subtype had distinct demographic and clinical features, including lower levodopa responsiveness for non-axial motor symptoms and greater responsiveness of pain to antiparkinsonian treatment.
Collapse
Affiliation(s)
- Nuno Vila-Chã
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal.,Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal
| | - Sara Cavaco
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal
| | - Alexandre Mendes
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Alexandra Gonçalves
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Inês Moreira
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Joana Fernandes
- Laboratory of Neurobiology of Human Behavior, Centro Hospitalar do Porto, Porto, Portugal.,Unity in Multidisciplinary Research on Biomedicine (UMIB), Abel Salazar Biomedical Sciences Institute, University of Porto, Porto, Portugal
| | - Joana Damásio
- Department of Neurology, Centro Hospitalar do Porto, Porto, Portugal.,Institute for Molecular and Cell Biology (IBMC), University of Porto, Porto, Portugal
| | - Luís Filipe Azevedo
- Centre for Health Technology and Services Research (CINTESIS), University of Porto, Porto, Portugal.,National Observatory for Pain-NOPain, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal
| | - José Castro-Lopes
- National Observatory for Pain-NOPain, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Experimental Biology, Faculty of Medicine, University of Porto, Porto, Portugal
| |
Collapse
|