Can adaptive training and exercise improve balance and mobility in people with Parkinson's disease? u3138050

The paper this assignment focuses on is:

Gobbi, L., Oliveira-Ferreira, M., Caetano, J., Lirani-Silva, E., Barbieri, F., Stella, F. and Gobbi, S. (2009). Exercise programs improve mobility and balance in people with Parkinson's disease. Parkinsonism and related disorders, 15, pp.49-52

This paper used two exercise interventions for improving balance and mobility in people with Parkinson's disease, a multi-mode exercise program and an adaptive program, however this page will focus only on the adaptive program.

What is the background to this research?
Parkinson’s disease is a progressive neurological condition affecting approximately 80,000 Australians. The underlying cause of Parkinson’s is a lack of dopamine, making it difficult to control the movement of limbs. There is no known cure to Parkinson’s; however there are many treatments available to counteract the debilitating effects. . Research has shown that exercise can improve gait, balance, mobility, flexibility and temor. A common problem with Parkinson’s is the loss of functional independence, which is related to the performance of activities of daily life – or ADL’s. Physical inactivity is related to losses in ADL performance, so the purpose of this study was to ascertain the effectiveness of an adaptive program that focused on breaking up periods of inactivity and improving functional balance and mobility.

Where is the research from?
This study was a collaborative effort from the posture and gait studies lab and physical activity and ageing lab at Sao Paolo State University, Department of Physical Education from the faculty Estacio de Sa, and the Faculty of Medical Sciences at Campinas state University.

What kind of research was this?
This research was as randomised controlled trial using an adaptive program to improve balance and mobility.

What did the research involve?
This study involved a low intensity, ‘adaptive’ program including flexibility, strength, motor coordination and balance. The research was conducted over a period of six months, with 60 minute sessions once per week for a total of 24 sessions. Patients were instructed to take their Parkinson’s medication as normal (if relevant) before participating in the program. The timed up and go test (TUG) and Berg’s FBS were used to assess the participants’ balance and mobility before and upon completion of the adaptive program. The Berg’s FBS was used as it is a reliable tool for assessing functional stability, and the TUG was used to assess functionally important tasks such as turning, gait initiation and sit-to-stand ability.

What were the basic results?
The exercise program showed improvement in both balance and mobility as shown by an increase in the Bergs scale and a decrease in the TUG test.

How did the researchers interpret the results?
It was stated that ‘participation in physical activities can promote gains in functional balance that are related to fall prevention’. Improvements seen from the program showed that breaking up the periods of physical inactivity can be an important factor to stop ‘accelerated ageing’.

What conclusions should be taken away from this research?
People with Parkinson’s disease can benefit from adaptive exercises as they help facilitate and prolong the performance of ADL’s and arguably, quality of life. Participating in exercise, regardless of intensity, for longer than six months has shown significant gains in functional balance and mobility. Therefore to gain maximal benefits provided by the program, people with Parkinson’s should participate in exercise daily and for a minimum of six months.

It is important to know that in study the participants ranged from stage I to III and majority of them had scored under 20 seconds for the pre-exercise TUG test, which classifies them as independent individuals. Improvements in this particular study could be due to the fact that participants were already functionally independent. Further studies are needed to determine the effect of this exercise program upon functionally dependent persons.

What are the implications of this research?
The implementation of an adaptive program into the Parkinson’s community can result in improvements in functional balance, mobility, and the performance of ADL’s, all of which can help with functional independence. Targeted exercises are not needed but rather exercises that mimic movements of everyday life such as shifting balance from one foot to the other and changing from a seated to a standing position. The program should also be focused on breaking up periods of physical inactivity.

Further investigation is needed to determine if this program is beneficial for functionally dependent patients. However, this study does show that adaptive programs can be effective for independent individuals, by increasing balance and mobility and slowing the accelerated ageing associated with Parkinson’s disease.

References