Background Deficits in the cerebellar locomotor region (CLR) have been associated with loss of gait automaticity in individuals with freezing of gait in Parkinson's disease (freezers); however, exercise interventions that restore gait automaticity in freezers are lacking. We evaluated the effects of the adapted resistance training with instability ([ARTI] complex exercises) compared with traditional motor rehabilitation (without complex exercises) on gait automaticity and attentional set‐shifting. We also verified associations between gait automaticity change and CLR activation change previously published. Methods Freezers were randomized either to the experimental group (ARTI, n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. Gait automaticity (dual‐task and dual‐task cost [DTC] on gait speed and stride length), single‐task gait speed and stride length, attentional set‐shifting (time between Trail Making Test parts B and A), and CLR activation during a functional magnetic resonance imaging protocol of simulated step initiation task were evaluated before and after interventions. Results Both training groups improved gait parameters in single task (P < 0.05), but ARTI was more effective than traditional motor rehabilitation in improving DTC on gait speed, DTC on stride length, dual‐task stride length, and CLR activation (P < 0.05). Changes in CLR activation were associated with changes in DTC on stride length (r = 0.68, P = 0.002) following ARTI. Only ARTI improved attentional set‐shifting at posttraining (P < 0.05). Conclusions ARTI restores gait automaticity and improves attentional set‐shifting in freezers attributed to the usage of exercises with high motor complexity. © 2020 International Parkinson and Movement Disorder Society

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O objetivo deste estudo foi verificar dentre os sintomas motores, sintomas não motores e o medo de cair quais seriam os principais preditores de qualidade de vida em indivíduos nos estágios 2 e 3 da doença de Parkinson (DP). Trinta e nove indivíduos com DP (64,1±9,1 anos, 10,3±4,7 duração da DP) avaliados no estado on da medicação participaram do estudo. A disfunção motora foi avaliada por meio dos seguintes testes: parte III da Escala Unificada de Avaliação da Doença de Parkinson (UPDRS-III), teste Timed up and Go (TUG), Teste de Sistema de Avaliação do Equilíbrio (BESTest) e uma repetição máxima dos membros inferiores (1RM no leg press). A disfunção não motora foi avaliada por meio dos seguintes testes: Avaliação Cognitiva de Montreal (MoCA), Inventário de Depressão de Beck (IDB) e o Índice de Qualidade do Sono de Pittsburgh (PSQI). O medo de cair foi avaliado por meio da Escala Internacional de Eficácia de Quedas (FES-I). A qualidade de vida foi avaliada por meio do teste Questionário da Doença de Parkinson (PDQ-39). Uma regressão múltipla linear, método stepwise foi empregada para verificar o principal preditor do escore da PDQ-39. A única variável independente que entrou no modelo de regressão múltipla linear (stepwise) e mostrou uma alta capacidade para explicar o escore de qualidade de vida de indivíduos com DP foi a FES-I (R2 ajustado = 0,73, P<0,0001). Assim, como implicação clínica, é possível sugerir que estratégias de treinamento físico que promovam diminuição no medo de cair podem impactar positivamente na qualidade de vida de indivíduos com DP moderada.

A decrease in brain volume (i.e., brain atrophy) is a marker of cognitive health in older adults. Insufficient weekly accumulation of moderate and vigorous physical activity (MVPA) has been associated with lower brain volume. As this association has been established for a small number of brain areas and structures and atrophy rates seem to be nonuniform between them, more comprehensive analyses are warranted. We compared the volume of 71 brain areas and structures in 45 older adults who met and did not meet objectively measured MVPA recommendations. In addition, we used multiple regression models to determine whether cardiorespiratory fitness (VO2PEAK), MVPA and health-related risk factors could affect the atrophy of brain areas and structures. An accelerometer (GT9-X ActiGraph®) was worn for 7 days. Participants were then classified into two groups: &lt;150 minutes MVPA (&lt; 150'MVPA) (n=20) and ≥150 minutes MVPA (≥ 150'MVPA) (n=25) per week. Older adults who accumulated ≥ 150'MVPA per week had significantly higher absolute and relative (% of intracranial volume) volumes of 39 and 9 brain areas and structures, respectively, than those who accumulated &lt; 150'MVPA per week. Higher VO2PEAK seems to be a key predictor of the atrophy of brain areas and structures. In conclusion, meeting weekly physical activity recommendations seems to have a widespread effect on preserving the volume of more than 30 brain areas and structures in older adults. VO2PEAK seems to be the most frequent and important predictor of brain volume preservation.

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