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- Dr. N.M. (Nienke) de Vries
Cardiovascular disease Constipation Osteoporosis Insomnia Cognitive decline Depression All cause mortality
Phase Dr. N.M. (Nienke) de Vries Inactivity AND Parkinsons disease - - PowerPoint PPT Presentation
Phase Dr. N.M. (Nienke) de Vries Inactivity AND Parkinsons disease - - PowerPoint PPT Presentation
Evidence for Exercise of Gait Disturbances in PD in the Early Phase Dr. N.M. (Nienke) de Vries Inactivity AND Parkinsons disease Cardiovascular disease Osteoporosis Insomnia Cognitive decline Depression Constipation All cause mortality
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Disease-modifying effects ?? Generic health benefits Specific additional benefits in PD
Reasons for prescribing exercise
Positive effects of exercise
GAIT
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Starting point
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Exercise
Strategies Treadmill
Dance Martial arts Water based Exer- gaming Nordic Walking Dual task training Motor imagery Action
- bser-
vation
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Efficacy on outcomes per type of intervention
Motor Symptoms Balance outcomes Gait outcomes Quality of Life
- utcomes
(MDS-) UPDRS TUG BBS 6MWT 10MWT Gait speed Stride Length Cadence PDQ-39 Conventional PT (n=45) 0.48 [0.35, 0.60]** n=26 0.11 [-0.07, 0.29] n=14 0.03 [-0.25, 0.31] n=3 0.13 [-0.01, 0.28] n=6 0.30 [0.01, 0.59] n=6** 0.24 [0.03, 0.45] n=11 0.28 [-0.11, 0.67] n=4 0.52 [0.11, 0.92] n=4** 0.11 [0.01, 0.22] n=17* Resistance training (n=17) 0.20 [-0.02, 0.42] n=7 0.19 [-0.05, 0.43] n=6 0.31 [-0.47, 1.09] n=1 0.67 [0.09, 1.24] n=2*
- 0.07[-0.30, 0.16]
n=6
- 0.63 [-1.20, -0.06]
n=2 0.23 [0.01, 0.43] n=7 Treadmill training (n=32) 0.10 [-0.09, 0.29] n=16 0.07 [-0.19, 0.34] n=8 0.21 [-0.13, 0.55] n=5 0.29 [0.04, 0.55]* n=9 0.47 [0.08, 0.85] n=4* 0.52 [0.34, 0.69] n=23** 0.20 [-0.04, 0.44] n=12 0.12 [-0.15, 0.39] n=9
- 0.06 [-0.49,
0.36] n=4 Strategy training (n=14) 0.43 [-0.32, 1.18] n=1 0.53 [0.23, 0.82] n=6** 0.12 [-0.43, 0.68] n=1
- 0.02 [-0.90, 0.85]
n=1
- 0.04 [-0.60, 0.51]
n=1 0.45 [0.13, 0.76] n=6** 0.52 [0.11, 0.93] n=4 0.47 [-0.01, 0.95] n=3 0.17 [-0.34, 0.67] n=2 Dance (n=11) 0.72 [0.44, 1.01] n=8** 0.49 [0.19, 0.80] n=8** 0.59 [0.27, 0.91] n=7** 0.51 [0.10, 0.91] n=4* 0.32 [-0.02, 0.66] n=6 0.11 [-0.36, 0.58] n=3 1.33 [0.31, 2.34] n=1*
- 0.13 [-0.63,
0.38] n=3
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Tango
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Motor Symptoms Balance outcomes Gait outcomes Quality of Life
- utcomes
(MDS-) UPDRS TUG BBS 6MWT 10MWT Gait speed Stride Length Cadence PDQ-39 Martial arts (n=11) 0.26 [0.08, 0.43] n=10* 0.56 [0.36, 0.77] n=7** 0.24 [-0.02, 0.49] n=4 0.20 [-0.15, 0.55] n=3 0.29 [0.07, 0.52] n=6* 0.32 [0.07, 0.56] n=3*
- 0.09 [-0.66, 0.47]
n=2 Nordic walking (n=3) 0.74 [0.24, 1.24] n=3** 0.55 [0.06, 1.04] n=3* 0.99 [0.48, 1.50] n=3** 0.94 [0.28, 1.60] n=2* 0.37 [-0.15, 0.90] n=2 0.46 [-0.18, 1.11] n=1 Aerobic exercises (n=5) 0.92 [0.61, 1.22] n=4** 0.80 [0.44, 1.15] n=1** 1.02 [0.69, 1.34] n=3** 0.20 [-0.11, 0.52] n=2 Balance and gait training (n=28) 0.34 [0.11, 0.56] n=12* 0.36 [0.15, 0.58] n=11** 0.57 [0.35, 0.79] n=12**
- 0.12 [-0.48, 0.23]
n=4 0.15 [-0.56, 0.85] n=2 0.28 [0.12, 0.44] n=17** 0.36 [0.12, 0.59] n=10* 0.24 [-0.01, 0.48] n=8 0.28 [-0.04, 0.60] n=6
Efficacy on outcomes per type of intervention
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30-45 min/session, 3/week, 6 months
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‘Remote control from Nijmegen
Radboud University Nijmegen
Upload: new individual training schemes Download: real time & post hoc training output
Patient’s home
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Signing up is not enough!
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Delta UPDRS III (in OFF phase) Aerobic intervention Active control Difference 4.2 points (95% CI: 1.6 – 6.9); p=0.002
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Delta VO2max (ml/kg/min) Aerobic intervention Active control Difference 4.2 points (95% CI: 1.6 – 6.9) p < 0.001
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Effect of Aerobic Exercise
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Motor Symptoms Balance outcomes Gait outcomes Quality of Life
- utcomes
(MDS-) UPDRS TUG BBS 6MWT 10MWT Gait speed Stride Length Cadence PDQ-39 Hydrotherapy (n=8)
- 0.11 [-0.41, 0.19]
n=5 0.50 [0.25, 0.75] n=8** 0.31 [0.04, 0.59] n=7 0.39 [-0.01, 0.79] n=3 Dual task (n=3)
- 0.18 [-0.79, 0.42]
n=2
- 0.36 [-1.39, 0.66]
n=1
- 0.25 [-0.85, 0.34]
n=2
- 0.08 [-0.46, 0.30]
n=1
- 0.29 [-0.65, 0.07]
n=2
- 0.04 [-0.78, 0.71]
n=1 Exergaming (n=9) 0.58 [0.29, 0.87] n=7** 0.47 [0.17, 0.77] n=6* 0.23 [-0.20, 0.67] n=3
- 1.66 [-2.84,-0.48]
n=1* 0.30 [-0.02, 0.62] n=4 0.77 [-0.07, 1.60] n=1 0.45 [0.13, 0.77] n=4*
Efficacy on outcomes per type of intervention
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Conclusion
A total of 191 trials with 7998 participants were included. Main conclusions:
- Conventional physiotherapy significantly improved motor symptoms,
gait, and quality of life.
- Resistance training improved gait.
- Treadmill training improved gait.
- Strategy training improved balance and gait.
- Dance improved motor symptoms, balance and gait
- Nordic walking improved motor symptoms, balance and gait
- Balance and gait training improved motor symptoms, balance and gait
- Martial arts improved motor symptoms, balance, and gait.
- Exergaming improved balance, quality of life and gait.
- Hydrotherapy improved balance.
- Dual task training did not significantly improve any of the outcomes.
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How to select a gait intervention?
Which gait related problem? In which context? Are there personal factors or prefereces?
Evidence
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Barriers and Motivators
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Barriers and Motivators
- Barriers related to PD
- Ability to integrate exercise in daily life
- Personal factors
- Environmental factors
- Role of medical specialists
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Future perspectives
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Take home message in PD
❑Different types of exercise are effective to improve gait outcomes ❑ Adapt to personal preferences ❑ Coach to find ways, materials, places etc ❑ Follow-up and use remote technology if needed and when possible ❑ Try to include social support ❑ Choose someting fun!
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