# Exercise as it relates to Disease/Parkinson's: Exercise improves movement initiation!

The following passage is an in-depth critique on the journal article, "Aerobic exercise intervention improves aerobic capacity and movement initiation in Parkinson’s disease patients".

## What is the background to this research?

Parkinson’s Disease is a neurodegenerative brain disorder that effects millions of people around the world. Its unfortunate symptoms can have a drastic impact on the lives of people who have been diagnosed. The primary manifestations of Parkinson’s Disease are the abnormalities of movement; resulting from the lack of the neurotransmitter dopamine, and the loss of function of dopaminergic cells in the basal ganglia. Much of the current research concerning Parkinson’s is primarily focused on drug related therapy. The journal article, “Aerobic exercise intervention improves aerobic capacity and movement initiation in Parkinson’s disease patients”, aims to push further analysis on the effect of exercise interventions. The purpose of the study is to investigate the effect of a 16-week aerobic exercise intervention on aerobic capacity and movement initiation time for Parkinson’s Disease patients.

## Where is the research from?

The journal article was conducted and mediated by John L. Bergen. John is the assistant professor of the Division of Health, Leisure, and Exercise Science in the University of West Florida. He has an outstanding track record in research and has contributed immensely to the Exercise Science Community; this has led to the reliability and creditability in his research. The Parkinson’s Disease subjects were recruited from the patient list of the Tallahassee Neuroscience Centre. Tonya Toole, Robert Elliott, Brain Wallace, Keith Robinson and Charles Maitland all collaborated on this project. The methodologies were then conducted over 4 different constitutions: University of West Florida, Florida State University, Cardiac Rehabilitation Centre and Tallahassee Memorial Health Care Centre.

## What kind of research was this?

The research was a quantitative, randomized controlled trial. Randomized Controlled Trial studies are extremely beneficial when it comes to treatments and therapies for diseases and disorders (i.e. Parkinson’s Disease). The primary goal is to determine if a specific therapy (i.e. exercise intervention) makes a positive difference to the people receiving it. It is designed to randomly assign participants into an treatment group (perform intervention) or a control group (no intervention). Once the study is completed, quantitative data can be used to compare the outcome variable between both groups (i.e. aerobic capacity/movement initiation).

## What did the research involve?

The research involved the study of 8 Parkinson’s patients that were recruited from the Tallahassee Neuroscience Centre. The treatment group, which consisted of 4 out of the 8 patients, completed a 16-week aerobic exercise intervention. The exercise intervention consisted of a warm-up, cycle, incline treadmill protocol (60-70% heart rate reserve) and cool down. Each patient completed this 3 times a week. The other 4 patients (controlled group) remained inactive and did not perform any exercise throughout the intervention timeframe. Before and after the intervention was completed, aerobic capacity and movement initiation time were measured in all 8 participants. Aerobic capacity was measured through a cycle ergometer with a continuous incremental protocol until fatigue. Peak VO$_2$ was the variable being measured. A series of responses to both visual and proprioceptive cues were performed to calculate movement initiation.

## What were the basic results?

Aerobic capacity and movement initiation were the two variables being measured in this study.
Aerobic Capacity
Based on the Tukey HSD test (4.34), the treatment group showed a significantly improved peak VO$_2$, while the control group scores declined. The treatment groups peak VO$_2$ started from 19.5 ml/kg/min and increased to 24.5 ml/kg/min. The control group began at 15.9 ml/kg/min and declines to 14.1ml/kg/min. The treatment group also demonstrated a 32% increased pre-to-post power output. The controlled group had a 10% reduction from pre-to-post power output.
Movement Initiation
The controlled group showed no improvement from pre-to-post intervention. On the contrary, the 4 subjects that participated in the exercise intervention resulted in an improved movement initiation. They all had enhanced visual and proprioceptive responses. The results also indicate that movement initiation times were faster with proprioceptive cues compared to visual cues. In addiction, simple conditions times were faster than choice condition. The table below shows the pre-exercise and post-exercise results for the treatment group.
| | Visual (427 ms) | Proprioceptive (320 ms) | Simple (273 ms) | Choice (474 ms) | Flexion (389 ms) | (Extension 357 ms) |
| Pre-Exercise | 447 | 369 | 285 | 532 | 435 | 381 |
| Post-Exercise | 406 | 270 | 261 | 415 | 343 | 333 |

## What conclusions can we take from this research?

There is indisputable evidence that their is a positive relationship between exercise and improved motor control in Parkinson's disease. Moreover, aerobic exercise has the ability to improve aerobic capacity and movement initiation in PD Patients. The change in movement initiation indicates that aerobic capacity may reduce the detrimental effects of neuromuscular slowing with Parkinson's disease patients, by improving the subjects ability initiate and performed appropriate movement pattern. This can ultimately prolong and improve quality of life.

## Practical advice

Aerobic exercise evidently has a positive effect on Parkinson's Disease. Practitioners and families affected by Parkinson's need to be educated on these effects so that we motivate patients into implementing exercise into their day to day lives.
The current method for dealing with Parkinson's disease is through medication. However, the effects of such drugs may cause side-effects and are a short-term solution. Therefore, it is practical to implement an everyday exercise routine to lessen the dependency of drug therapy. This will have the potential to reduce the likelihood of side-effects and increase quality of life.

## Further information/resources:

Parkinson's Foundation: Exercise (URL: http://parkinson.org/Understanding-Parkinsons/Treatment/Exercise)
Parkinson's Disease and Exercise (PDF: http://exerciseismedicine.com.au/wp-content/uploads/2016/11/2014-Parkinsons-Disease-FULL.pdf)
Meta Analysis: HF Shu (2014) "Aerobic Exercise for Parkinson's Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials": Official Journal of Parkinson and Movement Disorder Society

## References

* ↑ John L. Bergen (2002) "Aerobic exercise intervention improves aerobic capacity and movement initiation in Parkinson’s disease patients"; NeuroRehabilitation 17:161-168
* ↑ Victoria Goodwin (2008) The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta‐analysis; Movement Disorders 631-640
* ↑ Pietro Mazzoni (2012) "Motor Control Abnormalities in Parkinson’s Disease"; Cold Spring Harb Perspect Med. 2:6
* ↑ Stephen Kiss (1988) Uneven Pattern of Dopamine Loss in the Striatum of Patients with Idiopathic Parkinson's Disease; New England Journal of Medicine
* ↑ Qinn MP (1997) "Parkinson's Disease: Drug Therapy"; Bailliere's Clinical Neurology 6(1):89-108