Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 7 , Pages 1221-1229, July 2008

The Effect of Exercise Training in Improving Motor Performance and Corticomotor Excitability in People With Early Parkinson's Disease

Presented in part to the Society for Neuroscience, October 17, 2006, Atlanta, GA; American Physical Therapy Association Combined Sections, February 1–5, 2006, San Diego, CA; the World Parkinson Congress, February 22–26, 2006, Washington, DC; and the National Parkinson Foundation Collaboration for Care Leadership Conference, October 20–22, 2005, San Francisco, CA.

  • Beth E. Fisher, PhD

      Affiliations

    • Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
    • Division of Neurology, University of Southern California, Los Angeles, CA
    • Corresponding Author InformationCorrespondence to Beth Fisher, PhD, Div of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar St, CHP 155, Los Angeles, CA 90089-9006
    • ,
  • Allan D. Wu, MD

      Affiliations

    • Department of Neurology, David Geffen School of Medicine, UCLA, Los Angeles, CA.
    • ,
  • George J. Salem, PhD

      Affiliations

    • Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
    • ,
  • Jooeun Song, MS

      Affiliations

    • Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
    • ,
  • Chien-Ho (Janice) Lin, PhD

      Affiliations

    • Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
    • ,
  • Jeanine Yip, DPT

      Affiliations

    • Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
    • ,
  • Steven Cen, PhD

      Affiliations

    • Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
    • ,
  • James Gordon, EdD

      Affiliations

    • Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
    • ,
  • Michael Jakowec, PhD

      Affiliations

    • Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
    • Division of Neurology, University of Southern California, Los Angeles, CA
    • ,
  • Giselle Petzinger, MD

      Affiliations

    • Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA
    • Division of Neurology, University of Southern California, Los Angeles, CA

published online 05 June 2008.

Abstract 

Fisher BE, Wu AD, Salem GJ, Song J, Lin C-H, Yip J, Cen S, Gordon J, Jakowec M, Petzinger G. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease.

Objectives

To obtain preliminary data on the effects of high-intensity exercise on functional performance in people with Parkinson's disease (PD) relative to exercise at low and no intensity and to determine whether improved performance is accompanied by alterations in corticomotor excitability as measured through transcranial magnetic stimulation (TMS).

Design

Cohort (prospective), randomized controlled trial.

Setting

University-based clinical and research facilities.

Participants

Thirty people with PD, within 3 years of diagnosis with Hoehn and Yahr stage 1 or 2.

Interventions

Subjects were randomized to high-intensity exercise using body weight–supported treadmill training, low-intensity exercise, or a zero-intensity education group. Subjects in the 2 exercise groups completed 24 exercise sessions over 8 weeks. Subjects in the zero-intensity group completed 6 education classes over 8 weeks.

Main Outcome Measures

Unified Parkinson's Disease Rating Scales (UPDRS), biomechanic analysis of self-selected and fast walking and sit-to-stand tasks; corticomotor excitability was assessed with cortical silent period (CSP) durations in response to single-pulse TMS.

Results

A small improvement in total and motor UPDRS was observed in all groups. High-intensity group subjects showed postexercise increases in gait speed, step and stride length, and hip and ankle joint excursion during self-selected and fast gait and improved weight distribution during sit-to-stand tasks. Improvements in gait and sit-to-stand measures were not consistently observed in low- and zero-intensity groups. The high-intensity group showed lengthening in CSP.

Conclusions

The findings suggest the dose-dependent benefits of exercise and that high-intensity exercise can normalize corticomotor excitability in early PD.

Key Words: Basal ganglia, Central nervous system, Neuronal plasticity, Rehabilitation, Walking

List of Abbreviations: AAMHR, age-appropriate maximal heart rate, BDNF, brain-derived neurotrophic factor, BWS, body-weight support, BWSTT, body weight–supported treadmill training, CNS, central nervous system, CSP, cortical silent period, FDI, first dorsal interosseous, GABA, γ-aminobutyric acid, MEP, motor evoked potential, METS, metabolic equivalents, MMSE, Mini-Mental State Examination, PD, Parkinson's disease, PT, physical therapy, ROM, range of motion, TMS, transcranial magnetic stimulation, UPDRS, Unified Parkinson's Disease Rating Scale, USC, University of Southern California

 

 Supported by the Kinetics Foundation and National Institute of Neurological Disorders and Stroke (grant no. K23-NS045764).

 No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the author(s) or on any organization with which the author(s) is/are associated.

 Reprints are not available from the author.

 Published online June 5, 2008 at www.archives-pmr.org.

PII: S0003-9993(08)00235-9

doi:10.1016/j.apmr.2008.01.013

Archives of Physical Medicine and Rehabilitation
Volume 89, Issue 7 , Pages 1221-1229, July 2008

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