Exercise as it relates to Disease/The effects of walking training on gait in patients with Parkinson's Disease

Nadeau, A Pourcher, E Corbeil, P 2013, Effects of 24 wk of treadmill training on gait performance in Parkinson's disease, Medicine & Science in Sports and Exercise, vol 46(4), 645-655.

What is the background to this research?
Parkinson’s Disease is a Neuro-degenerative disease resulting from degeneration of the dopaminergic system, progressively declining neurological function. Parkinson’s Disease showcases many different symptoms, physical symptoms include; impaired gait and balance, resting tremor, rigidity and slowed movements, although individuals may experience these and other symptoms more aggressively than others. Often as a result, people with Parkinson’s Disease decrease the amount of physical activity they participate, therefore having a decline of functional independence and well being as well as increasing the incidence of cardiovascular disease

Where is the research from?
The participants for this research were those of the local community, 45 participants with idiopathic Parkinson’s Disease were involved within the study, between the ages of 40 years to 80 years old.

What kind of research was this?
The study was designed as a double blinded, randomized control trial, lasting for 24 weeks.

What did the research involve?
Participants were randomly divided into three different groups using a generated program. The three groups were; mixed Treadmill training (mixed TT). Which involved incline, Speed Treadmill Training (Speed TT), involved only treadmill speed, and the Control group (Control) consisted of only light exercise. Both of the TT groups were controlled via heart rate and blood pressure measurements to ensure heart rate was not above 75% of maximum predicted. The speed TT group increased speed by 0.2 km/h once the participant had reached their 100% of their preferred walking pace. Mixed TT increased incline by 1% once their RPE (rate of Perceived exertion) was maintained below 4 on the Borg scale. Inline was then increase by 1% and 0.2 km/h speed at each session. Control group participated in exercise routines, tai chi, Latin dance, resistance band exercises and coordination movements, 30–90 seconds for each exercise. TT training was performed three times a week, for one hour, supervised, the control group attended two, one-hour sessions per week, completing a third one at home. Gait was measured using the walkway system for quantification of the spatial and temporal parameters of gait A 6-minute walking test was also completed, where they were asked to walk as fast as possible for the 6 minutes without running Cognitive function was measured via use of MMSE ( Mini-Mental State Examination)

What were the basic results?
The research shows large improvements in both walking speed and endurance after 6 months of treadmill training although improvements were noted at 3 months of TT. Both TT groups (mixed and speed treadmill training) showed improvements in walking speed, gait pattern, walking endurance, gait variability and Parkinson specific symptoms including other related heath problems and quality of life.

How did the researchers interpret the results?
It has been suggested that the results from this study clearly indicate that a structured regime of treadmill walking produced improved adaptations specific to gait patterns and performance of people with Parkinson’s disease. The results also indicated that people who underwent training of that of the mixed TT group produced results showing an improvement in health related quality of life as well as improved gait performance. Interestingly, the other two groups, the speed TT and the control groups did not show improvements in health related quality of life at the end of the study. It has also been suggested that a specific walking program such as the two TT protocols are more beneficial for patients with mild to moderate Parkinson’s disease than programs that may focus on relaxation, flexibility and lower intensity movements such as those completed in the control group, on improving gait performance. The researches also concluded that although the control group did not show improvements as those seen in the TT groups, exercising at that lower intensity including the stretching and tai chi did not worsen the quality of life and Parkinson’s specific symptoms, rather helped to maintain general and current physical condition. This suggested that this kind of activity is more beneficial that adopting a sedentary lifestyle as a result of Parkinson’s disease.

What conclusions should be taken away from this research?
It can be concluded from the present study that it is beneficial for people with Parkinson’s disease to participate in both TT and flexibility and lower intensity exercise. Although the greatest benefits improving walking speed, spatiotemporal gait parameters, walking endurance and health related quality of life, were seen when TT training methods were practiced, the improvements continuing until the end of 6 months. The most beneficial training method was the mixed TT, where the incline component improved muscular strength again improving the gait performance of people with Parkinson’s disease.

What are the implications of this research?
Participants who were assigned the TT groups found to have significant improvements resulting from this research, whereas the control group participants did not see any great positive improvements following the study although not experiencing a negative outcomes. Interestingly the group that underwent mixed TT had the greatest improvements in gait performance although it is unknown how long there improvements will last following cessation of the study training protocols. Specific programs targeted at Parkinson's and gait training had far greater outcomes rather than just generic fitness training and mobility resulting in a positive implications for these participants.

The findings from this study would be useful in forming a program for someone who may be suffering from Parkinson's disease, as the results strongly suggest better outcomes from this type of specific training over a longer period of time. Although TT had the greatest effect upon gait in Parkinson's disease patients, progression of the exercise program is essential to maintain continued improvements in both the TT and control groups.