Single Bout Exercise on Learning in PD
Condition: Parkinson Disease
MeSH terms: Parkinson Disease
Study type: Observational [Patient Registry]

Summary: 
      Parkinson's disease (PD) is a neurodegenerative disorder associated with a loss of dopamine
      in the basal ganglia and is characterized by several cardinal motor signs. In addition to the
      commonly recognized motor symptoms, cognitive impairments are also often observed in people
      with PD. Unlike motor deficits, cognitive impairments are not always responsive to
      dopaminergic treatment. While medication may ameliorate some cognitive dysfunctions (e.g.,
      executive function), it may exacerbate others (e.g., motor learning). Therefore, it is
      crucial for clinicians to look for treatment approaches, other than medication, to enhance
      cognitive function. In this proposed study, the investigators are especially interested in
      determining a method to enhance motor learning ability in people with PD.

      Motor learning deficits in people with PD have been well established through different tasks
      including motor adaptation task such as maintain balance on a stabilometer or motor sequence
      task such as performing a serial reaction time task (SRTT). Motor sequence learning is
      important in acquiring real-life motor skill such as tying shoes laces. Based on the past
      evidences, people with PD have impairments in motor sequence learning, particularly in
      implicit sequence learning. Since implicit motor sequence learning constitutes a critical
      part of everyday activities such as typing and changing clothes, establishing an approach to
      enhance implicit sequence learning is important.

      In the literature conducted with non-disable adults, one of the most effective method to
      enhance motor learning is aerobic exercise. Only one study, to the best of knowledge, has
      investigated the effect of aerobic exercise on learning to maintain balance on a stabilometer
      in people with PD. To date, no study has investigated whether a single bout of aerobic
      exercise could improve implicit sequence learning in PD. Therefore, the goal of this proposed
      study is to investigate the effect of a single bout of aerobic exercise on implicit sequence
      learning and the associated neurophysiological changes in people with PD.
    

Detailed description: 
      Parkinson's disease (PD) is a neurodegenerative disorder associated with loss of dopamine in
      the basal ganglia and is characterized by several cardinal motor signs, such as tremor,
      rigidity, bradykinesia, and postural instability. In addition to the commonly recognized
      motor symptoms, non-motor symptoms such as olfactory dysfunction, emotional issues, autonomic
      dysfunction and cognitive impairments are also often observed in people with PD. Among these
      non-motor symptoms, cognitive dysfunction is the most disturbing deficit and can hugely
      affect an individual's daily activity. Unlike motor deficits, these cognitive impairments are
      not always responsive to dopaminergic treatment. While medication may ameliorate some
      cognitive dysfunctions (e.g., executive function), it may exacerbate others (e.g., motor
      learning).Therefore, it is crucial for clinicians to look for treatment approaches, other
      than medication, to enhance cognitive function . In this proposed study, the investigators
      are especially interested in determining a method to enhance motor learning ability and
      reduce motor learning deficit in people with PD as motor learning is a crucial basis in
      learning new skills and optimizing activities of daily living.

      Motor learning deficits in people with PD have been well established through different tasks
      including motor adaptation task such as maintain balance on a stabilometer or motor sequence
      task such as performing a serial reaction time task (SRTT). Motor sequence learning is
      important in acquiring real-life motor skill such as tying shoes laces and using chopsticks.
      There are two types of experiment paradigms to assess motor sequence learning, they are
      implicit sequence task and explicit sequence task. Compared with age-matched non-disable
      adults, people with PD demonstrated different level of impairments in learning those tasks.
      In this study, the investigators will especially focus on the impairment in motor sequence
      learning in people with PD. Based on the evidences, implicit sequence learning is more
      affected in people in PD compared to explicit sequence learning. Since implicit motor
      sequence learning constitutes a critical part of everyday activities such as typing and
      changing clothes, therefore the investigators are more interested in exploring implicit
      sequence learning in people with PD.

      As previously reviewed, motor learning dysfunction could not be ameliorated by dopaminergic
      intake, thus several researchers aimed to find alternative method to improve motor learning
      ability. In the literature conducted with non-disable adults, one of the most effective
      method to enhance motor learning is aerobic exercise.7 Rhee et al. (2016) conducted a study
      and showed that a single bout of 20 minutes high intensity aerobic exercise can improve the
      performance of a finger sequence learning task in non-disable adults. Only one study, to the
      best of our knowledge, has investigated the effect of aerobic exercise on learning to
      maintain balance on a stabilometer in people with PD. The participants with PD were required
      to perform a single bout of 30-minute moderate intensity (60-70% VO2max) cycling exercise
      before practicing the stabilometer task. Their results found that compared to the non-aerobic
      condition, 30 minutes of aerobic exercise led to great improvements in motor performance at
      retention. However, there are some limitations of this study which may influence the result.
      First of all, 30 minutes of aerobic exercise before skill learning might be too fatiguing for
      people with PD, and might compromise subsequent practice of the stabilometer task.
      Furthermore, the authors found improvements in maintaining balance on a stabilometer but the
      related neurophysiological changes have not been determined. Therefore, the goal of this
      proposed study is to modify the above limitations and to conduct a study to investigate the
      effect of a single bout of aerobic exercise to implicit sequence learning and the related
      neurophysiological changes in people with PD. More importantly, the investigatorse would like
      to investigate whether corticomotor excitability will change along with motor learning
      improvement in people with PD.

      The purpose of this proposed study is to explore whether a single-bout aerobic exercise could
      enhance implicit motor sequence learning in people with PD. Moreover, the neurophysiological
      changes associated with aerobic exercise and learning will be determined.
    

Intervention name(s): aerobic exercise (cycling); Implicit sequence learning
Intervention type(s): Behavioral; Behavioral
Intervention description(s): People who perform aerobic exercise will ride on a stationary bike for 20 minutes after motor skill learning; All participants will practice the serial reaction time task (SRTT) on the first day, and retention performance will be assessed immediately, on the 2nd day, and on the 7th day of study.
Other intervention name(s): serial reaction time task (SRTT)
Observational model: Case-Control
Time perspective: Cross-Sectional
Sampling method: Non-Probability Sample
Study population: 
        Participants diagnosed of idiopathic PD and non-disabled age-matched controls will be
        recruited.