PD Evidence for Intervention

Question 1

Study comparing control to aerobic exercise to flexibility/balance/function

Answer 1

FBFled to better function for household activities at 4 months

AE training led to better economy of gait over 16 months.

Question 2

PRE vs. low intensity balance and stretching

Answer 2

Resistance Exercise group improved
substantially more on UPDRS Motor than
Control at 24 months

Question 3

Tai chi vs. stretching vs. strengthening

Answer 3

Balance measures: Tai chi was better than with strengthening or stretching

Gait measures: Tai chi better than stretching

Falls: Tai chi was better than stretching

UPDRS Motor: Tai chi better than stretching

Tai Chi was not superior to strengthening on any outcome except balance (primary measure)

Question 4

Bottom Line Message from PD Intervention Studies

Answer 4

Flexibility/balance/ function improves overall ability for household activities; may be hard to continue without a trainer

Aerobic conditioning improves walking efficiency; improvements sustained long term

Resistance exercise improves UPDRS Motor; improvements sustained long term

Tai Chi improves balance; also improves walking, UPDRS Motor, reduces falls

Question 5

Is Exercise Neuroprotective?

Answer 5

Animal studies (rodents, primates) suggest that
exercise might be neuroprotective for PD.

Studies are needed in humans but are
expensive

Question 6

Evidence related to vigorous activity

Answer 6

Retrospective evidence – suggests midlife,
regular exercise reduces risk of subsequent PD

Exercise reduces cognitive impairment in general
population

Question 7

Imagery & Physical Practice

Answer 7

Intervention vs. Control
Intervention group - imagery preceded practice
Control group – only practice
Both groups concluded with relaxation
Intervention group used mental imagery during relaxation
Positive outcomes for imagery plus practice
Timed up and go (.0005)
Up from supine (.0023)
Stance to supine (.06)
360 turn, steps (.0016)

Question 8

Cueing Training in the Home Immediate results

Answer 8

4.2% improvement on the PG scores
Severity of freezing was reduced by 5.5%
Step length improved 4 cm
Falls efficacy improved
Freezers: Significant improvement in FOG
Score
Effects of intervention reduced significantly
at 6 week follow up

Question 9

Application of Auditory Cues

Answer 9

Rhythmic Auditory Stimulation (RAS)
 Metronome
 Tone embedded into instrumental music
 Music with a specific tempo
General guidelines
 Find patient’s natural cadence
 Gradually increase (10% increments)
 Aim for 112 to 116 steps / min (normal cadence)

Question 10

Spinal Flexibility Exercises - Ex vs. Wait Listed

Answer 10

Significantly better FAR and FR
Secondary analysis: All exercisers significantly improved Functional Reach,Functional Axial Rotation, Supine to stand, 360 turn (steps and time)

Question 11

Strength of people with PD

Answer 11

Decreased Strength of extremities or trunk

Abnormal muscle activation patterns &
delayed relaxation time

Question 12

Which people with PD are weak?

Answer 12

UPDRS Motor and force
< 30 no difference
> 30: 50% reduction in force production
(quadriceps)
UPDRS Motor and force central activation
< 30 no difference
> 30 significant and substantial difference

Question 13

Eccentric LE Strength Training

Answer 13

Significant Outcomes
Quad muscle volume
Stair descent
Six minute walk

Question 14

Intervention Strategies – Early PD

Answer 14

Keep active
Emphasize activities that specifically challenge balance control
Tango Dance
Consider need for flexibility, strength, and
economy of movement (Schenkman et al)
‘Training Big’
Sensorimotor agility program early

Question 15

Intervention Strategies – Middle Stage of PD

Answer 15

Sensorimotor agility program to delay mobility
disability
Strategies training
Maintain / regain flexibility, aerobic capacity
‘Training Big’

Question 16

Intervention Strategies – Late Stage of PD

Answer 16

Intervention to improve balance and gait

is appropriate for people in Stage 4