low-load resistance training with blood flow restriction in people with parkinson's disease

Conditions: Parkinson Disease

Summary: the study's objective is to determine the feasibility of low-load resistance training with blood flow restriction in people who have advanced parkinson's disease and impaired mobility using a mixed-methods convergent parallel design in a single cohort. the study's long-term goal is to develop clinically feasible exercise interventions that are effective at improving mobility, participation, and quality of life for people with advanced parkinson's disease.

this study will use a mixed-methods convergent parallel design to determine the feasibility of low-load bfr training in 20 people with advanced pd symptoms and impaired mobility (hoehn and yahr stage \[h\&y\] 3-4). all participants will receive low intensity resistance training (20-30% of 1rm) with bfr targeting knee extensor, ankle plantarflexor, and elbow extensor muscles 2x/week for 8 weeks. intervention will be delivered by a physical therapist with specialized training in bfr. pre-defined feasibility criteria will be assessed in the primary aim. outcomes assessed before and immediately after the 8-week intervention will include quantitative muscle strength and mobility assessments, and quantitative and qualitative data on health-related qol. aim 1: determine low-load bfr training feasibility based on the following quantitative and qualitative criteria: 1) enrolling 20 participants, 2) retaining ≥80% participants, 3) obtaining ≥80% intervention adherence, 4) having no serious intervention-related adverse events, and 5) quantitatively and qualitatively measured acceptability. aim 2: determine changes in 1) knee extensor, ankle plantarflexor, and elbow extensor muscle strength using fixed myometry and 2) instrumented functional mobility (30-second sit-to-stand, timed up and go, self-selected walking speed, and berg balance scale) using a system of inertial measurement unit wearable sensors. exploratory aim: understand health-related qol changes using the parkinson's disease questionnaire-39 (pdq-39) and semi-structured interviews to elucidate how components of the intervention translate into qol changes through a mixed-method analysis of pdq-39 constructs of mobility, activities of daily living, emotional well-being, social stigma, social support, cognition, communications, and bodily discomfort.

Eligibility criteria:
inclusion criteria: * adults ages 18-89 with neurologist-confirmed diagnosis of pd * h\&y stage 2 (bilateral involvement without postural instability) up to h\&y stage 4 (severe disease) * able to provide informed consent exclusion criteria: * h\&y stage 1 (unilateral involvement only) or less * h\&y stage 5 (wheelchair or bed bound) * unable to provide consent or diagnosis of dementia * history of deep venous thrombosis/pulmonary embolism, peripheral vascular disease, thrombophilia or other clotting disorders; report of easy bruising * any comorbid conditions or pain that substantially affects ability to safely complete rehabilitation (e.g. neurologic, vascular, cardiac problems, orthopedic, or ongoing medical treatments) as determined by a neurologist or physical therapist * currently undergoing supervised resistance training with a physical therapist or other exercise professional * using blood flow restriction currently or in the previous 3 months prior to enrollment * cannot tolerate bfr pressure cuff inflated to 60% of total limb occlusion pressure during baseline assessment * pd-related medication change in the month prior to enrollment

Keywords: parkinson disease blood flow restriction low-load resistance training