Maguire C1,2, Mangold M3, Helfer M3, Zueger B4
1Bildungszentrum Gesundheit Basel-Stadt, Muenchenstein, Switzerland, 2Bern University of Applied Sciences, Health Division, Physiotherapy, Bern, Switzerland, 3Bildungszentrum Gesundheit Basel-Stadt, Physiotherapy, Muenchenstein, Switzerland, 4zoeCANTIENICA Dance Studis, Basel, Switzerland
Background: Poor balance and reduced gait function are common and disabling characteristics of Parkinson's Disease (PD). Interventions such as exercise or dance therapy improve gait and balance function, but effect-sizes are small to moderate and infrequently generate Minimally Clinical Important Differences. Animal models and clinical trials indicate that the neurotrophin Brain Derived Neurotrophic Factor (BDNF), which influences synaptic plasticity and cognitive function, is released following aerobic exercise. Serum levels of BDNF are significantly lower in people with PD compared to healthy controls. Interventions to improve gait and balance conducted following aerobic exercise may have greater effect sizes.
Purpose: To investigate the feasibility of a moderate intensity aerobic training programme (AT) prior to dance-and-movement therapy (DMT) and to compare the effectiveness on balance and gait function compared to relaxation therapy prior to DMT.
Methods: A controlled, non-randomized pilot study. A convenience sample of twenty people with PD were recruited. Inclusion criteria: 18-80 years, Modified Hoehn and Yahr Scale level 2 to 3, exclusion criteria: increased risk of cardiovascular incident during exercise stress testing or moderate intensity aerobic training, orthopedic or additional neurological conditions which could influence participation, recent change in medication. Intervention: 10-subjects (AT-group) 30 minutes “moderate” aerobic training on a bicycle ergometer at 40-59% of Heart Rate Reserve (maximum heart-rate calculated during V02 Peak test) followed by 20 minute rest then one hour DMT. Control: 10-subjects 30 minutes relaxation therapy followed by 20 minutes rest the one hour DMT. All twice weekly for one month in groups of 3-5 subjects.
Outcomes: Primary- Timed Up-and-Go Test, Secondary- Berg Balance Scale, UPDRS, 10m walk test, 6-minute walk test, adherence and training feasibility. Data collection is ongoing.
Results: Although the study is ongoing and data collection will be complete in December 2018 the following preliminary results are available: 0ne group of four subjects has completed the AT-group intervention. Adherence: 95.83% of training completed (1 subject missed 1 time), all subjects were able to complete the 30 minute training on all occasions present, and heart rate was maintained between defined HRR limits. All patients were able to complete the one hour DMT. Pre and post results (median (IQR)): TUG pre 9.2s (0.1), post 8.7s (0.3); BBS pre 49 (1), post 55(1); UPDRS pre 21(15), post 12 (6); 10m-walk-test pre 1.7s(0.3), post 1.7s(0.1), 6-minute-walk-test pre 374m (72), post 376m (45). The control relaxation and further AT training groups are currently participating in the study and data collection is ongoing.
Conclusion(s): Results so far indicate that a twice weekly, moderate intensity aerobic training and DMT with people with PD is feasible. Preliminary results indicate that balance may improve post-intervention, but gait speed and endurance do not. Final data will enable a more valid evaluation of these parameters and a comparison of effect size between DMT completed after AT or relaxation therapy.
Implications: Final results will provide information regarding whether aerobic training increases the effectiveness of dance-and-movement-therapy. This could have important consequences for physiotherapy. It will provide information to allow power calculations for larger studies.
Keywords: Parkinsons Disease, Aerobic Training, Dance-and-Movement-Therapy
Funding acknowledgements: No external funding was provided
Purpose: To investigate the feasibility of a moderate intensity aerobic training programme (AT) prior to dance-and-movement therapy (DMT) and to compare the effectiveness on balance and gait function compared to relaxation therapy prior to DMT.
Methods: A controlled, non-randomized pilot study. A convenience sample of twenty people with PD were recruited. Inclusion criteria: 18-80 years, Modified Hoehn and Yahr Scale level 2 to 3, exclusion criteria: increased risk of cardiovascular incident during exercise stress testing or moderate intensity aerobic training, orthopedic or additional neurological conditions which could influence participation, recent change in medication. Intervention: 10-subjects (AT-group) 30 minutes “moderate” aerobic training on a bicycle ergometer at 40-59% of Heart Rate Reserve (maximum heart-rate calculated during V02 Peak test) followed by 20 minute rest then one hour DMT. Control: 10-subjects 30 minutes relaxation therapy followed by 20 minutes rest the one hour DMT. All twice weekly for one month in groups of 3-5 subjects.
Outcomes: Primary- Timed Up-and-Go Test, Secondary- Berg Balance Scale, UPDRS, 10m walk test, 6-minute walk test, adherence and training feasibility. Data collection is ongoing.
Results: Although the study is ongoing and data collection will be complete in December 2018 the following preliminary results are available: 0ne group of four subjects has completed the AT-group intervention. Adherence: 95.83% of training completed (1 subject missed 1 time), all subjects were able to complete the 30 minute training on all occasions present, and heart rate was maintained between defined HRR limits. All patients were able to complete the one hour DMT. Pre and post results (median (IQR)): TUG pre 9.2s (0.1), post 8.7s (0.3); BBS pre 49 (1), post 55(1); UPDRS pre 21(15), post 12 (6); 10m-walk-test pre 1.7s(0.3), post 1.7s(0.1), 6-minute-walk-test pre 374m (72), post 376m (45). The control relaxation and further AT training groups are currently participating in the study and data collection is ongoing.
Conclusion(s): Results so far indicate that a twice weekly, moderate intensity aerobic training and DMT with people with PD is feasible. Preliminary results indicate that balance may improve post-intervention, but gait speed and endurance do not. Final data will enable a more valid evaluation of these parameters and a comparison of effect size between DMT completed after AT or relaxation therapy.
Implications: Final results will provide information regarding whether aerobic training increases the effectiveness of dance-and-movement-therapy. This could have important consequences for physiotherapy. It will provide information to allow power calculations for larger studies.
Keywords: Parkinsons Disease, Aerobic Training, Dance-and-Movement-Therapy
Funding acknowledgements: No external funding was provided
Topic: Neurology: Parkinson's disease
Ethics approval required: Yes
Institution: Etics Committee Northwest Switzerland
Ethics committee: Etics Committee Northwest Switzerland
Ethics number: ID 2018-00717
All authors, affiliations and abstracts have been published as submitted.
