A four-week task-specific exercise program at home can improve turning ability and balance, and reduce disease severity in people with early to mid-stage Parkinson’s disease, a small study shows.
This exercise program for Parkinson’s specifically focuses on rotating those parts of the body that are most involved in turning. The researchers say it could be a promising alternative rehabilitation program for patients with a stiff trunk, which makes turning difficult and less risky.
Research, “Benefits of a task-specific exercise program for overall turnaround in Parkinson’s disease: a randomized controlled trial,” published in the journal Physiotherapy Research International.
A stiff trunk is a common symptom of Parkinson’s disease. Instead of turning the body in a top-down fashion—moving the head first, then the shoulders and hips—the patient tends to move all of these body parts together, or “in a whole.”
The researchers noted that this stiffness of movement can interfere with turning and balance, thereby increasing the risk of falls. The team added that while Parkinson’s disease treatments such as levodopa therapy and deep brain stimulation are designed to address these difficulties, they are best used in conjunction with exercise training.
However, how task-specific exercise practice improves the “overall” turn in Parkinson’s disease has not been reported.
Researchers at Mahidol University in Thailand evaluated the rotational motor and clinical disease outcomes of a one-month task-specific exercise program in a small patient population.
They recruited 22 patients with early to mid-stage Parkinson’s disease matched for age and disease severity. Half were randomly assigned to the exercise group, and the other half continued their usual medication as the control group. Rotational movements and clinical outcomes determined by measures including the Unified Parkinson’s Disease Rating Scale or UPDRS were assessed before and after the exercise program.
Three weekly task-specific exercises supervised by a physical therapist for two weeks in the clinic, followed by two supervised and two at-home exercises in the third week, and then five at-home exercises in the fourth and final week.
The main exercise program consists of 45 minutes of 10 rotations with different parts of the body—head, shoulders, hips, etc.—in sitting, standing, and lying down positions at the same time. Its goal is to increase the flexibility and mobility of each body part.
Patients then performed a five-minute throwing task to improve balance and turned in each direction for 10 minutes while walking to increase their range of body rotation. There was a 15-minute warm-up and relaxation period of deep breathing and stretching before and after the exercise.
To measure rotational movements (kinematics) and stepping movements, special sensors are installed in the center of the head, mid-thorax and feet. The participants performed a half-circle turn, and the team recorded the delay or delay in the movement of each body part as they turned, as well as their speed and step motion.
According to the analysis, compared to the control group, those who participated in the exercise experienced shorter delays or faster movements in all body parts including the head, chest, front and rear feet. Overall, in the exercise group alone, the mean onset latency was significantly lower—indicating a faster onset of exercise.
During a half-circle, the exercise group showed significant improvements in stride length, total steps, stride length, and turning speed compared with the control group.
“This result can be explained by the fact that the desired movement is repeated [180-degree turns] Task-specific training should enhance motor learning by reducing motor planning complexity and reducing reliance on sensory feedback,” the researchers wrote.
The UPDRS score showed that the exercise group had significantly lower (improved) UPDRS total scores, motor scores, and stiffness scores than their pretraining scores, suggesting that these individuals had less Parkinson’s severity.
The exercise program also significantly improved balance (as measured by a functional range test) and reduced fear of falling, as assessed using the Fall Efficacy Scale, a self-report questionnaire used to assess fear of falls in older adults.
“The main finding of this study is that [four]A week-specific home workout program with a TSM focus [task-specific movement]may improve overall steering and clinical outcomes in early to mid-stage patients [Parkinson’s disease],” the researchers wrote.
A limitation of one study was that the control group did not receive the same level of attention as the exercise group. Therefore, “it cannot be ruled out as a factor in group differences,” they said.