A mixture of gait training and strengthening exercises may be beneficial for patients with Parkinson's disease (PD), suggest findings from a randomized trial.
"All types of exercise do not produce the same results, and certain exercises are more effective than others for selected outcomes," say Lisa Shulman (University of Maryland School of Medicine, Baltimore, USA) and colleagues.
Treadmill exercise improved the patients' gait, whereas stretching resistance exercises improved muscle strength, they report in the Archives of Neurology.
"This research adds to the evidence regarding the value of interventions for PD beyond medications and surgery and offers an opportunity for patients to be active participants in their care," write Liana Rosenthal and E Ray Dorsey (The Johns Hopkins University School of Medicine, Baltimore, Maryland) in an associated editorial.
They add: "Exercise puts the patient - not a pill - at the center of care, which is exactly where patients want and ought to be."
The trial included 67 patients who were randomly assigned to undertake stretching and resistance exercises (two sets of 10 repetitions on each leg on three resistance machines), or treadmill training at low intensity (50 minutes at 40-50% of heart rate reserve) or high intensity (30 minutes at 70-80% of heart rate reserve). The patients exercised three times a week for 3 months.
Surprisingly, the low-intensity treadmill exercise had a larger impact on gait than did the high-intensity exercise, improving distance on the 6-minute walk test by 12% versus 9%.
"One explanation is that, when the velocity is increased, gait mechanics may become strained, 'sloppy,' and less efficient as patients try to keep pace," suggest Shulman et al. They say that "the key differentiating factor may be training duration or the effect of training velocity on gait biomechanics, particularly for participants with reduced physiologic reserve."
Stretching and resistance exercise also improved distance on the 6-minute walk test, by 9%, and was the only intervention to result in improved muscle strength, by 16%. Conversely, the treadmill intervention improved cardiovascular fitness by 7-8%, whereas stretching and resistance exercise did not.
However, in line with previous research, the changes in patients' walking speed and fitness did not translate into improvements in ambulation at home (Step Activity Monitor) or activities of daily living performance (Schwab and England Activities of Daily Living Scale).
"It is unclear whether the extent of improvements is inadequate to improve function or whether the measures are insensitive to these changes for clinical practice," says the team.
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