# Exercise as it relates to Disease/Exercise for Patients with Parkinson's Disease- Does it improve spinal function and flexibility?

This is an analysis of the journal article "Exercise to Improve Spinal Flexibility and Function for People with Parkinson's Disease" By Schenkman, M. et al. (1998)

## Background to this research

The World Health Organisation defines physical activity as ‘any bodily movement produced by skeletal muscles that requires energy expenditure’. Physical inactivity in our society has become one of the biggest health concerns, costing the Australian government $719 million per year in healthcare, $9 billion in productivity and a staggering $3.8 billion in mortality each year. A major concern over sedentary behaviour has risen as of recent, with a considerable amount of the population living sedentary lifestyles, working long hours, and not making the time for physical activity.
With increasing research linking this behaviour to cardiovascular disease, cancer, type 2 diabetes, obesity and mortality, it is critical that the world is educated and shown the importance of physical activity to their health, fortune and future.
Physical activity is one of the most beneficial, effective and easily modifiable interventions that can be done by anyone to overcome the world’s sedentary pandemic. Exercise has not only proven to reduce sedentary lifestyles, but it has found benefits for those living with disease.
More specifically, physical activity could be an intervention used to improve spinal function and flexibility for those living with early and midstage Parkinson’s disease. As this disease causes musculoskeletal impairments to areas such as the axial structures and extremities, exercise specifically designed to improve spinal function and flexibility may improve balance control, daily tasks and other physical limitations present in those with Parkinson's disease. A study by Schenkman, M et al investigates the benefits of physical activity in reducing the limitations caused by parkinson's disease.

### Where is the research from?

Schernkman et al. from the Center for the Study of Aging and Human Development, a resource for the Duke University and Medical Centre community in Durham NC, USA.

### What kind of research was this?

This was a randomised, controlled trial, enrolling men and women with Parkinson's disease into this experiment through advertisement, local support groups and local neurologists.

### What did the research involve?

Participants were recruited through advertisements in local newspapers, presentations at local support groups, and through referrals from local neurologists. From these participants, a group of fifty one men and women between the ages of 55-84 with Parkinson's disease, with either stage 2 or 3 of Hoehn and Yahr, and had a measure of functional axial rotation of 120° or less to either side were selected for the study. They were excluded from the study if they had been hospitalised in the last 3 months, had other neurological disorders (i.e. stroke), or if they had changed Parkinson specific medication in the past month. Of the fifty-one, only forty-six completed the randomised, controlled trial.
The chosen group of 46 individuals were assigned randomly to one of two groups, the intervention group, or as the control group (meaning no specific exercises). The intervention was conducted over 10 weeks, with 30 sessions that had been specifically designed for each individual by a physical therapist. The programs included series of stages progressing from the supine position to standing, with increasing difficulty in activities throughout the stages of the program.
This experiment recorded the changes in spinal flexibility (functional axial rotation and range of motion through the spine) and physical performance (functional reach and timed supine to stand) before and after the 10 week program.

### What were the basic results?

Schenkman, M. et al. found that significant differences were achieved between the control group and intervention group in relation to functional axial rotation, functional reach and 360° turning for those with early-to-mid stage of Parkinson's disease. Although the sample size was small, the results suggest that exercise did have a large impact on strengthening and improving the neurological impairments that occur as a result of Parkinson's disease. These results provide clinical evidence of improvements with this intervention, and thus show great practicality for introducing these exercises into the daily routine of those with Parkinson's disease.
Results from the experiment suggest that exercise as an intervention for those with Parkinson's disease can lead to improved spinal flexibility and function, as well as improvements in coordination, balance, daily motor skills and one's independence. Investigation over a longer period of time is needed to further understand these findings and to build a bigger body of research into determining the effects for those who consistency engage in a long-term program.

### How did the researchers interpret the results?

The results of the experiment were tested using MANOVA software to compare both groups at baseline, and after the 10 week intervention. The results showed a P-value level of significance less than 0.50. This information is statistically significant, showing a large difference between the results of the control group and intervention group. As well, a residualised change score model was used to compare the data, which also showed significantly different data between the two groups from the start of the program, to after the 10 weeks. Taken together, this data suggests that functional movement and flexibility can be improved through exercise for those with Parkinson's disease.

### What conclusions can we take from this research?

With the results collected from this study, this body of research shows strong evidence for introducing specific flexibility and strengthening exercises to help improve the function and flexibility of those with Parkinson's disease. The experimenters successfully conducted this study, and gathered significant evidence to back up their hypothesis and to suggest the importance of exercise interventions for this particular population of people.
Extensive literature is provided within the text, appropriately supporting the findings of this experiment. A recent study from 2008, 'The effectiveness of exercise interventions for people with Parkinson's disease' shows a larger body of empirical evidence to support that exercise strategies do have an effect on delaying or reversing functional decline (physically and psychologically) for those with Parkinson's disease. Improving physical performance and activities of daily living. Various studies have showed similar results, indicating that exercise can have an effect on not only the function and spinal flexibility of those with Parkinson's disease, but also on their motor performance and corticomotor excitability. Exercise for those with Parkinson's has a number of other benefits, not just physically, but to their overall health, psychological health and social health.
Overall, this area of study needs further investigation and larger long-term experiments to fully understand the effects of specific exercise interventions, the risks and also the advantages of such practises on those with Parkinson's disease.

### What are the implications of this research?

Schenkman, M. et al have outlined the benefits of an intervention program for those with Parkinson's disease. However, in order for the intervention to be successful, all participants need to willing to participate consistently to see maximal results from such a program. As well, before taking on this practical advice, those with Parkinson's disease who are interested, should have a risk assessment done and be cleared by their doctor prior to starting.

### Further reading

For further information regarding the benefits of exercise to improve spinal function and flexibility; click on the links below.
* The effectiveness of exercise interventions for people with Parkinson's disease: http://onlinelibrary.wiley.com/doi/10.1002/mds.21922/full
* Exercise and Parkinson's disease: http://www.webmd.com/parkinsons-disease/guide/parkinsons-exercise
* National Parkinson's Foundation; Exercise: http://www.parkinson.org/understanding-parkinsons/treatment/Exercise/

### References

* 1 2 3 4 Schenkman, M et al. (1998) Exercise to Improve Spinal Flexibility and Function for People with Parkinson's Disease. Journal of the American Geriatrics Society. Vol 46 pp 1207-1216
* 1 2 World Health Organisation (2016). Global strategy on diet, physical activity and health. Available from: <http://www.who.int/entity/dietphysicalactivity/pa/en/index.html>
* ↑ Medibank Private(2008)The Cost of Physical Inactivity. Retrieved 13th September 2016, from http://www.medibank.com.au/client/documents/pdfs/the_cost_of_physical_inactivity_08.pdf
* 1 2 Fisher, B. et al (2008). The Effect of Exercise Training in Improving Motor Performance and Corticomotor Excitability in People With Early Parkinson's Disease. Science Direct. Vol 89 (7) pp. 1221-1229
* 1 2 3 Goodwin, V. et al. (2008). The effectiveness of exercise interventions for people with Parkinson's Disease: a systematic review and meta analysis. Vol 23, pp 631-640
* ↑ Scandalis, T. et al. (2001)Resistance Training and Gait Function in Patients with Parkinson’s Disease. American Journal of Physical Medicine & Rehabilitation. Vol 80 (1) pp.38-43