# Exercise as it relates to Disease/Parkinson's Disease: Finding Rhythm in Your Step

This is an appraisal of the journal article "Increased neuromuscular consistency in gait and balance after partnered, dance-based rehabilitation in Parkinson’s disease" by Allen et al. (2017)

## What is the background to this research?

Individuals with Parkinson's disease (PD) suffer from a high risk of falls due to difficulties in gait and balance. Though doctors do not yet know the main cause of this disorder, this article has attempted to decrease these risks by understanding and improving motor performance through measuring different markers after intervening them through adapted tango (AT). Consequently there is a growing amount of evidence supporting exercise as an intervention for PD and improving gait and balance, however this may help in advancing patient screening for rehabilitation prescription and start an era of new interventions to improve the reacquisition of movements lost in PD.

## Where is the research from?

Allen, McKay, Sawers, Madeleine, Hackney and Ting conducted this study at both the Emory University and Georgia Institute of Technology in the USA. This study was published in the Journal of Neurophysiology in the American Physiological Society, which is a nonprofit society with over 10,500 members committed to scientific research on physiological science. Majority of members have doctoral degrees in physiology and/or medicine and other health professions. Regardless of this research being held in America, the findings are still relevant for all individuals with PD.
Allen and McKay are well established authors who have been published in multiple studies involving gait and neuromuscular diseases.

## What kind of research was this?

This research is classified as a pilot study due to its small scale and feasible argument, but has case-controlled elements due to the specific population chosen. Despite the fact that they did not have a group without the disease, normative data was mentioned on young healthy adults and their responses from dance. Furthermore there was an absence of a controlled group not participating in AT, making the results incomparable.

## What did the research involve?

Six participants (mean+SD, age: 64+16.6, weight (kg): 72.4+12.66) with PD were tested pre and post intervention measuring their gait and balance with a motor module analysis using electromyography (EMG) data. All participants were tested during the time of their self-determined optimal ON state, though there was no control for medication wear off time during these testings. The intervention was conducted for three weeks, that involved all participants to partake in a total of 15 AT sessions that ran for 90 minutes. With every lesson taught by an experienced professional ballroom dance instructor.

## What were the basic results?

After the three week intervention was complete, the six participants were retested on their balance and gait. The researchers found positive changes in their neuromuscular control and they were the first to show that motor module efficiency increased for gait and balance, without increasing the number of motor modules. Though the number of motor modules being recruited is associated with increased motor performance, they state that motor module distinctness and consistency may act as feasible markers for improvements of motor performance.
Moreover with these findings, even though all participants improved in gait and balance after short-term rehabilitation, some participants in the study decreased in motor module number.

## What conclusions can we take from this research?

This study provided interesting data, in terms of finding new markers to use when measuring motor performance within individuals suffering from PD. But due to its small sample size of six, these results may not associate changes of true improvement when using these markers.
However, dance as an intervention has shown a promising trend when it comes to improving motor performance for PD. This could be important as this may open up more opportunities for rehabilitation and prescription purposes for individuals with PD without the use of medications. Nonetheless, more research is needed (incorporating larger sample sizes, proper control groups, other forms of dance and their effectiveness etc.) before any real changes can be implemented.

## Practical advice

Dance being used as an effective tool for rehabilitation for individuals with PD is only growing with its suggested evidence. Though further research is needed before it can be appropriately prescribed, there has been no evidence showing that not doing some form of exercise can be detrimental towards PD.
With a growing community towards dance and PD, this could be a prominent option for individuals adhering to a new kind of physical activity. Assuring that the general practitioner or your current health professional says it is safe to do so.

## Further information/resources

* Infographic - Benefits of Dance Therapy
* Interested in participating - Dance for Parkinson's Australia
* What has research revealed about the effects of dance in PD?

## References

* ↑ Allen et al. Increased neuromuscular consistency in gait and balance after partnered, dance-based rehabilitation in Parkinson’s disease. 2017
* ↑ Health Direct. https://www.healthdirect.gov.au/parkinsons-disease
* ↑ Goodwin VA et al. The Effectiveness of Exercise Interventions for People with Parkinson’s Disease: A Systematic Review and Meta-Analysis. Movement Disorders. 2008
* ↑ Hirsch et al. The Effects of Balance Training and High-Intensity Resistance Training on Persons with Idiopathic Parkinson’s Disease. 2003
* ↑ American Physiological Society. https://www.physiology.org/about-APS
* ↑ Google Scholar. https://scholar.google.com.au/citations?hl=en&user=PPj8DnQAAAAJ
* ↑ Google Scholar. https://scholar.google.com.au/citations?hl=en&user=NqacUroAAAAJ
* ↑ Cheung et al. Muscle synergy patterns as physiological markers of motor cortical damage 2012
* ↑ Gammon et al. Dance Therapy for Individuals with Parkinson Disease 2009