Strength Training and Medication Effects in Parkinson Disease Effects on Hypokinesia in Parkinson Disease
Condition: Parkinson Disease
MeSH terms: Parkinson Disease; Hypokinesia
Study type: Interventional

Summary: 
      Parkinson disease is a degenerative neurologic condition characterized by slowness of
      movement, tremor, and loss of balance control. It results in significant degrees of
      disability for affected individuals. Exercise and medication management are two treatments
      frequently used to treat Parkinson disease, and although some individuals benefit from these
      treatments, by what effect exercise works is presently not known. We will examine muscle
      structure and movement control responses to strengthening exercises and compare them to the
      therapeutic response observed as a result of medication intake. This process will allow us to
      better understand the mechanisms underlying the therapeutic effects of strengthening exercise
      for persons with Parkinson disease.
    

Detailed description: 
      Idiopathic Parkinson disease (IPD) is the model movement disorder to explore the motor
      function of the basal ganglia. (Morris ME, 2005) Alterations in the output of the basal
      ganglia lead to reductions in muscle force output and movement amplitude while inactivity and
      impaired mobility contribute to the loss of muscle size and strength.

      Collectively these factors lead to reductions in the size and speed (hypokinesia) of
      functional movements such as gait. Hypokinesia during gait initiation and gait are
      biomechanical events that can precipitates movement deficits such as bradykinesia and falls.
      Previous studies have suggested that resistance training is beneficial in the management of
      persons with PD. Although anatomic, behavioral, and mobility related improvements have been
      demonstrated with resistance training intervention, it is unclear if the observed changes are
      derived solely from peripheral musculoskeletal changes or from central nervous system
      mediated alterations in force output and movement amplitude. The responsiveness of muscle
      force, movement amplitude, and hypokinesia to the CNS mediated effects of dopamine
      replacement provide a model system to which the effects of resistance training can be
      compared. In order to examine this question, we plan to conduct a controlled trial to
      rigorously examine the effects of high force resistance training on muscle structure, muscle
      force output, and hypokinesia in persons with moderate IPD and in the process, characterize
      the potentially differential effects of resistance training effects and dopamine replacement.
      This study assembles a team of investigators with experience in high force resistance
      training, measurement of the biomechanical and clinical balance function in persons with PD,
      and the statistical analysis expertise. Persons with IPD will be recruited, examined, and if
      they meet the inclusion criteria will be randomly assigned to one of two groups (experimental
      or standard care control). A battery of tests including muscle structure, muscle force
      production, and measures of hypokinesia and will be assessed on and off dopamine replacement
      medication both prior to and after a 12 week resistance training intervention. The first
      specific aim of the study is to determine if high force resistance training results in
      improvements in muscle structure, muscle force output, and hypokinesia in persons with
      moderate IPD. The second specific aim is to characterize and compare any differential effects
      of high force resistance training and dopamine replacement on muscle force output and
      hypokinesia in persons with moderate IPD. We hypothesize that dopamine replacement and
      resistance training will interact to improve muscle force output and reduce hypokinesia. In
      addition, we hypothesize that examination of kinematic patterns during gait initiation will
      reveal differential effects on lower extremity hypokinesia. The results of this study will
      help to better understand the differential contributions of resistance training and dopamine
      replacement on hypokinesia in persons with PD.
    

Intervention name(s): Resistance Exercise via Negative Eccentric Work; Standard care exercise training
Intervention type(s): Behavioral; Behavioral
Intervention description(s): High intensity resistance training delivered 2-3 times per week for 12 weeks; Evidence based exercise training (resistance training, aerobic training, flexibility training) 2-3 times per week for 12 weeks.
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Hypokinesia; Gait; Quality of life; Dopamine replacement; Resistance training