Exercise Does Not Impact Gait or Signal Changes in Freezing and Nonfreezing Parkinson Disease

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All participants in this study demonstrated slower backward gait velocities when compared with forward gait velocities.
All participants in this study demonstrated slower backward gait velocities when compared with forward gait velocities.

An exercise program consisting of treadmill walking, dancing, or guided stretching exercises does not significantly impact gait or blood oxygen-level dependent (BOLD) signal changes among patients with Parkinson disease (PD) with freezing and nonfreezing of gait, according to a study published in Parkinsonism and Related Disorders.

Study investigators enrolled a total of 37 patients with PD who had participated in a larger prospective, controlled exercise study. Behavioral assessments and magnetic resonance imaging (MRI) scans were performed while patients were not taking medications. Investigators characterized patients as freezers (n=13) vs nonfreezers (n=24) by using question 1 on the New Freezing of Gait Questionnaire.

Participants had previously completed a 12-week exercise program of either treadmill walking (n=11), tango dancing (n=13), or guided stretching (n=13). Post-test evaluations were completed within a 5-week period before and after the exercise intervention, and participants were instructed to not modify their exercise routine between baseline and post-test evaluations.

All participants in this study demonstrated slower backward gait velocities when compared with forward gait velocities (F[1,34] = 55.04; P <.001). Additionally, freezers and nonfreezers had a significantly shorter stride length while performing backward gait (F[1,34] = 77.58; P <.001). The investigators performed a region of interest functional MRI analysis and found that freezers showed a significantly lower BOLD signal in the cerebellum (F[1,32] = 7.01; P =.01), primary motor (left: F[1,32] = 7.09; P =.01; right: F[1,32] = 7.45; P =.01), and primary sensory (left: F[1,32] = 9.59; P =.004; right: F[1,32] = 8.18; P =.007) cortices during imagined backward gait when compared with nonfreezers.

The small sample size, as well as the inclusion of patients with only mild or moderate disease severity, are potential limitations of the study.

Further longitudinal research in freezers and nonfreezers is needed to “help with early detection of potential freezers and help further understanding of how different aspects of the disease are related to one another, providing a framework for development of more holistic treatment.”

Reference

Myers PS, McNeely ME, Pickett KA, Duncan RP, Earhart GM. Effects of exercise on gait and motor imagery in people with Parkinson disease and freezing of gait [published online May 8, 2018]. Parkinsonism Relat Disord. doi: 10.1016/j.parkreldis.2018.05.006

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