Sensory focused exercise improves anxiety in Parkinson’s disease: A randomized controlled trial

Abstract

Anxiety has been implicated as one of the greatest influences on quality of life in Parkinson's disease (PD). The etiology of anxiety is unclear, although previous work suggests that anxiety may be linked to sensory deficits that cause uncertainty in movement. Thus, the current study examined whether focusing attention on sensory feedback during goal-based exercise has the potential to provide benefits to anxiety in PD. Thirty-five participants with PD were randomized to either a Sensory Attention Focused Exercise (SAFEx) (i.e. internal focus of attention, n = 18) or Sham Exercise control (i.e. external focus of attention, n = 17) and completed 33 one-hour attention-based exercise sessions over 11-weeks. Before and after the program (pre and post), participants completed the Parkinson Anxiety Scale (PAS) questionnaire. The PAS includes three anxiety sections: persistent, episodic, and avoidance. Changes in the total PAS score and within each section of the PAS were subjected to two-factor mixed repeated measures ANCOVA. Significant group by time interactions demonstrated that from pre to post, total PAS scores (p = 0.007) and episodic anxiety scores (p = 0.010) significantly decreased in the SAFEx group only (ΔTotal PAS =-5.2, F (1,27) = 5.41, p = 0.028, η p 2 = 0.17; ΔEpisodic Score =-1.8, F (1,27) = 6.89, p = 0.014, η p 2 = 0.20). In conclusion, focusing attention on sensory feedback while completing goal-based exercises may provide significant benefits to improving anxiety in PD. As such, sensory attention focused exercise may be a critical adjunct therapy for improving anxiety, and ultimately quality of life in people with PD.

Boxing vs Sensory Exercise for Parkinson’s Disease: A Double-Blinded Randomized Controlled Trial

“…Further, participants were not asked to modify their medication schedule to accommodate for exercise timing. Power analysis based on data from previous published rehabilitation study 2,13,16,17,19,34 and the minimal clinically important difference in the UPDRS-III indicated a need for approximately 32 total (16 per group) to have 80% power, assuming a 5% type I error (α value). We have satisfied these requirements.…”

“…27 When examining the lasting effects of an exercise therapy, small changes to disease severity may be better captured using an objective assessment tool and may further validate the findings. 28 Finally, previous studies conducted on boxing 2,3 and sensory exercise [15][16][17][18][19][20] did not account for external physical activity levels. Similar to drug trials, it is important to ensure the results of a rehabilitation therapy which can be attributed solely to the intervention.…”

“…[11][12][13] Similarly, sensory exercise can target potential executive function and sensory deficits that may underlie the motor symptoms of PD. [15][16][17][18][19][20] Sensory exercise is low intensity and requires participants to complete exercise with their eyes closed. 16 Previous studies have suggested sensory allows for sustained levels of dopamine in the basal ganglia, improving overall disease severity of PD.…”

“…First, washout benefits were rarely accounted for. 2,3,[15][16][17][18][19][20] Most studies only included a short washout period, and while these studies can conclude immediate improvements may be achievable, lasting effects of exercise may be missed. It has been suggested that a sufficient washout period (∼more than 8 weeks) must be employed to account for any potential long-term impact of treatment.…”

“…Although both boxing and sensory exercise present with disease severity improvement immediately after intervention, 2,3,[15][16][17][18][19][20] studies have yet to investigate how long the benefits of these programs last after program cessation, which would be more indicative of the programs ability to impact the underlying disease. As such, this study aimed to compare the effect of high-intensity boxing and sensory exercise on Parkinson's disease severity and whether or not these effects wear off.…”