Treadmill training and kinesiotherapy versus conventional physiotherapy in Parkinson’s disease: a pragmatic study

Abstract

Introduction: Physiotherapy has been identified in the literature as an important treatment for individuals with Parkinson’s disease (PD) to improve functional capacity. Little is discussed about the physiotherapy practice environment for this population. Objective: To assess pragmatically the effects of two physiotherapy protocols: Conventional Physiotherapy (CP) and Treadmill Training and Kinesiotherapy (TTK) in PD patients. Method: Twenty-four PD patients classified from 1 to 3 on the Hoehn and Yahr scale were randomly distributed into two groups. In CP group (12 patients), exercises aimed to improve range of motion, bradykinesia, postural adjustments and gait. In TTK group (12 patients), exercises aimed to improve physical fitness, mobility and functional independence. The treatments were performed for 50 minutes, twice a week for 14 weeks. The following evaluations were performed before and after the interventions: Unified Parkinson’s Disease Rating Scale (UPDRS); gait speed (GS); up stairs (US) and down stairs (DS) tests; timed get-up-and-go test (TUG) and 6-Minute Walk Distance Test (6-MWDT). Sociodemographic and clinical data were presented as descriptive analysis. Variables with normal and non-normal distributions were analyzed by specific statistical tests. Results: Intragroup analysis showed significant results for the TTK group (TUG, US, DS, GS, UPDRS total and UPDRS II) and for the CP group only UPDRS total. Intergroup analysis was favorable for the TTK group (TUG, US, DS, 6-MWDT). Conclusion: CP group improved the patients’ general clinical status, while treadmill and kinesiotherapy improved the physical-functional and clinical aspects.

Treadmill training and physiotherapy similarly improve dual task gait performance: a randomized-controlled trial in Parkinson’s disease

“…Results of this study show significant improvements in UPDRS-III and walking capacity similar to other studies testing the effect of physiotherapy and treadmill training interventions (Gassner et al 2019 ; Paz et al 2019 ; Pellecchia et al 2004 ; Radder et al 2020 ). When compared to the LSVT BIG training (derived from the Lee Silverman Voice Treatment) with longer intervention periods (16 sessions for 1 h each over 4 weeks) that has been proven to be effective and decreases the UPDRS- III score by 5 points (Ebersbach et al 2010 ) or 7 points (Ebersbach et al 2015 ), our interventions reached a similar or even higher effect.…”

“…Furthermore, walking capacity measured by the 2-min walking test improved significantly. Compared to studies assessing the walking capacity in a 6-min walking test in physiotherapy and treadmill walking, our results show similar improvements (Paz et al 2019 ; Radder et al 2020 ).…”

“…Structured physiotherapy is commonly known to be effective in improving motor symptoms and gait in patients with PD (Armstrong and Okun, 2020 ; Paz et al 2019 ; Pellecchia et al 2004 ; Radder et al 2020 ). Treadmill training as an instrumented training approach significantly improved gait (Gassner et al 2019 ; Paz et al 2019 ; Radder et al 2020 ) as well as the motor part of the Unified Parkinson’s Disease Rating Scale (UPDRS-III) (Gassner et al 2019 ; Paz et al 2019 ). In direct comparison, treadmill training was more effective in improving single task gait performance than standardized physiotherapy without treadmill walking (Mehrholz et al 2015 ; Paz et al 2019 ).…”

Physical Therapist Management of Parkinson Disease: A Clinical Practice Guideline From the American Physical Therapy Association

“…There were 3 high-quality 44 , 48 , 79 and 3 moderate-quality studies 73 , 81 , 82 that favor resistance training compared with control to improve strength and power. The control groups in these studies included pharmacologic treatment alone; 26 , 30 nonexercise, education-based interventions 61 , 63 , 64 ; or a low-intensity home-based exercise intervention. 55 When comparing resistance training with other modes of exercise, there are 2 high-quality studies 43 , 49 and 1 moderate-quality study 66 that favor resistance training to improve strength and power.…”

“…Three high-quality studies 42 , 52 , 53 and 1 moderate-quality study 64 compared multimodal interventions that included a resistance training component to another active intervention (eg, power yoga, low-intensity exercise, turning-based training, conventional physical therapy). No clear pattern was observed to indicate superiority of multimodal interventions with a resistance training component versus other active interventions.…”