Training and Parkinson's
Condition: Parkinson Disease; Weight-Lifting Exercise Program
MeSH terms: Parkinson Disease
Study type: Interventional

Summary: 
      The purpose of the current study is to compare the impacts of specifically designed power
      training and strength training programs on function and physical performance in Parkinson's
      patients. Specific aims are to examine the impact of these interventions on performance
      variables such as balance, strength, power, posture, gait and physical function.
    

Detailed description: 
      This study will look at how well two different training programs (strength and power
      training) do at improving the participant's physical functions. Before and after training,
      the participant will go to our laboratory on four separate days for screening and testing.

      Approximate time schedules for each day are provided below:

      Day 1 0:00-0:40: Informed consent meeting Mini-mental test, and Health Status Questionnaire,
      Hoehn & Yahr Classification of Disability for PD, UPDRS motor examination and PQ-39.

      Details regarding study participation will be explained and the participant will be provided
      the opportunity to ask questions about the study as well as being informed that the
      participant have the right to end participation at any time without consequence. In addition,
      this time will be used to identify if the participant can safely take part in the study.

      0:40-0:41: Randomization of intervention The participant will successively pull one piece of
      paper out of a bowl. Each piece of paper will have one of the two intervention programs on
      it.

      0:41-0:46: Anthropometric Measurements The participant's height and weight will be measured
      using a standard mechanical physician's scale with a height rod. In addition, the
      participant's blood pressure will be measured using our automated system.

      0:46-0:70: Familiarization with the tests Details of each field test including the Berg
      Balance Test, TUG, the standard proprioception test on the Proprio 5000, muscle power and
      strength, the Dynamic Gait Analysis (DGI), and 3D gait and tremor analysis be explained to
      the participant. The participant will be allowed to practice the tests under our guidance and
      will be allowed to ask any questions at this time.

      Unified Parkinson's Disease Rating Scale (UPDRS) Motor Examination

      The participant's speech, facial expression, tremor, rigidity, posture, gait, and slowness of
      body movement will be observed and rated by a trained researcher during the course of other
      assessment activities and certain other items will be specifically tested by that researcher.
      These activities include:

        -  rapid hand movement,

        -  gait initiation and gait,

        -  rising from chair and

        -  response to sudden posterior pull on shoulders while standing. .

      Day 2 0:00-0:05: The Falls Efficacy Scale (FES) This will be used to determine the
      participant's level of self-efficacy (how the participant feels about himself or herself) as
      it relates to fear of falling.

      The FES takes about 5 minutes to complete and consists of questions related to the
      participant's concern about the possibility of falling when the participant do 10 specific
      daily living activities (ADL).

      0:05-0:20: The Berg Balance Scale.

      The Berg Balance Scale is a 14-item test designed to measure the participant's standing
      balance while the participant are standing still and moving. The test takes about 15-20
      minutes and tests the following activities:

      Sitting to standing, Standing unsupported, Sitting unsupported, Standing to sitting,
      Transfers, Standing with eyes closed, Standing with feet together, Reaching forward with
      outstretched arm, Retrieving object from floor, Turning to look behind, Turning 360 degrees,
      Placing alternate foot on stool, Standing with one foot in front, and Standing on one foot.

      0:20-0:25: Recovery period

      0:25-0:35: The Timed Up and Go Test (TUG) The participant will be asked to stand up from a
      standard chair with a seat height of between 40 and 50 cm, walk a 3-m distance at a normal
      pace, turn, walk back to the chair, and sit down. The test takes approximately 2-4 minutes to
      complete with instructions.

      0:35-0:40: Recovery period

      0:40-0:55: The Dynamic Posturography Test (Proprio 5000) The participant will complete a
      dynamic balance test on a moving platform that rocks around at different speeds and angles
      and tests how well the participant can keep the participant's balance. For the participant's
      safety the participant will wear a harness that is attached to the machine so that the
      participant cannot fall.

      Day 3 0:00-0:30: Muscle strength and Power Examination.

      Measurements will be taken during:

        -  Chest Press (pushing the machine handles away from the chest like the participant do in
           a push-up),

        -  Seated Rows (pulling the machine handles toward the body, like rowing a boat)

        -  Lat Pulldowns (bringing the machine handles down toward the participant's shoulder)

        -  Shoulder Press (pushing the machine handles upward away from the participant's shoulder)

        -  Biceps curl (bring the handles up by bending the elbows, like "making a muscle")

        -  Triceps pushdown (pushing the handles straight down starting with the elbows bent and
           handles at the waist)

        -  Leg Press (sitting with legs bent and pushing outward)

        -  Calf Raises (toe pushdown),

        -  Hip adduction (pushing both legs inward toward the center line of the participant's
           body)

        -  Hip abduction (pushing both legs outward away from the center line of the participant's
           body) Muscle strength and power will be assessed using air resistance rather than
           plates. To determine strength, one-repetition maximum (1RM) will be measured for each
           muscle group. The participant will perform the concentric phase within the limits of the
           participant's own specific range of motion for each joint/movement tested over 2 s
           periods. The tester will gradually increase the resistance for each repetition until the
           participant are not able to move the lever arm one time through the full ROM. The
           participant will be asked how hard the test felt after each repetition and each muscle
           group will be finished in a maximum of seven repetitions.

      0:30-0:40: Recovery Period

      0:50-0:90: Power test After measurement of the participant's strength for each movement, we
      will measure the participant's power using the same machines. The participant's power will be
      assessed at 40%, 50%, 60%, 70%, 80%, or 90% of the participant's maximum strength depending
      on the exercise. Before performing each exercise, the participant will be instructed to
      perform the exercises as fast as possible through the full ROM. A 3-minute rest will be
      provided between exercises. Three trials will be performed per exercise and the highest power
      recorded will be designated as the participant's peak power.

      Day 4 0:00-0:20: Gait Test: The gait test will be a standard 10m gait test at usual (two
      trials) and maximum (2 trials) speed. The participant will be timed using a wireless infrared
      timing system and movement analysis will be performed using our 3D movement analysis system
      and force plates.

      0:20-0:25: Recovery Period 0:25-0:40: Hand tremor will be tested using an infrared camera.
      The participant will then be asked to turn over five coins and button the front of a shirt.
      These tests will be timed.

      Training program After the pre-testing of the study is done, the participant will come to the
      lab twice a week for 12 consecutive weeks, for a total of 24 visits. Each visit will be
      approximately 60 minutes long and will consist of 5 minutes warm-up, 50 minutes of the
      training program to which the participant have been randomly assigned and five minutes of
      cool-down. The training programs will be a power training program and a standard strength
      program.

      All training will be performed on our Keiser air-driven machines. Subjects will perform 10
      exercises including:

      Chest Press Seated Rows Lat Pulldowns Shoulder Press Biceps curl Triceps pushdown Leg Press
      Calf Raises Hip adduction Hip abduction And perform 3 sets of 12-15 repetitions of each
      exercise,

      Both programs will begin with low resistance/speed training with gradual increases for the
      first two weeks and then progress to the specific program.

      Strength training will use 75-80% of the subjects maximum for the specific exercise and
      contractions will occur at 2s concentric and 3s eccentric. For power training the subjects
      will perform the concentric phase at high speed, while eccentric portion lasts approximately
      2 sec.
    

Intervention name(s): Strength Training; Power Training
Intervention type(s): Other; Other
Intervention description(s): Eleven resistance training exercises performed on pneumatic resistance training machines using 2 second concentric and 3 second eccentric contractions at 75-80% of each subjects maximal strength. Subjects will perform 3 sets per exercise, two times per week for 12 weeks.; Eleven resistance training exercises performed on pneumatic resistance training machines using maximum speed concentric and 3 second eccentric contractions at the load that produces the highest power for the individual. Subjects will perform 3 sets per exercise, two times per week for 12 weeks.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment