Exercise programs improve mobility and balance in people with Parkinson's disease

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Summary

Compromised balance and loss of mobility are among the major consequences of Parkinson's disease (PD). The literature documents numerous effective interventions for improving balance and mobility. The purpose of this study was to verify the effectiveness of two exercise programs on balance and mobility in people with idiopathic PD. Thirty-four participants, with idiopathic PD that ranged from Stage I to Stage III on the Hoehn & Yahr (H&Y) scale, were assigned to two groups. Group 1 (n = 21; 67±9 years old) was engaged in an intensive exercise program (aerobic capacity, flexibility, strength, motor coordination and balance) for 6 months: 72 sessions, 3 times a week, 60 minutes per session; while Group 2 (n = 13; 69±8 years old) participated in an adaptive program (flexibility, strength, motor coordination and balance) for 6 months: 24 sessions, once a week, 60 minutes per session. Balance and basic functional mobility were assessed in pre- and post-tests by means of the Berg Balance Scale and the Timed Up and Go Test. Before and after the interventions, groups were similar in clinical conditions (H&Y, UPDRS, and Mini-Mental). A MANOVA 2 (programs) by 2 (moments) revealed that both groups were affected by the exercise intervention. Univariate analyses showed that participants improved their mobility and balance from pre- to post-test. There were no differences between groups in either mobility or balance results. Both the intensive and adaptive exercise programs improved balance and mobility in patients with PD.

Introduction

Functional independence is related to the capacity to perform activities of daily living (ADL) independently. Balance and mobility are crucial to their performance. Motor disturbances related to Parkinson's disease (PD) can contribute to the decline of balance and mobility [1], which subsequently can lead to a reduction in functional independence. As a consequence, individuals with PD experience an increase both with difficulties in performing daily activities and in the risk of falls [2].

Non-pharmacologic therapies related to PD, such as physical exercises and nutrition, are not known to attenuate the disease's severity or reduce its progression, but they can contribute to improvements in the patient's quality of life [3, 4]. Systematic participation in physical activity programs can help individuals. maintain not only their motor repertories, but also their ability to perform daily living activities.

Crizzle and Newhouse [5] reviewed the literature and concluded that, through exercise, patients with PD improve their physical performance and the execution of activities of daily living. In addition, they suggested that future studies should include the development of standardized exercise programs specific to problems associated with PD, as well as standardized testing methods for measuring improvements in PD patients.

Physical activity programs for PD patients that focus on improvements in functional capacity and mobility vary according to the type of proposed activity, whether it will be practiced by individuals or in a group, the program's duration, the duration and frequency of weekly sessions, and type of evaluation. Such programs include intensive sports training [6], treadmill training with body weight support [7], resistance training [8, 9], aerobic exercise [10], alternative forms of exercise [11], home-based exercise intervention [12], and the practice of movement strategies [4].

Within this context, the purpose of this study was to verify the effectiveness of two intervention programs on functional balance and mobility in people with idiopathic PD. Two physical exercise programs, a multi-mode exercise program and an adaptive program – whose features differed relative to duration, intensity and the exercises' complexity – were applied to PD patients. The effectiveness of the programs was judged relative to the patients' functional balance and mobility, which were measured by means of Berg's Functional Balance Scale (FBS) [13] and the Timed Up and Go Test (TUG) [14], respectively.

Berg's FBS was chosen because it is typically used in older populations [15] as a reliable tool for measuring functional stability [16], and because it has a strong association with well-established measurement instruments for people with PD, such as the motor subscale of the Unified Parkinson's Disease Rating Scale (UPDRS), and the modified Hoehn and Yahr (H&Y) Staging Scale [17]. The TUG was chosen to assess a series of functionally important tasks related to daily living activities and independent mobility: sitting to standing, gait initiation, walking, turning and sitting [18], to detect changes in mobility in PD patients [19], and to quantify the effects of an intervention program [4].

Section snippets

Participants

Thirty-four participants, with idiopathic PD that ranged from Stage I to Stage III on the H&Y rating scale, gave their informed consent to participate in the experimental procedure, as required by the Declaration of Helsinki and the Institutional Research Ethics Committee (Protocol #002529/2007). They were assigned to two exercise groups. Group 1 (n = 21; 67±9 years old; 11 females; 10 males) was engaged in a multi-mode exercise program, while Group 2 (n = 13; 69±8 years old; 5 females; 8

Results

There were no significant differences between intervention programs for both of the dependent variables at baseline (Berg's FBS: t = 1.79, P > 0.05; TUG: t = −0.94, P> 0.05). Figure 1 illustrates the descriptive results (means and standard deviations) of the dependent variables (score on Berg's FBS and time taken to complete the TUG).

A 2 (groups) by 2 (times of intervention) MANOVA revealed that both groups were affected by the intervention programs (Wilks' Lambda = 0.755, F3,30 = 3.242, p =

Discussion

The purpose of this study was to investigate the effects of two intervention programs, a multi-mode exercise program and an adaptive program, on the mobility and functional balance in people with PD. The results revealed positive effects for both intervention programs. Berg's FBS and the TUG test provided useful measures to changes in aspects that are related to functional balance and mobility, following interventions based on physical exercises.

The TUG time values indicate individuals' levels

Conflict of interests

The authors have no conflicts of interest to disclose.

Acknowledgements

This work was supported by a scholarship grants from Brazilian agencies (CNPq, FAPESP, and CAPES).

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