# Exercise as it relates to Disease/Can exercise beat Parkinson’s?

Based on information taken from the article "The effects of loading and unloading treadmill walking on balance, gait, fall risk, and daily function in Parkinsonism" (Toole, Maitland 2005).

## Background to this research

The research was based on the effects of exercise on individuals with Parkinson's Disease. Parkinson's Disease is a disorder that effect the nervous system of an individual. This disorder causes symptoms such as trembling, limb stiffness and a balance impairment due to the reduced production of Dopamine, the chemical responsible for the fluidity of muscle movements.
The research completed in this study has aimed to give an understanding to how exercise can affect people with the Disease and may provide insight as to how exercise may be prescribed as a form of treatment in the near future. With this information exercise may be able to be used at the initial treatment in Parkinson's, lowering costs of treatment for affected individuals and the health care system.

## Where is the research from?

The research was carried out by a joint venture of departments, including the Department of Clinical Sciences and the Neuroscience Centre and Parkinson’s Centre from the Florida State University in Tallahassee, Florida USA.
Members of the team have also been involved with the National Parkinson's Foundation Clinic such as C. Maitland who serves as director of the Facility. Maitland has also been recognised in his field with honours such as being named in the Best Doctors in America.

## What kind of research was this?

The research on this subject was done using a Cross Sectional Study that aims to show correlation between disease and a chosen factor within a population. In this study the Authors chose to find a correlation between Parkinson's Disease and the effects of different exercise activities within males and females with Parkinson's Disease.

## What did the research involve?

The study was of the effects of loading and unloading treadmill walking on balance, gait, fall risk and daily function in Parkinsonism. The study was comprised of 23 participants with different levels of Parkinsonism. Participants were categorized into stages based on their level of Parkinsonism. The stages included 1A,1B, 2A, 2B, 3A, 3B and finally 4, with 4 being most severe. The participants were split into groups and undertook an exercise program specific to each group. The Group 1 program consisted of 20 minutes of treadmill walking with no loading or unloading, 3 days a week for 6 weeks. Group 2 used a program of unweighted exercise at a 25% body weight reduction for 15 minutes, 3 days/week for 6 weeks. Group 3 was the weighted group and had treadmill exercise with 5% added weight using a scuba diving belt for the same duration of exercise. After these programs had been completed tests of Gait, Balance, Strength and Range of Motion were taken to acquire data to provide a conclusion..
With the introduction of a "control group" (Group 1) within the population, it has provided the method of study a helpful comparative measurement for the validity of the study. The limitations of the methodology included the ability of the participants to complete the program due to health, to accommodate for this the program included that participants were not to exceed 60% of the theoretical heart rate capacity, to lower the intensity and risk for injury.

## What were the basic results?

Throughout the program a 99% attendance rate was achieved, it was noted also that participants did participate even in below optimum health. During the balance testing there was no statistically significant difference between groups. The gait analysis tests showed findings of a decreased time that a supported leg was used in all groups, with an increased velocity.
| Time of Test | Single Support Time (Left Leg) |
| Pre-Test | 40.09% |
| Post-Test | 40.07% |
| Follow Up | 40.03% |
The test for strength showed no significant differences between groups, however the aim of the method was not to strength train. Strength test were only carried out to display a change in balance ability. The research team also tested Falls in SOT conditions and they found a decrease in falls for all groups. Range of Movement tests showed left leg dorsiflexion and knee flexion improved across all groups.
The discussion of this study it was interpreted that participants with Parkinson’s can undertake an exercise program consisting of treadmill walking. They also found that weight bearing exercise will not improve overall gait and balance ability, however general treadmill walking will increase overall gait and balance and reduce the risk of falls. It was also noted that these improvements in gait and balance were found not to be the result of improvements in strength.
From the findings of the study the authors of this article have displayed an accurate depiction of the in-depth results of the programs completed. They have noted that there were improvements in the gait and balance of participants but have included information that it was not due to added weight bearing and subsequent muscle strength that was produced in their corresponding tests.

## What conclusions can we take from this research?

From reviewing this article, I concluded that the data shows; Improvements in Gait and Balance and Reduction in risk of falls
I believe that the data collected showed such a small difference with the exercise program that it is hard to tell if the implementation of a treadmill-based exercise will provide any significant changes in gait, balance and overall strength. In the paper "Effects of exercise on mobility in people with Parkinson's disease" by N. van der Kolk, it states that there is a small increase in improvements of gait and balance with an exercise program. The article "Aerobic exercise intervention improves aerobic capacity and movement initiation in Parkinson’s disease patients" by J. Bergen, they found that an aerobic training program has more significant impacts on the aerobic capacity and the improvement of neuromuscular slowing of individuals with the disease.

## Practical advice

From this research we can extract that small improvements in gait and balance can occur with an exercise intervention with reduction in Falls to be expected. It is stated in the conclusion of the research that people with Parkinson's Disease have the capacity to enter a physical therapy program. It is important that before physical therapy program is undertaken that an Exercise Physiologist is contacted as to the details of a recommended exercise program. For example, the study included exercise that did not surpass 60% of a theoretical heart rate capacity, lowering the exercise volume and intensity is important to avoid injury unexpected illness.
Further readings of the impact of exercise of Parkinsonism include;
* "Aerobic exercise intervention capacity and movement initiation in Parkinson’s disease patients" - J. Bergen
* "Effects of exercise on mobility in people with Parkinson's disease" - N. van der Kolk

## References

* ↑ NeuRA. Parkinson's Disease Health Information (2018). Retrieved from; https://www.neura.edu.au/health/parkinsons-disease/extra-information/
* ↑ Brain Foundation. Parkinson's Disease (2018). Retrieved from; http://brainfoundation.org.au/disorders/parkinsons-disease
* ↑ Charles G Matland M.D, Florida State University College of Medicine. Retrieved from https://med.fsu.edu/index.cfm?fuseaction=directory.full&usemenu=&usetemplate=column&directoryID=10821
* 1 2 3 4 Tonya Toole, Charles G. Maitland, Earl Warren, Monica F. Hubmann and Lynn Panton. The effects of loading and unloading treadmill walking on balance, gait, fall risk, and daily function in Parkinsonism. Neuro Rehabilitation 20 (2005) 307–322
* ↑ Nicolien M. van der Kolk MD. Effects of exercise on mobility in people with Parkinson's disease. Official Journal of the International Parkinson's and Movement Disorder Society (16 October 2013)
* ↑ John L. Bergen. Aerobic exercise intervention improves aerobic capacity and movement initiation in Parkinson’s disease patients. Neuro Rehabilitation 17 (2002) 161–168