This Article Full Text (PDF) All Versions of this Article: 1545968308328726v1 23/6/600    most recent References Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Saved Citations Download to citation manager Request Permissions Request Reprints Add to My Marked Citations Citing Articles Citing Articles via Scopus Google Scholar Articles by Ridgel, A. L. Articles by Alberts, J. L. PubMed PubMed Citation Articles by Ridgel, A. L. Articles by Alberts, J. L. Pubmed/NCBI databases Medline Plus Health Information Parkinson's Disease Patient Rights Social Bookmarking                         What's this?

Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson's Disease Patients

Department of Biomedical Engineering, Cleveland Clinic, Cleveland, OH

Jerrold L. Vitek, MD, PhD

Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, Department of Neuroscience, Cleveland Clinic, Cleveland, OH

Jay L. Alberts, PhD

Center for Neurological Restoration, Cleveland Clinic, Cleveland, OH, Center for Functional Electrical Stimulation, Louis Stokes Veterans Administration, Cleveland, OH, albertj{at}ccf.org

Background. Animal studies indicate forced exercise (FE) improves overall motor function in Parkinsonian rodents. Global improvements in motor function following voluntary exercise (VE) are not widely reported in human Parkinson's disease (PD) patients. Objective. The aim of this study was to compare the effects of VE and FE on PD symptoms, motor function, and bimanual dexterity. Methods. Ten patients with mild to moderate PD were randomly assigned to complete 8 weeks of FE or VE. With the assistance of a trainer, patients in the FE group pedaled at a rate 30% greater than their preferred voluntary rate, whereas patients in the VE group pedaled at their preferred rate. Aerobic intensity for both groups was identical, 60% to 80% of their individualized training heart rate. Results. Aerobic fitness improved for both groups. Following FE, Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved 35%, whereas patients completing VE did not exhibit any improvement. The control and coordination of grasping forces during the performance of a functional bimanual dexterity task improved significantly for patients in the FE group, whereas no changes in motor performance were observed following VE. Improvements in clinical measures of rigidity and bradykinesia and biomechanical measures of bimanual dexterity were maintained 4 weeks after FE cessation. Conclusions. Aerobic fitness can be improved in PD patients following both VE and FE interventions. However, only FE results in significant improvements in motor function and bimanual dexterity. Biomechanical data indicate that FE leads to a shift in motor control strategy, from feedback to a greater reliance on feedforward processes, which suggests FE may be altering central motor control processes.

Key Words: Parkinson's disease • Exercise • Manual dexterity • Motor control • Grasping forces • Movement disorder

This version was published on July 1, 2009

Neurorehabilitation and Neural Repair, Vol. 23, No. 6, 600-608 (2009)
DOI: 10.1177/1545968308328726


CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter    What's this?