Exploring Outcome Measures for Exercise Intervention in People with Parkinson's Disease

Background. It is widely believed that exercise improves mobility in people with Parkinson's disease (PD). However, it is difficult to determine whether a specific type of exercise is the most effective. The purpose of this study was to determine which outcome measures were sensitive to exercise intervention and to explore the effects of two different exercise programs for improving mobility in patients with PD. Methods. Participants were randomized into either the Agility Boot Camp (ABC) or treadmill training; 4x/week for 4 weeks. Outcome measures were grouped by the International Classification of Function/Disability (ICF). To determine the responsiveness to exercise, we calculated the standardized response means. t-tests were used to compare the relative benefits of each exercise program. Results. Four of five variables at the structure/function level changed after exercise: turn duration (P = 0.03), stride velocity (P = 0.001), peak arm speed (P = 0.001), and horizontal trunk ROM during gait (P = 0.02). Most measures improved similarly for both interventions. The only variable that detected a difference between groups was postural sway in ABC group (F = 4.95; P = 0.03). Conclusion. Outcome measures at ICF body structure/function level were most effective at detecting change after exercise and revealing differences in improvement between interventions.

[1]  Catherine Sherrington,et al.  Balance and falls in Parkinson's disease: A meta‐analysis of the effect of exercise and motor training , 2011, Movement disorders : official journal of the Movement Disorder Society.

[2]  R. Fitzpatrick,et al.  PDQ-39: a review of the development, validation and application of a Parkinson’s disease quality of life questionnaire and its associated measures , 1998, Journal of Neurology.

[3]  Ryan P. Duncan,et al.  Randomized Controlled Trial of Community-Based Dancing to Modify Disease Progression in Parkinson Disease , 2012, Neurorehabilitation and neural repair.

[4]  A. Bonnet,et al.  [The Unified Parkinson's Disease Rating Scale]. , 2000, Revue neurologique.

[5]  B. E. Maki,et al.  Measuring balance in the elderly: validation of an instrument. , 1992, Canadian journal of public health = Revue canadienne de sante publique.

[6]  G. Chard International Classification of Functioning, Disability and Health , 2004 .

[7]  Elizabeth Eckstrom,et al.  Tai Chi and fall reductions in older adults: a randomized controlled trial. , 2005, The journals of gerontology. Series A, Biological sciences and medical sciences.

[8]  L. E. Powell,et al.  The Activities-specific Balance Confidence (ABC) Scale. , 1995, The journals of gerontology. Series A, Biological sciences and medical sciences.

[9]  A. Wernig,et al.  Weight-supported treadmill vs over-ground training for walking after acute incomplete SCI , 2006, Neurology.

[10]  B. Bloem,et al.  Evidence‐based analysis of physical therapy in Parkinson's disease with recommendations for practice and research , 2007, Movement disorders : official journal of the Movement Disorder Society.

[11]  Aaas News,et al.  Book Reviews , 1893, Buffalo Medical and Surgical Journal.

[12]  Margaret Schenkman,et al.  Exercise to Improve Spinal Flexibility and Function for People with Parkinson's Disease: A Randomized, Controlled Trial , 1998, Journal of the American Geriatrics Society.

[13]  James McNames,et al.  Mobility Lab to Assess Balance and Gait with Synchronized Body-worn Sensors. , 2011, Journal of bioengineering & biomedical science.

[14]  W. Marsden I and J , 2012 .

[15]  恵子 紀国谷 国際生活機能分類(International Classification of Functioning, Disability and Health: ICF)にみた福祉・保健・医療の専門職協働における連携に関する貢献と課題 , 2007 .

[16]  E. Papa,et al.  The Effects of Exercise on Balance in Persons with Parkinson's Disease: A Systematic Review Across the Disability Spectrum , 2009, Journal of neurologic physical therapy : JNPT.

[17]  T. Steffen,et al.  Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism , 2008, Physical Therapy.

[18]  Treadmill Training for Individuals With Parkinson Disease , 2012, Physical Therapy.

[19]  A. Damiano,et al.  A review of health-related quality-of-life concepts and measures for Parkinson's disease , 1999, Quality of Life Research.

[20]  Becky G. Farley,et al.  Training BIG to move faster: the application of the speed–amplitude relation as a rehabilitation strategy for people with Parkinson’s disease , 2005, Experimental Brain Research.

[21]  G M Earhart,et al.  Dance as therapy for individuals with Parkinson disease. , 2009, European journal of physical and rehabilitation medicine.

[22]  Lorenzo Chiari,et al.  ISway: a sensitive, valid and reliable measure of postural control , 2012, Journal of NeuroEngineering and Rehabilitation.

[23]  Jeffrey M. Hausdorff,et al.  Six weeks of intensive treadmill training improves gait and quality of life in patients with Parkinson's disease: a pilot study. , 2007, Archives of physical medicine and rehabilitation.

[24]  F. Horak,et al.  iTUG, a Sensitive and Reliable Measure of Mobility , 2010, IEEE Transactions on Neural Systems and Rehabilitation Engineering.

[25]  Lillemor Lundin-Olsson,et al.  Criteria for evaluation of measurement properties of clinical balance measures for use in fall prevention studies. , 2008, Journal of evaluation in clinical practice.

[26]  Adrian H. Taylor,et al.  The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta‐analysis , 2008, Movement disorders : official journal of the Movement Disorder Society.

[27]  Rebecca Stowe,et al.  Physiotherapy versus placebo or no intervention in Parkinson's disease. , 2012, The Cochrane database of systematic reviews.

[28]  S. R. Alouche,et al.  Different protocols of physical exercise produce different effects on synaptic and structural proteins in motor areas of the rat brain , 2012, Brain Research.

[29]  Andreas Kupsch,et al.  Comparing exercise in Parkinson's disease—the Berlin BIG Study , 2010, Movement disorders : official journal of the Movement Disorder Society.

[30]  J. Gerber,et al.  High intensity eccentric resistance training decreases bradykinesia and improves Quality Of Life in persons with Parkinson's disease: a preliminary study. , 2009, Parkinsonism & related disorders.

[31]  Laurie A. King,et al.  Do Clinical Scales of Balance Reflect Turning Abnormalities in People With Parkinson's Disease? , 2012, Journal of neurologic physical therapy : JNPT.

[32]  F. Horak,et al.  Delaying Mobility Disability in People With Parkinson Disease Using a Sensorimotor Agility Exercise Program , 2009, Physical Therapy.

[33]  ...But is the outcome meaningful? JNPT's recommendations for reporting results of controlled trials. , 2011, Journal of neurologic physical therapy : JNPT.

[34]  R. Fitzpatrick,et al.  The Parkinson's Disease Questionnaire (PDQ-39): development and validation of a Parkinson's disease summary index score. , 1997, Age and ageing.

[35]  W. Greenough,et al.  Learning causes synaptogenesis, whereas motor activity causes angiogenesis, in cerebellar cortex of adult rats. , 1990, Proceedings of the National Academy of Sciences of the United States of America.

[36]  Katy Mitchell,et al.  Gait and step training to reduce falls in Parkinson's disease. , 2005, NeuroRehabilitation.

[37]  Bruce H Dobkin,et al.  Body-weight-supported treadmill rehabilitation after stroke. , 2011, The New England journal of medicine.

[38]  B. Dobkin,et al.  Should Body Weight–Supported Treadmill Training and Robotic-Assistive Steppers for Locomotor Training Trot Back to the Starting Gate? , 2012, Neurorehabilitation and neural repair.

[39]  M. T. J. Buñuales,et al.  La clasificación internacional del funcionamiento de la discapacidad y de la salud (CIF) 2001 , 2002 .

[40]  Antonio Nardone,et al.  Using psychometric techniques to improve the Balance Evaluation Systems Test: the mini-BESTest. , 2010, Journal of rehabilitation medicine.