Balance and fear of falling in subjects with Parkinson’s disease is improved after exercises with motor complexity

Silva‐Batista, Carla; Corcos, Daniel M.; Kanegusuku, Hélcio; Piemonte, Maria Elisa Pimentel; Gobbi, Lilian Teresa Bucken; Lima‐Pardini, Andrea Cristina de; Mello, Marco Túlio de; Forjaz, C. L. M.; Ugrinowitsch, Carlos

doi:10.1016/j.gaitpost.2017.12.027

Cited by 69 publications

(65 citation statements)

References 56 publications

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“…Our results suggest an acceptable MDC for OSI on the fall risk protocol (ie, 0.41 ) ( Table 2). Thus, according to our results, Silva-Batista et al 38 showed that resistance training with instability produced changes in OSI beyond measurement error as suggested by our MDC data, validating the clinical improvements obtained at post-training. Finally, in terms of reliability, our results of balance using the BBS for both protocols can be considered excellent (ICCs ≥0.92).…”

Section: Discussionsupporting

confidence: 90%

“…Only one study 38 investigated the effect of exercise training on OSI for fall risk protocol from BBS in PD patients. Silva-Batista et al 38 compared the effects of the resistance training vs resistance training with instability on OSI in the fall risk protocol using the BBS in PD patients. The results demonstrated a decrease of 1.3 after 3 months of resistance training with instability suggesting a decreased fall risk.…”

Section: Discussionmentioning

confidence: 99%

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Minimal Detectable Change for Balance Using the Biodex Balance System in Patients with Parkinson Disease

Lira

Ugrinowitsch

Fecchio

et al. 2019

PM&R

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Background Minimal detectable change (MDC) when assessing balance using the Biodex Balance System (BBS) in patients with Parkinson disease (PD) is currently unknown, limiting the interpretability of the scores. Objective To determine the MDC on the Anterior/Posterior Stability Index (APSI), Medial/Lateral Stability Index (MLSI), and Overall Stability Index (OSI) from postural stability and fall risk protocols of the BBS in patients with PD. Design This was a repeated‐measures design (at a 1‐week interval). Setting Strength training laboratory of a public university. Patients 46 patients with PD (men and women) at stages 2 and 3 (67.9 ± 7.4 years old) were assessed in the “on” state (fully medicated). Methods Patients performed three trials of 20 s for each protocol. Main Outcome Measurements Absolute and relative MDC (MDC%) calculated for APSI, MLSI, and OSI from the postural stability (stable condition) and fall risk protocols (unstable condition). Results For the postural stability, the MDC and MDC% were 0.26° and 17% for APSI, 0.41° and 21% for MLSI, and 0.22° and 12% for OSI, respectively. For the fall risk, the MDC and MDC% were 0.51° and 18% for APSI, 0.21° and 15% for MLSI, and 0.41° and 20% for OSI, respectively. These results were considered acceptable, despite indices with high MDC for MLSI (postural stability) and APSI (fall risk). Conclusions Patients with PD have more mediolateral and anteroposterior changes in the stable and unstable conditions, respectively. These abnormal balance strategies can occur principally due to postural instability of PD. However, our results demonstrated acceptable MDCs in both conditions in all of the assessed axes. Thus, BBS should be incorporated into the clinical evaluation to help therapists to determine if intervention‐induced changes in balance are clinically significant or due to measurement error. Level of Evidence II

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Minimal Detectable Change for Balance Using the Biodex Balance System in Patients with Parkinson Disease

Lira

Ugrinowitsch

Fecchio

et al. 2019

PM&R

Self Cite

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“…Nonetheless, the underlying pathophysiologic mechanisms that potentially contribute to these blunted responses in patients with PD are still not fully understood. This becomes important because exercise is frequently employed as a coping resource to manage quality of life, motor function, physical capacity, fatigue perception, and disease progression of PD (Allen et al 2017;David et al 2016;Kelly et al 2014;Krumpolec et al 2017;Santos et al 2016;Silva-Batista et al 2018;Silveira et al 2018;Zhou et al 2017). Importantly, the abnormal responses to exercise could make exercise prescription more difficult to be managed to some patients with PD.…”

Section: Introductionmentioning

confidence: 99%

Blunted cardiovascular responses to exercise in Parkinson’s disease patients: role of the muscle metaboreflex

Sabino‐Carvalho

Teixeira

Samora

et al. 2018

Journal of Neurophysiology

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Patients with Parkinson's disease (PD) exhibit attenuated cardiovascular responses to exercise. The underlying mechanisms that are potentially contributing to these impairments are not fully understood. Therefore, we sought to test the hypothesis that patients with PD exhibit blunted cardiovascular responses to isolated muscle metaboreflex activation following exercise. For this, mean blood pressure, cardiac output, and total peripheral resistance were measured using finger photoplethysmography and the Modelflow method in 11 patients with PD [66 ± 2 yr; Hoehn and Yahr score: 2 ± 1 a.u.; time since diagnosis: 7 ± 1 yr; means ± SD) and 9 age-matched controls (66 ± 3 yr). Measurements were obtained at rest, during isometric handgrip exercise performed at 40% maximal voluntary contraction, and during postexercise ischemia. Also, a cold pressor test was assessed to confirm that blunted cardiovascular responses were specific to exercise and not representative of generalized sympathetic responsiveness. Changes in mean blood pressure were attenuated in patients with PD during handgrip (PD: ∆25 ± 2 mmHg vs. controls: ∆31 ± 3 mmHg; P < 0.05), and these group differences remained during postexercise ischemia (∆17 ± 1 mmHg vs. ∆26 ± 1 mmHg, respectively; P < 0.01). Additionally, changes in total peripheral resistance were attenuated during exercise and postexercise ischemia, indicating blunted reflex vasoconstriction in patients with PD. Responses to cold pressor test did not differ between groups, suggesting no group differences in generalized sympathetic responsiveness. Our results support the concept that attenuated cardiovascular responses to exercise observed in patients with PD are, at least in part, explained by an altered skeletal muscle metaboreflex. NEW & NOTEWORTHY Patients with Parkinson's disease (PD) presented blunted cardiovascular responses to exercise. We showed that cardiovascular response evoked by the metabolic component of the exercise pressor reflex is blunted in patients with PD. Furthermore, patients with PD presented similar pressor response during the cold pressor test compared with age-matched controls. Altogether, our results support the hypothesis that attenuated cardiovascular responses to exercise observed in patients with PD are mediate by an altered skeletal muscle metaboreflex.

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“…The proposed tool can help clinicians to more accurately identify the level of FoF in PD patients. Accurate prediction leads to timely intervention, such as rehabilitation protocols (e.g., exercise [34] and cognitive behavioral therapy [35]), to maintain and improve the quality of life in PD patients.…”

Section: Introductionmentioning

confidence: 99%

A new postural stability-indicator to predict the level of fear of falling in Parkinson’s disease patients

et al. 2020

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Background: Fear of falling (FoF) is defined as a lasting concern about falling that causes a person to limit or even stop the daily activities that he/she is capable of. Seventy percent of Parkinson's disease (PD) patients report activity limitations due to FoF. Timely identification of FoF is critical to prevent its additional adverse effects on the quality of life. Self-report questionnaires are commonly used to evaluate the FoF, which may be prone to human error. Objectives: In this study, we attempted to identify a new postural stability-indicator to objectively predict the intensity of FoF and its related behavior(s) in PD patients. Methods: Thirty-eight PD patients participated in the study (mean age, 61.2 years), among whom 10 (26.32%) were identified with low FoF and the rest (73.68%) with high FoF, based on Falls Efficacy Scale-International (FES-I). We used a limit of stability task calibrated to each individual and investigated the postural strategies to predict the intensity of FoF. New parameters (FTR i s; functional time ratio) were extracted based on the center of pressure presence pattern in different rectangular areas (i = 1, 2, and 3). The task was performed on two heights to investigate FoF-related behavior(s). Results: FTR 1/2 (the ratio between FTR 1 and FTR 2) was strongly correlated with the FES-I (r = − 0.63, p < 0.001), Pull test (r = − 0.65, p < 0.001), Timed Up and Go test (r = − 0.57, p < 0.001), and Berg Balance Scale (r = 0.62, p < 0.001). The model of FTR 1/2 was identified as a best-fitting model to predicting the intensity of FoF in PD participants (sensitivity = 96.43%, specificity = 80%), using a threshold level of ≤ 2.83. Conclusions: Using the proposed assessment technique, we can accurately predict the intensity of FoF in PD patients. Also, the FTR 1/2 index can be potentially considered as a mechanical biomarker to sense the FoF-related postural instability in PD patients.

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Balance and fear of falling in subjects with Parkinson’s disease is improved after exercises with motor complexity

Cited by 69 publications

References 56 publications

Minimal Detectable Change for Balance Using the Biodex Balance System in Patients with Parkinson Disease

Minimal Detectable Change for Balance Using the Biodex Balance System in Patients with Parkinson Disease

Blunted cardiovascular responses to exercise in Parkinson’s disease patients: role of the muscle metaboreflex

A new postural stability-indicator to predict the level of fear of falling in Parkinson’s disease patients

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