Exercising with a robotic exoskeleton can improve memory and gait in people with Parkinson’s disease by facilitating progressive exercise intensity

McGibbon, Chris A.; Sexton, Andrew; Gryfe, Pearl

doi:10.1038/s41598-024-54200-y

Cited by 3 publications

(1 citation statement)

References 52 publications

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“…Alongside pharmacological management, exercise is important in the management of Parkinson’s Disease. Exercise has been shown to attenuate motor and non-motor symptoms [ 1 ] and improve sleep [ 2 ], mood [ 3 ], and memory [ 3 ]. There are some indications that exercise can subsequently slow disease progression, especially in the early stages [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

“Exercise… to Me, It’s Freedom”: Motivation, Support, and Self-Management to Keep Physically Active with Parkinson’s Disease: A Qualitative Study

Ahern,

Curtin,

Timmons

et al. 2024

Geriatrics

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The benefits of exercise have been widely explored among people with Parkinson’s (PwP). Exercise can improve non-motor (fatigue, pain, sleep, etc.) and motor features (balance, muscle strength, gait speed, etc.), maintain function, as well as prevent disease progression. Although the benefits are well known, PwP continue to show difficulty adhering to physical activity and exercise. This study aims to explore motivation to exercise, support, and self-management needs among people with Parkinson’s, their family members, and physiotherapists. Purposeful and maximum-variation sampling methods (age, sex, geographical setting, and disease severity) were employed. PwP and family members were recruited through physiotherapy services and local support groups. Twelve semi-structured interviews with PwP and two group interviews, one with family members (n = 4) and one with physiotherapists (n = 5), were conducted. Interview guides were informed by patient–public input and a recent systematic review. Interviews were recorded, transcribed, and analysed using thematic analysis informed by the Grounded Theory methodology. Four common themes emerged: (1) The value of an intrinsic connection with exercise, for which there are challenges. A greater connection to exercise led to long-term adherence. (2) Adapting exercise to the needs and preferences of a person is essential. Preferred exercises and environments were mixed, with differences emerging between sexes. (3) Physiotherapists’ aim to only maintain physical function led to frustration. Limited self-management opportunities, stigma, and dehumanisation were discussed. (4) Non-motor symptoms, stigma, fear, and determination as well as apathy, pain, and low mood were discussed. Exercise provided physical, emotional, and social rewards. Supports are necessary; however, challenges arise when PwP’s motivations are mismatched to family members’ and physiotherapists’ goals. Co-created goals, tailored to their preferences, and exercise plans with supported self-management are recommended.

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Section: Introductionmentioning

confidence: 99%

“Exercise… to Me, It’s Freedom”: Motivation, Support, and Self-Management to Keep Physically Active with Parkinson’s Disease: A Qualitative Study

Ahern,

Curtin,

Timmons

et al. 2024

Geriatrics

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Exercising with a robotic exoskeleton can improve memory and gait in people with Parkinson’s disease by facilitating progressive exercise intensity

McGibbon,

Sexton,

Gryfe

2024

Sci Rep

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People with Parkinson’s disease (PwPD) can benefit from progressive high-intensity exercise facilitated with a lower-extremity exoskeleton, but the mechanisms explaining these benefits are unknown. We explored the relationship between exercise intensity progression and memory and gait outcomes in PwPD who performed 8 weeks (2 × per week) of progressive exercise with and without a lower-extremity powered exoskeleton, as the planned exploratory endpoint analysis of an open-label, parallel, pilot randomized controlled trial. Adults 50–85 years old with a confirmed diagnosis of PD participated. Twenty-seven participants randomized to exercise with (Exo = 13) or without (Nxo = 14) the exoskeleton were included in this exploratory endpoint analysis. Detailed exercise logs were kept and actigraphy was used to measure activity count*min−1 (ACPM) during all exercise sessions. Only the Exo group were able to progressively increase their ACPM over the entire 8-week intervention, whereas the Nxo group plateaued after 4 weeks. Exercise intensity progression correlated with change in the memory sub-scale of the SCOPA-COG and change in gait endurance from the 6MWT, consistent with the prevailing hypotheses linking high-intensity interval exercise to improved muscle and brain function via angiogenic and neurotrophic mechanisms. Facilitating high-intensity exercise with advanced rehabilitation technology is warranted for improving memory and gait endurance in PwPD.Registration: ClinicalTrials.gov, NCT 03583879 (7/10/2018).

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Lower-Limb Exoskeletons for Gait Training in Parkinson’s Disease: The State of the Art and Future Perspectives

Fortunati,

Febbi,

Negro

et al. 2024

Healthcare

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Gait dysfunction (GD) is a common impairment of Parkinson’s disease (PD), which negatively impacts patients’ quality of life. Among the most recent rehabilitation technologies, a lower-limb powered exoskeleton (LLEXO) arises as a useful instrument for gait training in several neurological conditions, including PD. However, some questions relating to methods of use, achievable results, and usefulness compared to traditional rehabilitation methodologies still require clear answers. Therefore, in this review, we aim to summarise and analyse all the studies that have applied an LLEXO to train gait in PD patients. Literature research on PubMed and Scopus retrieved five articles, comprising 46 PD participants stable on medications (age: 71.7 ± 3.7 years, 24 males, Hoehn and Yahr: 2.1 ± 0.6). Compared to traditional rehabilitation, low-profile lower-limb exoskeleton (lp-LLEXO) training brought major improvements towards walking capacity and gait speed, while there are no clear major benefits regarding the dual-task gait cost index and freezing of gait symptoms. Importantly, the results suggest that lp-LLEXO training is more beneficial for patients with an intermediate-to-severe level of disease severity (Hoehn and Yahr > 2.5). This review could provide a novel framework for implementing LLEXO in clinical practise, highlighting its benefits and limitations towards gait training.

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Exercising with a robotic exoskeleton can improve memory and gait in people with Parkinson’s disease by facilitating progressive exercise intensity

Cited by 3 publications

References 52 publications

“Exercise… to Me, It’s Freedom”: Motivation, Support, and Self-Management to Keep Physically Active with Parkinson’s Disease: A Qualitative Study

“Exercise… to Me, It’s Freedom”: Motivation, Support, and Self-Management to Keep Physically Active with Parkinson’s Disease: A Qualitative Study

Exercising with a robotic exoskeleton can improve memory and gait in people with Parkinson’s disease by facilitating progressive exercise intensity

Lower-Limb Exoskeletons for Gait Training in Parkinson’s Disease: The State of the Art and Future Perspectives

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