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Resistance Training Reduces Depressive Symptoms in Older PD Patients, Trial Shows

Resistance training

Twenty weeks of resistance training significantly decreases depression symptoms and improves quality of life in older people with Parkinson’s disease (PD), a study has found.

The training, consisting of exercises involving the arms and legs and simulating daily activity movements, also improved patients’ flexibility, endurance, and walking performance.

Based on the promising results, researchers are calling for resistance training to be included in exercise programs for patients with Parkinson’s disease.

Their study, “Resistance training reduces depressive symptoms in elderly people with parkinson disease: A controlled randomized study,” was published in the Scandinavian Journal of Medicine and Science in Sports.

Loss of muscle strength and function predisposes Parkinson’s patients to sedentary behavior and social isolation, with consequent increase in depressive symptoms, affecting up to 40% of patients.

But studies suggest that those who have a more active lifestyle and exercise are less prone to depression.

Some researchers contend that exercise works at least as well as antidepressants. The effect of exercise as natural antidepressant is thought to be mediated either by stimulating the growth of new nerve cells — as antidepressant medications might — or releasing substances from muscles and fat cells (adipocytes) that can travel to the brain and work as antidepressants.

Up to now, known effective physical therapies against depression in Parkinson’s are based mostly on  aerobic exercises.

Here, Brazilian researchers conducted a trial to evaluate the benefits of another exercise modality — resistance training — in reducing depression and improving quality of life in elderly patients with PD.

Considering its potential physical benefits, researchers investigated how much this type of training improved patients’ movement and resistance capacity as well. The trial was sponsored by Pará State University, in Brazil.

Resistance training is a form of exercise designed to improve muscular fitness by exercising a muscle or a group of muscles against any object that poses an external resistance. This causes muscles to contract, which can help improve strength, power, muscle growth, and endurance.

The trial involved 33 patients, age 60 or older, who were randomly assigned to resistance training (17 patients) or a control group (16 patients) for 20 weeks. All were on stable medication and had Parkinson’s stage 1-3 on the Hoehn and Yahr scale.

Those in the resistance training group spent the first two weeks getting used to the exercises, under supervision. After that, they started having training sessions twice a week, on non-consecutive days.

Each session (30–40 minutes each) consisted of two series of of 8–12 repetitions of these exercises: bench press, deadlift, unilateral rowing, standing calf raise and abdominal reverse crunch. Such exercises involve the major muscle groups in the arms and legs and mimic the basic movements of daily activities.

Training loads were increased when the patient had a high performance, with full range of motion.

Unlike the control group, at the end of the 20 weeks, patients performing resistance training had fewer depressive symptoms. Clinician-rated HAM-D17 scores dropped from 17.9 to 10.3.

Patients in this group also reported improvements in their quality of life (as measured by the Parkinson’s disease Questionnaire, PDQ-39) and had better UPDRS scores, which rate Parkinson’s motor and non-motor symptoms.

Concerning motor capacity, resistance training also improved patients’ physical performance as seen in several tests — Timed Up and Go (pre-training, 33.2 seconds versus post training, 26.4 seconds), flexibility on the sit and reach test (pre, 20.7 cm versus post, 28.8 cm), aerobic endurance measured by the two-minute step test (pre, 79.2 steps versus post, 99.1 steps) and maximum walking speed (pre, 1 meter per second versus post, 1.3 meters per second).

In contrast, no significant changes were seen in the control group, either regarding depressive symptoms, quality of life, or motor skills.

“In addition to improving functional capacity and quality of life, resistance training reduces depressive symptoms of elderly with Parkinson’s disease,” the researchers said.

“To our knowledge, the present study is the first to show that 20 weeks of isolated resistance training reduced depressive symptoms in elderly people presenting PD. We suggest that resistance training should be a central component of exercise programs for patients with Parkinson’s disease,” they concluded.

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Heel, Toe: Walking with Mindfulness

walking

Slow Is the New Fast Jean Mellano

Mindfulness isn’t difficult, we just need to remember to do it.” — Sharon Salzberg

The ability to walk is something many of us, myself included, have always taken for granted. Now that I have Parkinson’s disease (PD), something that used to come as a matter of course to me is starting to deteriorate. PD has adversely affected my left side more than my right side. I find myself tripping more, since I tend to drag my left foot.

Walking now requires my conscious thought

Going for a walk is now more of a mindful task than an exercise for me. I find it much more therapeutic to focus on how I walk and be in the present moment than to think about the future and how my PD may progress. With each step I take, I concentrate on repeating to myself, “Heel, toe.”

My stride analysis

When there was snow on the ground, I decided to compare my walking steps when I did not focus on saying “heel, toe” with those from when I did. My footprints in the snow were very telling, so I took a photograph. On the left side of the photo are my steps when I was not thinking about my stepping patterns. You might notice that both feet show a bit of a drag in the snow. On the right side of the photo, as I moved forward, I really focused on flexing both of my feet and having my heel strike first. There are no signs of drag on either foot.

Am I putting too much thought into this?

Years of training to improve as a dancer and a cyclist have made analysis of my body movements come quite naturally to me. Whether it was improving my pedal stroke for more cycling power or perfecting my balance to do pirouette turns, I learned to be mindful and to be in touch with how my body was performing. Now I must use that skill to help myself be more attentive when I walk.

My neurologist says I tend to overthink things. I believe our greatest strengths can also be our greatest weaknesses. Sometimes, I do overthink, to the point of getting paralysis by analysis. However, I believe that mindful analysis of my PD symptoms (including my walking technique) is critical in helping me to create different ways of doing things that at one time (before PD) used to come as second nature to me.

Do not dwell in the past, do not dream of the future, concentrate the mind on the present moment.” — Unknown

***

Note: Parkinson’s News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Parkinson’s News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to Parkinson’s disease.

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Treadmill Walking Linked to Greater Gait Stability, Less Cognitive Control in Parkinson’s, Study Says

treadmill test

Treadmill walking, but not over-ground walking, can improve gait stability in patients with Parkinson’s disease, a study has found.

The research, “Treadmill walking reduces pre-frontal activation in patients with Parkinson’s disease” was published in Gait & Posture.

It is widely known that Parkinson’s patients have difficulties preforming learned motor skills automatically, a phenomenon referred to as decreased motor automaticity. Automaticity is the ability to perform movements without having to pay attention to the details of the movement, particularly for actions that require low levels of precision or for movements that are frequently made, such as walking.

Evidence indicates that the gait changes observed in Parkinson’s patients are associated with impaired rhythmicity and increased activation of the prefrontal cortex — a brain area responsible for higher thought processes, such as decision making, planning and reasoning. It’s believed that prefrontal activation occurs to compensate patients’ reduced automaticity.

Researchers from the Tel Aviv Sourasky Medical Center, in Israel, decided to investigate whether treadmill walking, when the pace is determined and fixed, reduced prefrontal activation in Parkinson’s patients (which improves  automatic motor skills) in comparison to over-ground walking.

Twenty Parkinson’s patients (10 men and 10 women; mean age 69.8 years) were asked to walk at a self-selected walking speed over-ground (in a 32-yard corridor) and then on a treadmill. Each walking condition was tested five times.

On the treadmill, patients had to walk for 30 seconds after they reached the steady state for their self-selected comfortable walking speed.

Using a non-invasive imaging technique called functional near-infrared spectroscopy (fNIRS), researchers assessed the participants’ prefrontal activation by measuring the changes in hemoglobin (the molecule in red blood cells that carries oxygen) concentrations within that brain region.

Gait and prefrontal activation were assessed during the two walking conditions in the “on” medication state (when medication does not wear off and motor symptoms are controlled). All participants completed the over-ground trials in approximately 30 seconds each.

Compared to over-ground walking, prefrontal activation was significantly decreased during treadmill walking, as measured by a lower hemoglobin concentration in that brain region.

Gait stability was greater on the treadmill, in comparison to the over-ground walking condition.

“From a clinical perspective, our findings add further support to the idea that training on the treadmill may be useful to improve gait stability while also freeing cognitive resources to allow for more targeted and challenging training such as dual task training,” researchers said. Dual-tasking involves performing a primary motor task, such as standing, and a secondary task, like talking, simultaneously. It is the primary means of assessing the automaticity of a given motor task.

Further research is warranted to assess the mechanisms behind prefrontal activation and how disease severity or medication regimens may influence the body’s response to an external pacemaker, such as treadmill exercising.

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Treadmill Incline Training Improves Walking Speed of Parkinson’s Patients, Study Finds

treadmill incline training

Eight weeks of training on a treadmill with continuously varying surface inclines improved gait disturbances, particularly walking speed, in Parkinson’s disease patients, researchers report.

Their finding were published in the study, “Exploring gait adaptations to perturbed and conventional treadmill training in Parkinson’s disease: Time-course, sustainability, and transfer,” in the journal Human Movement Science.

As the disease progresses, Parkinson’s patients experience an increase in gait difficulties and balance problems, lowering their mobility and quality of life.

In addition, studies have shown that Parkinson’s patients take shorter and slower steps, and have high stride-to-stride variability.

Because some gait disturbances are drug-resistant, nonpharmacological treatment options are needed to improve these patients’ quality of life.

“Improved stride length and stride-to-stride variability have been demonstrated following several weeks of treadmill practice for both, overground and treadmill walking, respectively,” the authors wrote.

Researchers had recently demonstrated that eight weeks of treadmill therapy with additional postural perturbations (i.e., varying surface inclines) improved overground gait speed and dynamic balance control in Parkinson’s patients.

Now the same team at Friedrich-Alexander University Erlangen-Nürnberg has analyzed spatiotemporal gait adaptations to treadmill training — with and without an incline — both on and off the machine.

They used data from a randomized controlled Phase 1 trial (NCT01856244) aimed at investigating the effectiveness of a sensorimotor treadmill intervention to improve walking and balance abilities in people in the early stages of Parkinson’s disease.

Sensorimotor treadmill training was conducted on a special machine that challenged the participants through small oscillations, simulating walking on natural, uneven surfaces. This intervention was compared with conventional treadmill training without surface perturbations.

Thirty-eight Parkinson’s patients were randomly assigned to 40 minutes of treadmill training two times per week for eight weeks. Of these patients, 18 performed treadmill training with continuously varying surface inclines, while the other 20 walked on the treadmill without surface perturbations.

Patients were assessed every week during training protocol (prior to the training sessions), within one week after the intervention, and at a three-month follow-up.

Gait variability significantly decreased in both training groups. Nonetheless, longer stride length and time, stance time, and swing time were significantly improved only in the treadmill incline training group.

For reference, one gait cycle consists of two phases: stance, or the period of time that the foot is on the ground, and swing, meaning the period of time that the foot is off the ground moving forward.

Researchers then investigated the sustainability of gait changes over three months.

At the three-month follow-up, there were significant changes between the groups in stance and swing time, which were due to a much higher variability in the conventional treadmill training group. Statistical comparisons within the groups revealed no significant changes in the treadmill incline training group.

Additional statistical analysis also showed decreased step length asymmetry in the conventional treadmill training group.

The team then assessed the extent of transfer effects to overground gait in both training regimes.

“When considering the entire sample, significant changes in overground gait parameters at [week 8] were observed only for stance- and swing time, with a significantly decreased stance time … and a corresponding increase in swing time,” they wrote. However, these findings were statistically significant only in the treadmill incline training regime.

“[Parkinson’s disease] patients demonstrated marked gait adaptations to the eight-week treadmill intervention, which were partially retained after three months follow-up,” they noted.

Treadmill training with small oscillations seemed to reduce gait disturbances, but the transfer of such changes to overground walking was limited in most evaluated variables.

Further research is still necessary to corroborate these findings.

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Beat It! Learning to Walk to Music Reduces Falls for Parkinson’s Patients

walking and music

A training program in which patients walk while listening to regular beats can improve the velocity and cadence of Parkinson’s disease patients, while reducing their risk of falling, a study shows.

The study, “Rhythmic auditory stimulation for reduction of falls in Parkinson’s disease: a randomized controlled study,” was published in the journal Clinical Rehabilitation.

Parkinson’s disease patients experience difficulties in movement that affect their ability to produce a steady gait, resulting in a high incidence of falls. More than half of all Parkinson’s patients fall recurrently.

While there are several training techniques to aid in maintaining a steady gait and avoiding falls, studies suggest that gait motor control is dependent on a patient’s internal timing and that rhythm-based training could reduce risk of falling.

The rhythmic auditory stimulation (RAS) technique is among the approaches used to synchronize gait movements with time cues. But there have been no studies assessing the benefits of RAS in Parkinson’s patients.

So, researchers in Canada set out to determine if a home-based RAS program could aid in decreasing falls in patients with that history.

The study was a randomized, controlled trial (NCT03316365) that involved 60 Parkinson’s patients, 47 of whom completed the study.

The RAS training protocol involved 30 minutes of daily walking using “click-embedded music,” which was designed to enhance rhythm perception. Essentially, patients listened to folk or classical music with embedded metronome beats while performing their walking exercises.

Participants were divided into two groups, experimental and control. Both groups received RAS training up to week 8, after which the control group stopped training and the experimental group continued. Then  training was resumed for the control group between weeks 16 and 24. Patients in the experimental group received RAS training for the entire 24 weeks.

Participants were assessed at the beginning of the study and at eight, 16, and 24 weeks following that. Assessment criteria included stride length, speed, balance, and falls.

As expected, no significant differences were seen between the two groups at week eight. However, at week 16, the experimental group showed significant improvement in velocity, cadence, stride length, decreased number of falls, and fear of falling compared to the control group.

At week 24 — after the control group had resumed RAS training — the signifiant differences in velocity, cadence, stride length, and fear of falling remained, but there were no longer significant differences in the number of falls.

Taken together, the findings indicate that “RAS gait training significantly reduced the number of falls and modified key [parameters] in gait control in patients with Parkinson’s disease,” researchers wrote.

“This clinical investigation demonstrates that RAS gait training is a potential intervention to reduce the risk of falling, since it directly addresses temporal instability, which is one of the most detrimental variables associated with falls,” they concluded.

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Source: Parkinson's News Today

Socks with Sensors Being Tested to Detect Early Signs of Walking Disorders, Parkinson’s

ODU

Special socks using a wearable fitness-tracking technology are being investigated in a pilot study to see if they can detect early signs of movement or walking disorders, like Parkinson’s disease, or  in people.

Inspired by technology like Fitbit  — wearable equipment that track fitness performance like daily steps and heart rate — researchers at Old Dominion University in Virginia, working in collaboration with neurologists at Sentara Healthcare, are using washable socks wired with special sensors capable of tracking movement, detecting step numbers and gait patterns that might reveal clinical evidence of problems.

Developed Sensoria, these noncommercial fitness socks include a removable device capable of recording five to seven days’ worth of information, and sensors that can measure gait, acceleration and balance, according to a news story in  The Virginian-Pilot. Data is held in a small device attached to the socks, which can then be downloaded to a computer or sent to a smartphone or tablet.

A two-part pilot study is now underway in university students. If the data seem accurate, a second-part is planned involving 60 older adults — a mix of healthy people serving as controls and Parkinson’s patients, with both groups wearing the socks for seven days, the news article states.

“The ‘silver tsunami’ of older adults over the age of 65 is expected to double over the next 20 to 30 years,” Steven Morrison, an ODU professor and director of research for the School of Physical Therapy and Athletic Training, said in a university press release. “We are going to have more older adults at risk for falls, so anything we can do to decrease that risk will be better for the population as a whole.”

If all goes well, the researchers plan to reach out to Parkinson’s groups like the Michael J. Fox Foundation and  the National Institutes of Health (NIH) to support further studies into this fitness technology and its ability to detect problems before symptoms are evident, or a need for changes in treatment given someone with a disease diagnosis.

A YouTube video on this pilot study is available here.

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Source: Parkinson's News Today

Michael J.Fox Foundation Uses Parkinson’s Awareness Month to Promote Summer Events

summer fun for parkinson's

During Parkinson’s Awareness Month the Michael J. Fox Foundation (MJFF) wants to help those making summer plans turn their hobbies into a fundraiser for Parkinson’s disease research.

As part of the effort, the foundation has selected some of the best outdoors fundraisers taking place this year, including cycling, walking, running or swimming for Parkinson’s.

Anyone can register for a local event and help advance research toward a cure. There are options available for patients and their community to help the movement.

Fox Trot 5K Run/Walks

The foundation hosts an increasing number of Fox Trot 5K run/walks nationwide every year. This year, people can join the Orlando Fox Trot 5K run/walk on May 19 in Orlando, Florida, or the New York City Fox Trot 5K in Riverside Park, New York City, on Aug. 9.

If there is no 5K run/walk planned nearby, people may choose any race in their community and fundraise through Team Fox, or select other athletic and community-hosted events featured on the foundation’s website.

Tour de Fox Cycling Series

For those who prefer cycling, the Tour de Fox Cycling Series is back with two new events. Along with tour stops in Vancouver, British Columbia, Sonoma County, California, and Greenville, South Carolina, the tour will be heading to Southlake, Texas and Madison, New Jersey.

Pedaling 4 Parkinson’s

For those seeking an additional challenge, they can join a group of friends and meet in Denver, Colorado,  for Pedaling 4 Parkinson’s on June 16.

New England Parkinson’s Ride

The largest independent Team Fox will be joining the 11th annual New England Parkinson’s Ride, in Old Orchard Beach, Maine, on Sept. 8. All events host rides of different difficulty and distances, so that everyone can participate.

Escape from Alcatraz Triathlon

For those who would like to add water sports to the fund-raising challenge, there will be an “Escape from Alcatraz Triathlon” where participants can swim, bike and run their way closer to a cure for Parkinson’s. On June 3, Team Fox also will join the event.

The initiative’s goal is to get communities involved and help advance critical research to find a cure for this life-debilitating disease. Check here for more information about the events or other opportunities to participate in Parkinson’s Awareness Month.

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Source: Parkinson's News Today