Effect of exercise on perceived quality of life of individuals with Parkinson's disease. A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease. Comparison of strength training, aerobic training, and additional physical therapy as supplementary treatments for Parkinson’s disease: pilot study A Randomized Controlled Trial to Reduce Falls in People With Parkinson’s Disease The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease. Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. Feasibility, Safety, and Compliance in a Randomized Controlled Trial of Physical Therapy for Parkinson's Disease Effects of Moderate-Volume, High-Load Lower-Body Resistance Training on Strength and Function in Persons with Parkinson's Disease: A Pilot Study Progressive resistance training improves gait initiation in individuals with Parkinson's disease. Task-oriented progressive resistance strength training improves muscle strength and functional performance in individuals with stroke Exercise programs improve mobility and balance in people with Parkinson's disease. Physical therapy and Parkinson's disease High intensity eccentric resistance training decreases bradykinesia and improves Quality Of Life in persons with Parkinson's disease: a preliminary study. The effect of resistance training on the anxiety symptoms and quality of life in elderly people with Parkinson's disease: a randomized controlled trial. Effects of Group, Individual, and Home Exercise in Persons With Parkinson Disease: A Randomized Clinical Trial Enhancing both motor and cognitive functioning in Parkinson’s disease: Aerobic exercise as a rehabilitative intervention Exercise to improve spinal flexibility and function for people with Parkinson's disease: a randomized, controlled trial.
The purpose of this study was to determine if individuals with Parkinson 's disease ( PD ) who completed an 8-week , supervised PoleStriding exercise program  would undergo significant improvements in cognitive skills , activities of daily living , motor function , and quality of life . The Unified Parkinson 's Disease Rating Scale ( UPDRS ) and the Parkinson 's Disease Question naire ( PDQ-39 ) were used to measure functional independence .  Six male volunteers ( 72.7+/-3.7 years of age ) performed PoleStriding exercise three times per week for 37+/-3 minutes . Differences in the participants ' pre- and post-training scores on the UPDRS and PDQ-39 were analyzed using the Wilcoxin Signed Ranks Test . A statistically significant improvement occurred in the UPDRS ( P<0.026 ) and PDQ-39 ( P<0.028 ) scores following the moderate-intensity exercise intervention . The results of this nonr and omized clinical trial indicate that an 8-week individualized PoleStriding exercise program increases perceived functional independence and quality of life in individuals with PD The effects of progressive resistance exercise ( PRE ) on the motor signs of Parkinson 's disease have not been studied in controlled trials . The objective of the current trial was to compare 6- , 12- , 18- , and 24-month outcomes of patients with Parkinson 's disease who received PRE with a stretching , balance , and strengthening exercise program .  The authors conducted a r and omized controlled trial between September 2007 and July 2011 . Pairs of patients matched by sex and off-medication scores on the Unified Parkinson 's Disease Rating Scale , motor subscale ( UPDRS-III ) , were r and omly assigned to the interventions with a 1:1 allocation ratio . The PRE group performed a weight-lifting program . The modified fitness counts ( mFC ) group performed a stretching , balance , and strengthening exercise program . Patients exercised 2 days per week for 24 months at a gym . A personal trainer directed both weekly sessions for the first 6 months and 1 weekly session after 6 months . The primary outcome was the off-medication UPDRS-III score . Patients were followed for 24 months at 6-month intervals . Of 51 patients , 20 in the PRE group and 18 in the mFC group completed the trial . At 24 months , the mean off-medication UPDRS-III score decreased more with PRE than with mFC ( mean difference , -7.3 points ; 95 % confidence interval , -11.3 to -3.6 ; P<0.001 ) . The PRE group had 10 adverse events , and the mFC group had 7 adverse events . PRE demonstrated a statistically and clinical ly significant reduction in UPDRS-III scores compared with mFC and is recommended as a useful adjunct therapy to improve Parkinsonian motor signs . © 2013 Movement Disorder Society Introduction Physical rehabilitation is commonly used in patients with Parkinson ’s disease ( PD ) to improve their health and alleviate the symptoms . Objective We compared the effects of three programs , strength training ( ST ) , aerobic training ( AT ) , and physiotherapy , on motor symptoms , functional capacity , and electroencephalographic ( EEG ) activity in PD patients . Methods Twenty-two patients were recruited and r and omized into three groups : AT ( 70 % of maximum heart rate ) , ST ( 80 % of one repetition maximum ) , and physiotherapy ( in groups ) . Subjects participated in their respective interventions twice a week for 12 weeks . The assessment s included measures of disease symptoms ( Unified Parkinson ’s Disease Rating Scale [ UPDRS ] ) , functional capacity ( Senior Fitness Test ) , and EEG before and after 12 weeks of intervention . Results The PD motor symptoms ( UPDRS-III ) in the group of patients who performed ST and AT improved by 27.5 % ( effect size [ES]=1.25 , confidence interval [CI]=−0.11 , 2.25 ) and 35 % ( ES=1.34 , CI=−0.16 , 2.58 ) , respectively , in contrast to the physiotherapy group , which showed a 2.9 % improvement ( ES=0.07 , CI=−0.85 , 0.99 ) . Furthermore , the functional capacity of all three groups improved after the intervention . The mean frequency of the EEG analysis mainly showed the effect of the interventions on the groups ( F=11.50 , P=0.0001 ) . Conclusion ST and AT in patients with PD are associated with improved outcomes in disease symptoms and functional capacity Background . Falls are common and disabling in people with Parkinson ’s disease ( PD ) . There is a need to quantify the effects of movement rehabilitation on falls in PD . Objective . To evaluate 2 physical therapy interventions in reducing falls in PD . Methods . We r and omized 210 people with PD to 3 groups :  progressive resistance strength training coupled with falls prevention education , movement strategy training combined with falls prevention education , and life-skills information ( control ) . All received 8 weeks of out-patient therapy once per week and a structured home program . The primary end point was the falls rate , recorded prospect ively over a 12 month period , starting from the completion of the intervention . Secondary outcomes were walking speed , disability , and quality of life . Results . A total of 1547 falls were reported for the trial . The falls rate was higher in the control group compared with the groups that received strength training or strategy training . There were 193 falls for the progressive resistance strength training group , 441 for the movement strategy group and 913 for the control group . The strength training group had 84.9 % fewer falls than controls ( incidence rate ratio [ IRR ] = 0.151 , 95 % CI 0.071 - 0.322 , P < .001 ) . The movement strategy training group had 61.5 % fewer falls than controls ( IRR = 0.385 , 95 % CI 0.184 - 0.808 , P = .012 ) . Disability scores improved in the intervention groups following therapy while deteriorating in the control group . Conclusions . Rehabilitation combining falls prevention education with strength training or movement strategy training reduces the rate of falls in people with mild to moderately severe PD and is feasible OBJECTIVE To assess immediate and near-term effects of 2 exercise training programs for persons with idiopathic Parkinson 's disease ( IPD ) . DESIGN R and omized control trial . SETTING Public health facility and medical center . PARTICIPANTS Fifteen persons with IPD . INTERVENTION Combined group ( balance and resistance training ) and balance group ( balance training only ) underwent 10 weeks of high-intensity resistance training ( knee extensors and flexors , ankle plantarflexion ) and /or balance training under altered visual and somatosensory sensory conditions , 3 times a week on nonconsecutive days . Groups were assessed before , immediately after training , and 4 weeks later . MAIN OUTCOME MEASURES Balance was assessed by computerized dynamic posturography  , which determined the subject 's response to reduced or altered visual and somatosensory orientation cues ( Sensory Orientation Test [ SOT ] ) . Muscle strength was assessed by measuring the amount of weight a participant could lift , by using a st and ardized weight- and -pulley system , during a 4-repetition-maximum test of knee extension , knee flexion , and ankle plantarflexion . RESULTS Both types of training improved SOT performance . This effect was larger in the combined group . Both groups could balance longer before falling , and this effect persisted for at least 4 weeks . Muscle strength increased marginally in the balance group and substantially in the combined group , and this effect persisted for at least 4 weeks . CONCLUSION Muscle strength and balance can be improved in persons with IPD by high-intensity resistance training and balance training OBJECTIVE To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed , strength , and fitness for patients with Parkinson disease . DESIGN A comparative , prospect i ve , r and omized , single-blinded clinical trial of 3 types of physical exercise . SETTING The Parkinson 's Disease and Movement Disorders Center at the University of Maryl and and the Baltimore Veterans Affairs Medical Center , Geriatric Research Education and Clinical Center . PATIENTS A total of 67 patients with Parkinson disease who had gait impairment were r and omly assigned to 1 of 3 arms of the trial . INTERVENTIONS ; ( 1 ) A higher-intensity treadmill exercise ( 30 minutes at 70%-80 % of heart rate reserve ) , ( 2 ) a lower-intensity treadmill exercise ( 50 minutes at 40%-50 % of heart rate reserve ) , and ( 3 ) stretching and resistance exercises ( 2 sets of 10 repetitions on each leg on 3 resistance machines [ leg press , leg extension , and curl ] ) . These exercises were performed 3 times a week for 3 months . MAIN OUTCOME MEASURES The primary outcome measures were gait speed ( 6-minute walk ) , cardiovascular fitness ( peak oxygen consumption per unit time [ $ $ VO2 ] , and muscle strength ( 1-repetition maximum strength ) . RESULTS All 3 types of physical exercise improved distance on the 6-minute walk : lower-intensity treadmill exercise  ( 12 % increase ; P=.001 ) ,  stretching and resistance exercises  ( 9 % increase ; P<.02 ) , and higher-intensity treadmill exercise  ( 6 % increase ; P=.07 ) , with no between-group differences . Both treadmill exercises improved peak $ $ VO2 ( 7%-8 % increase ; P<.05 ) more than did the stretching and resistance exercises . Only stretching and resistance improved muscle strength ( 16 % increase ; P<.001 ) . CONCLUSIONS The effects of exercise were seen across all 3 exercise groups . The lower-intensity treadmill exercise result ed in the greatest improvement in gait speed . Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness . Only the stretching and resistance exercises improved muscle strength . Therefore , exercise can improve gait speed , muscle strength , and fitness for patients with Parkinson disease . The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation Both efficacy and clinical feasibility deserve consideration in translation of research outcomes . This study evaluated the feasibility of rehabilitation programs within the context of a large r and omized controlled trial of physical therapy . Ambulant participants with Parkinson 's disease ( PD ) ( n = 210 ) were r and omized into three groups : ( 1 ) progressive strength training ( PST ) ; ( 2 ) movement strategy training ( MST ) ; or ( 3 ) control ( “ life skills ” ) . PST and MST included fall prevention education .  Feasibility was evaluated in terms of safety , retention , adherence , and compliance measures . Time to first fall during the intervention phase did not differ across groups , and adverse effects were minimal . Retention was high ; only eight participants withdrew during or after the intervention phase . Strong adherence ( attendance > 80 % ) did not differ between groups ( P = .435 ) . Compliance in the therapy groups was high . All three programs proved feasible , suggesting they may be safely implemented for people with PD in community-based clinical practice Background . Resistance training research has demonstrated positive effects for persons with Parkinson 's disease ( PD ) , but the number of acute training variables that can be manipulated makes it difficult to determine the optimal resistance training program . Objective . The purpose of this investigation was to examine the effects of an 8-week resistance training intervention on strength and function in persons with PD . Methods . Eighteen men and women were r and omized to training or st and ard care for the 8-week intervention . The training group performed 3 sets of 5–8 repetitions of the leg press , leg curl , and calf press twice weekly . Tests included leg press strength relative to body mass , timed up- and -go , six-minute walk , and Activities-specific Balance Confidence question naire . Results . There was a significant group-by-time effect for maximum leg press strength relative to body mass , with the training group significantly increasing their maximum relative strength ( P < .05 ) . No other significant interactions were noted ( P > .05 ) . Conclusions . Moderate volume , high-load weight training is effective for increasing lower-body strength in persons with PD An impaired ability to initiate walking is a common feature of postural instability and gait impairment in Parkinson 's disease . While progressive resistance training ( PRT ) has been proposed to be an effective modality to improve balance and gait function in people with Parkinson 's disease , there are a limited number of r and omized trials and no studies have evaluated gait initiation performance . Thus , the purpose of this study was to examine the potential benefits PRT on GI performance in people with Parkinson 's disease . Eighteen individuals with idiopathic PD were r and omly assigned to either a twice weekly PRT program or a non-contact control group for 10 weeks . Biomechanical analysis of GI was performed pre- and post-intervention . Dependent variables of interest included the displacement of the center-of-pressure ( COP ) during the anticipatory postural phase of GI as well as the initial stride length and velocity . The PRT group demonstrated improvements in the posterior displacement of the COP and the initial stride length and velocity . There were no improvements in any variables for the control subjects . These results suggest that PRT may be an effective non-pharmacological and nonsurgical treatment to improve GI performance in PWP Objective : To examine the effectiveness of task-oriented progressive resistance strength training on lower extremity strength and functional performance in chronic stroke subjects . Design : Single-blind , r and omized controlled trial . Setting : Medical centre and district hospital . Subjects : Forty-eight subjects at least one year post stroke . Interventions : Participants r and omly allocated to two groups , control  ( n-/24 ) and experimental  ( n-/24 ) . Subjects in the control group did not receive any rehabilitation training . Subjects in the experimental group were put on a four-week task-oriented progressive resistance strength training . Main measures : Lower extremity muscle strength , gait velocity , cadence , stride length , six-minute walk test , step test , and timed up and go test . Results : Muscle strength significantly improved in the experimental group for strong side muscle groups ( ranged from 23.9 % to 36.5 % ) and paretic side muscle groups ( ranged from 10.1 % to 77.9 % ) . In the control group muscle strength changes ranged from 6.7 % gain to 11.2 % decline . The experimental group showed significant improvement in all selected measures of functional performance except for the step test . In the control group , the number of repetitions of the step test significantly decreased ( -20.3 % ) with no change in other functional tests . There was a significant difference between groups for muscle strength and all functional measures . The strength gain was significantly associated with gain in the functional tests . Conclusions : The task-oriented progressive resistance strength training programme could improve lower extremity muscle strength in individuals with chronic stroke and could carry over into improvement in functional abilities 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 In a r and omized , single-blind , crossover study , we evaluated physical disability in moderately advanced Parkinson 's disease ( PD ) patients after 4 weeks of normal physical activity and 4 weeks of an intensive physical rehabilitation program .  We used a  timed motor task  and a st and  ard assessment of PD severity ( the Unified Parkinson 's Disease Rating Scale [ UPDRS ] with subscales for mentation , activities of daily living [ ADL ] , and motor function ) completed by an investigator blinded to the physical rehabilitation status of the patient . Following physical rehabilitation , there was significant improvement in the UPDRS ADL and motor scores , but no change in mentation score . During the 6 months following physical rehabilitation , patients did not regularly exercise , and the UPDRS scores returned to baseline . We conclude that physical disability in moderately advanced PD objective ly improves with a regular physical rehabilitation program , but this improvement is not sustained when normal activity is resumed Persons with Parkinson disease ( PD ) often demonstrate bradykinesia during mobility tasks . Bradykinesia combined with other PD-related movement deficits may contribute to self-reported reductions in quality of life . At this time , no studies have examined the effects of resistance exercise as an intervention to reduce bradykinesia and improve self-reported quality of life . Therefore , we examined changes in muscle force production , clinical measures of bradykinesia , and quality of life following 12 weeks of a high intensity eccentric resistance exercise program in persons with mild to moderate PD . Twenty individuals with idiopathic PD were matched into an experimental or an active control group . All participants were tested prior to and following a 12-week intervention period . The experimental group performed high intensity quadriceps contractions on an eccentric ergometer 3 days a week for 12 weeks . The active control group participated in an evidence based exercise program of PD . The outcome variables were quadriceps muscle force , clinical bradykinesia measures ( gait speed , timed up and go ) and disease specific quality of life ( Parkinson 's disease question naire-39 [ PDQ-39 ] ) . Data was analyzed using separate 2 ( group ) x 2 ( time period ) ANOVAs . Results demonstrated significant time by group interaction effects for gait speed , timed up and go , and the composite PDQ-39 score ( p < 0.05 ) . Muscle force , bradykinesia , and QOL were improved to a greater degree in those that performed high intensity eccentric resistance training compared to an active control group . Additional research is needed to determine if this type of training has long-term impact and if it results in an alteration of the natural history of mobility and QOL decline in persons with PD OBJECTIVES To assess the effects of resistance training on the anxiety symptoms and quality of life in patients with Parkinson 's disease . METHODS Thirty-five elderly patients were r and omly divided into two groups : 17 patients in the control group and 18 in the intervention group . All patients maintained st and ard pharmacological treatment  for Parkinson 's disease , but the intervention group participated in a 24-week resistance training program . The anxiety symptoms were assessed through the Beck 's Anxiety Inventory , and quality of life by the Parkinson 's Disease Question naire-39 . RESULTS There was a significant reduction in anxiety level and increase in quality of life after 24 weeks of resistance training . CONCLUSION The results of the present study indicate that resistance training is an effective intervention in the reduction of anxiety symptoms and improves the quality of life in elderly people with Parkinson 's disease Background and Purpose : Comparative studies of exercise interventions for people with Parkinson disease ( PD ) rarely considered how one should deliver the intervention . The objective of this study was to compare the success of exercise when administered by ( 1 ) home exercise program , ( 2 ) individualized physical therapy , or ( 3 ) a group class . We examined if common comorbidities associated with PD impacted success of each intervention . Methods : Fifty-eight people ( age = 63.9 ± 8 years ) with PD participated . People were r and omized into ( 1 ) home exercise program , ( 2 ) individual physical therapy , or ( 3 ) group class intervention . All arms were st and ardized and based on the Agility Boot Camp exercise program for PD , 3 times per week for 4 weeks . The primary outcome measure was the 7-item Physical Performance Test . Other measures of balance , gait , mobility , quality of life , balance confidence , depressions , apathy , self-efficacy and UPDRS-Motor , and activity of daily living scores were included . Results : Only the individual group significantly improved in the Physical Performance Test . The individual exercise showed the most improvements in functional and balance measures , whereas the group class showed the most improvements in gait . The home exercise program improved the least across all outcomes . Several factors effected success , particularly for the home group . Discussion and Conclusions : An unsupervised , home exercise program is the least effective way to deliver exercise to people with PD , and individual and group exercises have differing benefits . Furthermore , people with PD who also have other comorbidities did better in a program directly supervised by a physical therapist . Video Abstract available for additional insights from the authors ( see Video , Supplemental Digital Content 1 , http://links.lww.com/JNPT/A112 ) BACKGROUND Aerobic exercise training ( AET ) has been shown to provide health benefits in individuals with Parkinson 's disease ( PD ) . However , it is yet unknown to what extent AET also improves cognitive and procedural learning capacities , which ensure an optimal daily functioning . OBJECTIVE In the current study , we assessed the effects of a 3-month AET program on executive functions ( EF ) , implicit motor sequence learning ( MSL ) capacity , as well as on different health-related outcome indicators . METHODS Twenty healthy controls ( HC ) and 19 early PD individuals participated in a supervised , high-intensity , stationary recumbent bike-training program ( 3 times/week for 12 weeks ) . Exercise prescription started at 20 min ( + 5 min/week up to 40 min ) based on participant 's maximal aerobic power . Before and after AET , EF tests assessed participants ' inhibition and flexibility functions , whereas implicit MSL capacity was evaluated using a version of the Serial Reaction Time Task . RESULTS The AET program was effective as indicated by significant improvement in aerobic capacity in all participants . Most importantly , AET improved inhibition but not flexibility , and motor learning skill , in both groups . CONCLUSION Our results suggest that AET can be a valuable non-pharmacological intervention to promote physical fitness in early PD , but also better cognitive and procedural functioning OBJECTIVES The effectiveness of an exercise intervention for people in early and midstage Parkinson 's disease ( stages 2 and 3 of Hoehn and Yahr ) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described . DESIGN AND SETTING Fifty-one men and women , aged 55 - 84 years , identified through advertisement , local support groups , and local neurologists were enrolled into a r and omized , controlled trial . Subjects were assigned r and omly to an intervention or a usual care arm ( i.e. , no specific exercise ) . Of the original 51 participants , 46 completed the r and omized , controlled trial . Participants in the exercise arm ( n = 23 ) received individual instruction three times per week for 10 weeks . Participants in the usual care arm ( n = 23 ) were " wait listed " for intervention . MEASUREMENTS Changes over 10 weeks in spinal flexibility ( i.e. , functional axial rotation ) and physical performance ( i.e. , functional reach , timed supine to st and ) were the primary outcome measures . RESULTS MANOVA conducted for the three primary outcome variables demonstrated significant differences ( P < or = .05 ) between the two groups . Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group . There was no significant difference in supine to sit time . CONCLUSION Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD
However , most physical performance outcomes did not show clinical ly worthwhile improvement after progressive resistance exercise .
CONCLUSION This review suggests that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson 's disease , but carryover of benefit does not occur for all measures of physical performance .
The current evidence suggests that progressive resistance training should be implemented in Parkinson 's disease rehabilitation , particularly when the aim is to improve walking capacity
QUESTION Does progressive resistance exercise improve strength and measures of physical performance in people with Parkinson 's disease ?