# Exercise as it relates to Disease/Exercise and Parkinson Disease: Comparing tango, treadmill, and stretching

This article is regards to comparing and seeking the benefits of Treadmill, Tango and Stretching on people with Parkinson Disease (PD).

## What is the background to this research?

Parkinson's disease (PD) is the second most common neurodegenerative disease after Alzheimer. PD is destroys pigmented aminergic brain stem neurons in the brain. Without these cells which produce dopamine, the brain slowly losses its control of movement over time. This causes symptom's such as tremor or shaking, muscle rigidity or stiffness, slowing of movement, stooped posture and balance problems. PD also brings non movement symptoms and problems, these include depression, anxiety, fatigue and sleep disorders. It has been shown that these are commonly missed by treating doctors.
The onset of PD can be typically seen in ages 50-65 however research has shown that there is a higher percentage of people with PD over the age of 65. In 2016, 6.1 million people had PD globally and 211,296 deaths occurred due to PD.
To date there has been no cure found for PD, however there are medications which minimize the effects of the motor control symptoms of the disease. Further research has shown the benefits of exercising and improving the functionality of movement including gait for people with PD. It has been found that interventions such as stretching, aerobic activities, strength and balance training have shown to be beneficial for functionality, movement, gait speed, strength and balance.

## Where is the research from?

* This study was undertaken at the Washington University School of Medicine in Saint Louis, Missouri
* The funding for the study was from Greater St Louis Chapter of the American Parkinson Disease Association (APDA), Parkinson Study Group and the Parkinson’s Disease Foundation’s Advancing Parkinson’s Treatments Innovations Grant, Barnes Jewish Hospital Foundation (Elliot Stein Family Fund and Parkinson Disease Research Fund), ad APDA Advanced Research Center at Washington University in St Louis.
* All of the authors have PhD and are respected in their fields. They have also been apart of other studies.

## What kind of research was this?

* This study was a Prospective Controlled Trial.
* The participants were serially assigned to either of the three interventions.
* A Prospective trial is a valid study design which provides valuable data and future proof however they can be expensive and require funding.
* Although a Prospective Controlled Trial is not the Gold standard it is still reliable study design which produces minimal bias.

## What did the research involve?

The Research involved Participants with idiopathic Parkinson's Disease take part in a 12 week study which included three exercise interventions and they were Tango, treadmill and stretching. They recruited from Washington University School of Medicine's Movement Disorders Center, the Greater St Louis Area Chapter of the American Parkinson Disease Association, and the St Louis community. The study design was based around community exercise classes and they had to complete 2 classes per week over the 12 week period. The participants were tested Pre, post the 12 weeks and also had follow up testing 12 weeks after the completion of the study.
119 people enrolled for the study however over the different stage people left for various reasons.
| Treadmill = 41 | Tango = 43 | Stretching = 35 |
| Baseline = 41 | Baseline = 43 | Baseline = 34 |
| Post = 31 | Post = 39 | Post = 27 |
| Follow up = 29 | Follow up = 36 | Follow up = 23 |
The sessions went for 1 hour which included a light warm up and cool down.
* Treadmill
* Participants walked at their preferred walking speed
* which were reevaluated weekly and the treadmills speed were adjusted
* Tango
* Participants Practiced argentine tango using a special curriculum for people with Parkinson disease
* They started out with the basic's then progressively learnt more steps and sequences each week
* They Changed parters and swapped leaders o it was not always the same.
* Stretching
* The stretching group partaked in gentle stretching which included full body exercises however these were not strength based.
Limitations in methodology:
* The main limitation that can be seen is that the participants were off Anti medication during the trial and follow up. This means that the results would not reflect every day life for the participants as many would usually take their medication. If they were taking medication the results might have differed most likely improving however we do not know which intervention would of improved or declined.
* Another limitation is the loss of participants from baseline to follow up which could have potentially effected the results.

## What were the basic results?

* Forward Velocity improved in the treadmill group
* Backward velocity improved in Tango however it was not a significant change. However there was significant results of improvement for the treadmill and stretching group between baseline and post testing. Treadmill also improved at the follow up test.
* Tango improved the most in timed walking distance by 4.4%.
* Tango group included a lot of standing around and learning the movements which could have limited the results.
* Stretching group may have improved for the backward velocity through an increase in flexibility.

## What conclusions can we take from this research?

* Exercise in particular walking on a treadmill, stretching and Tango can be beneficial for someone with PD to improve their movement functionality.
* The treadmill and Stretching were seen to be the key factor in improving forward velocity and backward velocity.
* Tango could potentially help with walking speed however further research needs to be completed.

## Practical advice

* Further research needs to be undertaken that includes PD participants that are on medication. If they are off anti PD medication it does not demonstrate their day to day life as most people diagnosed with PD take medication.
* This study and others have shown that exercise can be beneficial for the movement functionality, gait speed and balance. However there have been no significant results from these studies suggesting exercise helps with the psychological effects such as depression so further research needs to be done.
* The combination of exercise and medication will on increase the benefits of reducing physical symptoms of PD.

## Further information/resources

* Critiqued Study - https://journals.lww.com/jnpt/Fulltext/2019/01000/Exercise_and_Parkinson_Disease__Comparing_Tango,.4.aspx
* Parkinson Australia - https://www.parkinsons.org.au/
* Brain Foundation - https://brainfoundation.org.au/disorders/parkinsons-disease/
* Neurological Alliance - https://www.msaustralia.org.au/about-msa/neurological-alliance-australia-naa

## References

Add in the references using this code
* ↑ De Lau, L.M. and Breteler, M.M., 2006. Epidemiology of Parkinson's disease. The Lancet Neurology, 5(6), pp.525-535.
* ↑ NeuRA. (2019). Parkinson’s disease. [online] Available at: https://www.neura.edu.au/health/parkinsons-disease/ [Accessed 12 Sep. 2019].
* ↑ Shulman, L.M., Taback, R.L., Rabinstein, A.A. and Weiner, W.J., 2002. Non-recognition of depression and other non-motor symptoms in Parkinson's disease. Parkinsonism & related disorders, 8(3), pp.193-197.
* ↑ Van Den Eeden, S.K., Tanner, C.M., Bernstein, A.L., Fross, R.D., Leimpeter, A., Bloch, D.A. and Nelson, L.M., 2003. Incidence of Parkinson’s disease: variation by age, gender, and race/ethnicity. American journal of epidemiology, 157(11), pp.1015-1022.
* ↑ The Lancet Neurology. (2018). Global, regional, and national burden of Parkinson's disease, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. [online] Available at: https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30295-3/fulltext [Accessed 7 Sep. 2019].
* ↑ Goodwin, V.A., Richards, S.H., Taylor, R.S., Taylor, A.H. and Campbell, J.L., 2008. The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta‐analysis. Movement disorders, 23(5), pp.631-640.
* ↑ Rawson, K.S., McNeely, M.E., Duncan, R.P., Pickett, K.A., Perlmutter, J.S. and Earhart, G.M., 2019. Exercise and Parkinson Disease: Comparing Tango, Treadmill, and Stretching. Journal of Neurologic Physical Therapy, 43(1), pp.26-32.
* ↑ Kalogeropoulos,, A. (2014). Understanding Retrospective vs. Prospective Study designs. [ebook] Emory University School of Medicine. Available at: http://medicine.emory.edu/documents/research/kalogeropoulos-study-design-talk.pdf [Accessed 10 Sep. 2019].
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