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Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease.

Abstract

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, prospective, randomized, single-blinded clinical trial of 3 types of physical exercise.

SETTING

The Parkinson's Disease and Movement Disorders Center at the University of Maryland 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 randomly 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 resulted 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.

Links

  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    University of Maryland School of Medicine, Department of Neurology, Baltimore,MD21201, USA. lshulman@som.umaryland.edu

    , , , , , , , ,

    Source

    JAMA neurology 70:2 2013 Feb pg 183-90

    MeSH

    Adult
    Aged
    Electrocardiography
    Exercise
    Exercise Test
    Female
    Gait
    Humans
    Male
    Middle Aged
    Muscle Stretching Exercises
    Parkinson Disease
    Prospective Studies
    Resistance Training
    Single-Blind Method

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial
    Research Support, N.I.H., Extramural
    Research Support, Non-U.S. Gov't
    Research Support, U.S. Gov't, Non-P.H.S.

    Language

    eng

    PubMed ID

    23128427

    Citation

    TY - JOUR T1 - Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. AU - Shulman,Lisa M, AU - Katzel,Leslie I, AU - Ivey,Frederick M, AU - Sorkin,John D, AU - Favors,Knachelle, AU - Anderson,Karen E, AU - Smith,Barbara A, AU - Reich,Stephen G, AU - Weiner,William J, AU - Macko,Richard F, PY - 2012/11/7/entrez PY - 2012/11/7/pubmed PY - 2013/4/17/medline SP - 183 EP - 90 JF - JAMA neurology JO - JAMA Neurol VL - 70 IS - 2 N2 - 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, prospective, randomized, single-blinded clinical trial of 3 types of physical exercise. SETTING: The Parkinson's Disease and Movement Disorders Center at the University of Maryland 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 randomly 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 resulted 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. SN - 2168-6157 UR - https://www.unboundmedicine.com/medline/citation/23128427/full_citation L2 - http://archneur.jamanetwork.com/article.aspx?doi=10.1001/jamaneurol.2013.646 ER -