Treadmill training for patients with Parkinson's disease

Mehrholz, Jan; Kügler, Joachim; Storch, Alexander; Pohl, Marcus; Elsner, Bernhard; Hirsch, Kathleen

doi:10.1002/14651858.cd007830.pub3

Cited by 92 publications

(48 citation statements)

References 41 publications

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“…At T2, step length increased and rose above the lower limit of normality in both groups. Cadence increased to a limited extent, coherent with [ 15 ] and with the described relationship between stride length and cadence [ 82 ]. Hence, normalization of step length was helpful for increasing walking speed.…”

Section: Discussionsupporting

confidence: 70%

“…Differences between groups did not reach significance (Fisher's exact test = 3.14, p = 0.08). A similar picture applies to gait speed, by using the MDC published in [ 15 ] (0.09 m/s). Treatments improved speed in 10/17 patients of the PD-E group and 7/15 patients in the PD-P group.…”

Section: Resultsmentioning

confidence: 99%

“…Others reported increments in walking velocity with treadmill training [ 91 , 92 ]. A recent Cochrane review showed that treadmill training improves gait speed with respect to no intervention, with an effect size of about 0.40 [ 15 ]. In our cohorts, we estimated an effect size for gait speed of about 0.55 and 0.40, for balance exercise and mobile platform groups, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…For Mini-BESTest and gait speed, the response rate was the percentage of patients that improved after treatment, estimated by using the minimal detectable change (MDC). Cut-off for determining improvement was based on the values reported in [ 45 ] for the Mini-BESTest and [ 15 ] for gait. Differences in response rate between the groups (PD-E versus PD-P) were analyzed using Fisher's exact test (2-tailed).…”

Section: Methodsmentioning

confidence: 99%

“…This training is easy to administer, can be repeated regularly, and can be practiced at home at the end of the inpatient period with relatively little cost. A recent Cochrane survey, based on data with an overall moderate quality of evidence, confirmed a mild improvement by treadmill training of gait speed and stride length [ 15 ]. A conjecture about the limited success of treadmill training is that locomotion also requires adequate balance control in addition to effective rhythmic activation of the hind limb muscles [ 16 – 18 ].…”

Section: Introductionmentioning

confidence: 99%

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Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

et al. 2018

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We hypothesised that rehabilitation specifically addressing balance in Parkinson's disease patients might improve not only balance but locomotion as well. Two balance-training protocols (standing on a moving platform and traditional balance exercises) were assessed by assigning patients to two groups (Platform, n = 15, and Exercises, n = 17). The platform moved periodically in the anteroposterior, laterolateral, and oblique direction, with and without vision in different trials. Balance exercises were based on the Otago Exercise Program. Both platform and exercise sessions were administered from easy to difficult. Outcome measures were (a) balancing behaviour, assessed by both Index of Stability (IS) on platform and Mini-BESTest, and (b) gait, assessed by both baropodometry and Timed Up and Go (TUG) test. Falls Efficacy Scale-International (FES-I) and Parkinson's Disease Questionnaire (PDQ-8) were administered. Both groups exhibited better balance control, as assessed both by IS and by Mini-BESTest. Gait speed at baropodometry also improved in both groups, while TUG was less sensitive to improvement. Scores of FES-I and PDQ-8 showed a marginal improvement. A four-week treatment featuring no gait training but focused on challenging balance tasks produces considerable gait enhancement in mildly to moderately affected patients. Walking problems in PD depend on postural instability and are successfully relieved by appropriate balance rehabilitation. This trial is registered with ClinicalTrials.gov NCT03314597.

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Section: Discussionsupporting

confidence: 70%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

et al. 2018

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Diagnosis and Treatment of Parkinson Disease

Armstrong

Okun

2020

JAMA

1,755

1,357

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ImportanceParkinson disease is the most common form of parkinsonism, a group of neurological disorders with Parkinson disease–like movement problems such as rigidity, slowness, and tremor. More than 6 million individuals worldwide have Parkinson disease.ObservationsDiagnosis of Parkinson disease is based on history and examination. History can include prodromal features (eg, rapid eye movement sleep behavior disorder, hyposmia, constipation), characteristic movement difficulty (eg, tremor, stiffness, slowness), and psychological or cognitive problems (eg, cognitive decline, depression, anxiety). Examination typically demonstrates bradykinesia with tremor, rigidity, or both. Dopamine transporter single-photon emission computed tomography can improve the accuracy of diagnosis when the presence of parkinsonism is uncertain. Parkinson disease has multiple disease variants with different prognoses. Individuals with a diffuse malignant subtype (9%-16% of individuals with Parkinson disease) have prominent early motor and nonmotor symptoms, poor response to medication, and faster disease progression. Individuals with mild motor-predominant Parkinson disease (49%-53% of individuals with Parkinson disease) have mild symptoms, a good response to dopaminergic medications (eg, carbidopa-levodopa, dopamine agonists), and slower disease progression. Other individuals have an intermediate subtype. For all patients with Parkinson disease, treatment is symptomatic, focused on improvement in motor (eg, tremor, rigidity, bradykinesia) and nonmotor (eg, constipation, cognition, mood, sleep) signs and symptoms. No disease-modifying pharmacologic treatments are available. Dopamine-based therapies typically help initial motor symptoms. Nonmotor symptoms require nondopaminergic approaches (eg, selective serotonin reuptake inhibitors for psychiatric symptoms, cholinesterase inhibitors for cognition). Rehabilitative therapy and exercise complement pharmacologic treatments. Individuals experiencing complications, such as worsening symptoms and functional impairment when a medication dose wears off (“off periods”), medication-resistant tremor, and dyskinesias, benefit from advanced treatments such as therapy with levodopa-carbidopa enteral suspension or deep brain stimulation. Palliative care is part of Parkinson disease management.Conclusions and RelevanceParkinson disease is a heterogeneous disease with rapidly and slowly progressive forms. Treatment involves pharmacologic approaches (typically with levodopa preparations prescribed with or without other medications) and nonpharmacologic approaches (such as exercise and physical, occupational, and speech therapies). Approaches such as deep brain stimulation and treatment with levodopa-carbidopa enteral suspension can help individuals with medication-resistant tremor, worsening symptoms when the medication wears off, and dyskinesias.

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Transcranial Magnetic Stimulation Promotes Gait Training in Parkinson Disease

Chung

Mak

Hallett

2020

Annals of Neurology

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Objective: To determine whether priming with 1 or 25Hz repetitive transcranial magnetic stimulation (rTMS) will enhance the benefits from treadmill training up to 3 months postintervention in people with Parkinson disease (PD), and to evaluate the underlying changes in cortical excitability. Methods: This randomized double-blind, placebo-controlled trial was conducted between October 2016 and December 2018. Fifty-one participants with PD were randomized to receive 12 sessions of rTMS (25Hz, 1Hz, or sham) followed by treadmill training. All participants were assessed at baseline and 1 day, 1 month, and 3 months postintervention. Primary outcome was fastest walking speed, and secondary outcomes were timed up-and-go test (TUG), dual-task TUG (DT-TUG), motor section of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS-III), and electrophysiological evaluation of cortical excitability by TMS. Results: The 1 and 25Hz rTMS groups produced a greater improvement in fastest walking speed at 1 day and 3 months postintervention than the sham group. Only the 1 and 25Hz rTMS groups sustained the improvements in TUG, and had a significant improvement in DT-TUG and MDS-UPDRS-III for up to 3 months. Behavioral improvements correlated with increased cortical silent period and short-interval intracortical inhibition in both groups receiving real rTMS. Interpretation: Priming with 1 and 25Hz rTMS can augment the benefits of treadmill training and lead to long-term motor improvement up to 3 months postintervention. The motor improvement at follow-up was associated with a normalization of cortical excitability, which in turn suggests an alteration of the homeostatic plasticity range. Rebalancing cortical excitability by rTMS appears critical for plasticity induction.

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Treadmill training for patients with Parkinson's disease

Cited by 92 publications

References 41 publications

Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

Instrumental or Physical-Exercise Rehabilitation of Balance Improves Both Balance and Gait in Parkinson’s Disease

Diagnosis and Treatment of Parkinson Disease

Transcranial Magnetic Stimulation Promotes Gait Training in Parkinson Disease

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