Exercise to Improve Spinal Flexibility and Function for People with Parkinson's Disease: A Randomized, Controlled Trial
The effectiveness of an exercise intervention for people in early and midstage Parkinson's disease (stages 2 and 3 of Hoehn and Yahr) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described.
Fifty-one men and women, aged 55-84 years, identified through advertisement, local support groups, and local neurologists were enrolled into a randomized, controlled trial. Subjects were assigned randomly to an intervention or a usual care arm (i.e., no specific exercise). Of the original 51 participants, 46 completed the randomized, controlled trial. Participants in the exercise arm (n = 23) received individual instruction three times per week for 10 weeks. Participants in the usual care arm (n = 23) were "wait listed" for intervention.
Changes over 10 weeks in spinal flexibility (i.e., functional axial rotation) and physical performance (i.e., functional reach, timed supine to stand) were the primary outcome measures.
MANOVA conducted for the three primary outcome variables demonstrated significant differences (P < or = .05) between the two groups. Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group. There was no significant difference in supine to sit time.
Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD.
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- "However many patients do exercise kayaking as leisure activity in western countries18 but not in Pakistan. According to the results of our study trunk flexibility can be improved by kayaking exercises which supports the findings of Schenkman and his colleagues.10,15,19 "
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ABSTRACT: Objective: To determine the effectiveness of kayaking exercises in the management of axial rigidity, improve bed mobility by improving trunk rotation in Parkinson’s patients.
Methods: Experimental randomized controlled trail conducted at Physiotherapy department of IPM&R, DUHS and neurology Outpatient Department of Civil Hospital Karachi. Sample size of 48 was calculated with the use of openEpi. After baseline assessment 24 participants were assigned to each Kayaking exercise and general mobility exercise groups. Both groups received treatment for 75 minutes, 6 days a week for 4 weeks. Pre and post treatment measurements were determined by goniometer that assessed the cervical and thoracolumbar rotations whereas bed mobility was assessed by Modified Parkinson’s Activity Scale (MPAS).
Results: In Kayaking group mean cervical spine left rotation increased from 32.95+ 9.66 to 47.25 + 10.58, right side cervical spine rotation increased from 34.00 + 10.32 to 47.58 + 11.96, left side thoracolumbar rotation increased from 23.67 + 4.70 to 28.16 + 3.44, right side thoracolumbar rotation increased from 20.79 + 5.34 to 26.45 + 4.62. In control group mean cervical spine left rotation increased from 34.66+ 9.26 to 43.08 + 8.70, right side cervical spine rotation increased from 35.37 + 9.77 to 43.83 + 9.59 , left side thoracolumbar rotation increased from 23.70 + 4.77 to 26.87 + 3.73, right side thoracicolumbar rotation increased from 21.16 + 5.29 to 24.95 + 4.53 (P value <0.001).. Bed mobility on MPAS scale also showed significant improvements (P value <0.001).
Conclusion: Both Kayaking and general exercises resulted in significant improvements after 4 weeks of treatment. However, Kayaking exercises were slightly more beneficial than general exercises.
Available from: Sunee Bovonsunthonchai
- "This is supported by a previous study (Kerrigan et al., 2003) that found that stretching of the hip flexors and plantarflexors improved walking speed and suggested that stretching of the hip flexors might improve muscle flexibility and balance in the elderly. In addition, stretching exercises may reduce freezing of the gait, resulting in improved gait initiation time (Schenkman et al., 1998; ➔ Morris, 2000). Second, the TrainingBIG™ concept used in the study may assist the patients to correct their movement pattern through new programming in the brain, improving movement calibration and developing neural plasticity (Farley and Koshland, 2005; Farley et al., 2008). "
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ABSTRACT: The present study investigated the effects of physical therapy treatment on gait initiation in patients with Parkinson's disease (PD). Thirteen patients with PD were randomized into a treatment (n = 7) and control (n = 6) group. Participants were assessed for their severity level, using the Modified Hoehn and Yahr scale, and motor evaluation, using the Unified Parkinson's Disease Rating Scale (UPDRS), items III and IV. At pre-and post-assessments, gait initiation was assessed using a gait mat, synchronized with a video camera. The treatment group received a physical therapy training program based on the TrainingBIG™ technique and task-specific concepts, three times per week for four weeks. The control group received no physical therapy treatment. From analysis of the pre-and post-assessment variables, only the treatment group showed a significant decrease in preparatory phase time (p = 0.043) and increase in step length (p = 0.018). In addition, the treatment group had a significant increase in step length (p = .022) at post-assessment when compared to the control group. The present findings demonstrated that physical therapy treatment would be beneficial for patients with PD experiencing gait initiation problems.
Available from: Fay Horak
- "Delaying and minimizing these inevitable complications of PD with physical therapy exercise would have a major impact on patients and their families' quality of life, healthcare systems , and possibly even the course of disease progression. Exercise has received much attention in the past decade as a way to delay the onset of mobility disability and there are a steadily increasing number of randomized controlled trials demonstrating that varying types of exercise improve some aspects of balance or gait            . However, it is difficult to determine whether a specific type of exercise program is more effective than another. "
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ABSTRACT: 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.
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