Speed-Dependent Treadmill Training in Ambulatory Hemiparetic Stroke Patients: A Randomized Controlled Trial Rehabilitation treatment of gait in patients with Parkinson's disease with freezing: a comparison between two physical therapy protocols using visual and auditory cues with or without treadmill training. The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease Robot-assisted walking training for individuals with Parkinson’s disease: a pilot randomized controlled trial Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. Home-based treadmill training for individuals with Parkinson’s disease: a randomized controlled pilot trial Gait and step training to reduce falls in Parkinson's disease. The effects of treadmill or overground walking training program on gait in Parkinson's disease. Exercise for People in Early- or Mid-Stage Parkinson Disease: A 16-Month Randomized Controlled Trial PEDro: A Database of Randomised Controlled Trials in Physiotherapy Treadmill walking in Parkinson's disease patients: adaptation and generalization effect. Robotic Gait Training Is not Superior to Conventional Treadmill Training in Parkinson Disease Treadmill gait training improves baroreflex sensitivity in Parkinson’s disease Downhill Walking Training in Individuals with Parkinson's Disease: A Randomized Controlled Trial Does Treadmill Training Improve Lower-Extremity Tasks in Parkinson Disease? A Randomized Controlled Trial Treadmill training with body weight support: its effect on Parkinson's disease. Effects of 24 wk of treadmill training on gait performance in Parkinson's disease. Robot-assisted gait training versus equal intensity treadmill training in patients with mild to moderate Parkinson's disease: a randomized controlled trial. Reliability of the PEDro scale for rating quality of randomized controlled trials. Physical therapy and Parkinson's disease Treadmill exercise elevates striatal dopamine D2 receptor binding potential in patients with early Parkinson’s disease Effect of partial weight-supported treadmill gait training on balance in patients with Parkinson disease. Immediate effects of speed-dependent treadmill training on gait parameters in early Parkinson's disease. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease. Long-term effect of body weight-supported treadmill training in Parkinson's disease: a randomized controlled trial. The effects of speed-dependent treadmill training and rhythmic auditory-cued overground walking on gait function and fall risk in individuals with idiopathic Parkinson's disease: a randomized controlled trial.
Background and Purpose — A new gait training strategy for patients with stroke seeks to increase walking speed through treadmill training . This study compares the effects of structured speed-dependent treadmill training ( STT ) ( with the use of an interval paradigm to increase the treadmill speed stepwise according to principles of sport physiology ) with limited progressive treadmill training ( LTT ) and conventional gait training ( CGT ) on clinical outcome measures for patients with hemiparesis . Methods — Sixty ambulatory poststroke patients were each r and omly selected to receive 1 of the 3 different gait therapies : 20 subjects were treated with STT , 20 subjects were trained to walk on a treadmill with a 20 % increase of belt speed over the treatment period ( LTT ) , and 20 subjects were treated with CGT . Treatment outcomes were assessed on the basis of overground walking speed , cadence , stride length , and Functional Ambulation Category scores . Results — After a 4-week training period , the STT group scored significantly higher than the LTT and CGT groups for overground walking speed ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , cadence ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) , stride length ( STT versus LTT , P < 0.001 ; STT versus CGT , P < 0.001 ) , and Functional Ambulation Category scores ( STT versus LTT , P = 0.007 ; STT versus CGT , P < 0.001 ) . Conclusions — Structured STT in poststroke patients result ed in better walking abilities than LTT or CGT . This gait training strategy provides a dynamic and integrative approach for the treatment of gait dysfunction after stroke Freezing is a disabling symptom in patients with Parkinson 's disease . We investigated the effectiveness of a new rehabilitation strategy based on treadmill training associated with auditory and visual cues .  Forty Parkinsonian patients with freezing were r and omly assigned to two groups : Group 1 underwent a rehabilitation program based on treadmill training associated with auditory and visual cues , while Group 2 followed a rehabilitation protocol using cues and not associated with treadmill . Functional evaluation was based on the Unified Parkinson 's Disease Rating Scale Motor Section ( UPDRS III ) , Freezing of Gait Question naire ( FOGQ ) , 6-minute walking test ( 6MWT ) , gait speed , and stride cycle . Patients in both the groups had significant improvements in all variables considered by the end of the rehabilitation program ( all P = 0.0001 ) . Patients treated with the protocol including treadmill , had more improvement than patients in Group 2 in most functional indicators ( P = 0.007 , P = 0.0004 , P = 0.0126 , and P = 0.0263 for FOGQ , 6MWT , gait speed , stride cycle , respectively ) . The most striking result was obtained for 6MWT , with a mean increase of 130 m in Group 1 compared with 57 m in Group 2 . Our results suggest that treadmill training associated with auditory and visual cues might give better results than more conventional treatments . Treadmill training probably acts as a supplementary external cue Objective : To detect the effectiveness of incremental speed-dependent treadmill training on postural instability , dynamic balance and fear of falling in patients with idiopathic Parkinson 's disease . Design : R and omized controlled trial . Setting : Ankara Education and Research Hospital , 2nd PM&R Clinic , Cardiopulmonary Rehabilitation Unit . Subjects : Fifty-four patients with idiopathic Parkinson 's disease in stage 2 or 3 of the Hoehn Yahr staging entered , and 31 patients ( 21 training , 10 control ) had outcome data . Interventions : Postural instability of patients with Parkinson 's disease was assessed using the motor component of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale .  Twenty-one patients with Parkinson 's disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training . Before and after the training programme , balance , gait , fear of falling and walking distance and speed on treadmill were assessed in both Parkinson 's disease groups . Main measures : Walking distance and speed on treadmill , UPDRS , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale . Results : Initial total walking distance of the training group on treadmill was 266.45 ± 82.14 m and this was progressively increased to 726.36 ± 93.1 m after 16 training session ( P < 0.001 ) . Tolerated maximum speed of the training group on treadmill at baseline was 1.9 ± 0.75 km/h and improved to 2.61 ± 0.77 km/h ( P < 0.001 ) . Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme ( P < 0.01 ) . There was no significant improvement in any of the outcome measurements in the control group ( P > 0.05 ) . Conclusions : Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility , reduce postural instability and fear of falling in patients with Parkinson 's disease Abstract Background Over the last years , the introduction of robotic technologies into Parkinson ’s disease rehabilitation setting s has progressed from concept to reality . However , the benefit of robotic training remains elusive . This pilot r and omized controlled observer trial is aim ed at investigating the feasibility , the effectiveness and the efficacy of new end-effector robot training in people with mild Parkinson ’s disease . Methods Design . Pilot r and omized controlled trial . Setting . Robot assisted gait training ( EG ) compared to treadmill training ( CG ) . Participants . Twenty cognitively intact participants with mild Parkinson ’s disease and gait disturbance . Interventions . The EG underwent a rehabilitation programme of robot assisted walking for 40 minutes , 5 times a week for 4 weeks . The CG received a treadmill training programme for 40 minutes , 5 times a week for 4 weeks . Main outcome measures . The outcome measure of efficacy was recorded by gait analysis laboratory . The assessment s were performed at the beginning ( T0 ) and at the end of the treatment ( T1 ) . The main outcome was the change in velocity . The feasibility of the intervention was assessed by recording exercise adherence and acceptability by specific test . Results Robot training was feasible , acceptable , safe , and the participants completed 100 % of the prescribed training sessions . A statistically significant improvement in gait index was found in favour of the EG ( T0 versus T1 ) . In particular , the statistical analysis of primary outcome ( gait speed ) using the Friedman test showed statistically significant improvements for the EG ( p = 0,0195 ) . The statistical analysis performed by Friedman test of Step length left ( p = 0,0195 ) and right ( p = 0,0195 ) and Stride length left ( p = 0,0078 ) and right ( p = 0,0195 ) showed a significant statistical gain . No statistically significant improvements on the CG were found . Conclusions Robot training is a feasible and safe form of rehabilitative exercise for cognitively intact people with mild PD . This original approach can contribute to increase a short time lower limb motor recovery in idiopathic PD patients . The focus on the gait recovery is a further characteristic that makes this research relevant to clinical practice . On the whole , the simplicity of treatment , the lack of side effects , and the positive results from patients support the recommendation to extend the use of this treatment . Further investigation regarding the long-time effectiveness of robot training is warranted . Trial registration Clinical Trials.gov OBJECTIVE To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed , strength , and fitness for patients with Parkinson disease . DESIGN A comparative , prospect i ve , r and omized , single-blinded clinical trial of 3 types of physical exercise . SETTING The Parkinson 's Disease and Movement Disorders Center at the University of Maryl and and the Baltimore Veterans Affairs Medical Center , Geriatric Research Education and Clinical Center . PATIENTS A total of 67 patients with Parkinson disease who had gait impairment were r and omly assigned to 1 of 3 arms of the trial . INTERVENTIONS ; ( 1 ) A higher-intensity treadmill exercise ( 30 minutes at 70%-80 % of heart rate reserve ) , ( 2 ) a lower-intensity treadmill exercise ( 50 minutes at 40%-50 % of heart rate reserve ) , and ( 3 ) stretching and resistance exercises ( 2 sets of 10 repetitions on each leg on 3 resistance machines [ leg press , leg extension , and curl ] ) . These exercises were performed 3 times a week for 3 months . MAIN OUTCOME MEASURES The primary outcome measures were gait speed ( 6-minute walk ) , cardiovascular fitness ( peak oxygen consumption per unit time [ $ $ VO2 ] , and muscle strength ( 1-repetition maximum strength ) . RESULTS All 3 types of physical exercise improved distance on the 6-minute walk : lower-intensity treadmill exercise  ( 12 % increase ; P=.001 ) ,  stretching and resistance exercises  ( 9 % increase ; P<.02 ) , and higher-intensity treadmill exercise  ( 6 % increase ; P=.07 ) , with no between-group differences . Both treadmill exercises improved peak $ $ VO2 ( 7%-8 % increase ; P<.05 ) more than did the stretching and resistance exercises . Only stretching and resistance improved muscle strength ( 16 % increase ; P<.001 ) . CONCLUSIONS The effects of exercise were seen across all 3 exercise groups . The lower-intensity treadmill exercise result ed in the greatest improvement in gait speed . Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness . Only the stretching and resistance exercises improved muscle strength . Therefore , exercise can improve gait speed , muscle strength , and fitness for patients with Parkinson disease . The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation Objective : To investigate the feasibility and effectiveness of six weeks of home-based treadmill training in people with mild Parkinson ’s disease . Design : Pilot r and omized controlled trial of a six-week intervention followed by a further six weeks follow-up . Setting : Home-based treadmill training with outcome measures taken at a hospital clinic . Participants : Twenty cognitively intact participants with mild Parkinson ’s disease and gait disturbance . Two participants from the treadmill training group and one from the control group dropped out . Interventions : The treadmill training group undertook a semi-supervised home-based programme of treadmill walking for 20–40 minutes , four times a week for six weeks . The control group received usual care . Main outcome measures : The feasibility of the intervention was assessed by recording exercise adherence and acceptability , exercise intensity , fatigue , muscle soreness and adverse events . The primary outcome measure of efficacy was walking capacity ( 6-minute walk test distance ) . Results : Home-based treadmill training was feasible , acceptable and safe with participants completing 78 % ( SD 36 ) of the prescribed training sessions . The treadmill training group did not improve their walking capacity compared to the control group . The treadmill training group showed a greater improvement than the control group in fatigue at post test ( P = 0.04 ) and in quality of life at six weeks follow-up testing ( P = 0.02 ) . Conclusions : Semi-supervised home-based treadmill training is a feasible and safe form of exercise for cognitively intact people with mild Parkinson ’s disease . Further investigation regarding the effectiveness of home-based treadmill training is warranted INTRODUCTION Frequent falls and risk of injury are evident in individuals with Parkinson 's disease ( PD ) as the disease progresses . There have been no reports of any interventions that reduce the incidence of falls in idiopathic PD . PURPOSE Assess the benefit of gait and step perturbation training in individuals with PD . DESIGN R and omized , controlled trial . SETTING Outpatient research , education and clinical center in a tertiary care Veterans Affairs Medical Center . OUTCOME MEASURES Gait parameters , 5-step test , report of falls . SUBJECTS Eighteen men with idiopathic PD in stage 2 or 3 of the Hoehn and Yahr staging . METHODS Subjects were r and omly assigned to a trained or control group . They were asked about any falls  2 weeks prior to and after an 8 week period .  Gait speed , cadence , and step length  were tested on an instrumented walkway . Subjects were timed while stepping onto and back down from an 8.8 cm step for 5 consecutive steps . Gait training consisted of walking on a treadmill at a speed greater than over ground walking speed while walking in 4 directions and while supported in a harness for safety . Step training consisted of suddenly turning the treadmill on and off while the subject stood in the safety harness facing either forwards , backwards , or sideways . Training occurred 1 hour per day , three times per week for 8 weeks . A two-factor ( time and group ) analysis of variance with repeated measures was used to compare the groups . RESULTS Substantial reduction occurred in falls in the trained group , but not in the control group . Gait speed increased in the trained group from 1.28+/-0.33 meters/sec to 1.45+/-0.37 meters/sec , but not in the control group ( from 1.26 to 1.27 m/s ) . The cadence increased for both groups : from 112.8 to 120.3 steps/min for the trained group and 117.7 to 124.3 steps/min for the control group . Stride lengths increased for the trained group , but not the control group . The 5-step test speed increased in the trained group from 0.40+/-0.08 steps/sec to 0.51+/-0.12 steps/sec , and in the control group ( 0.36+/-0.11 steps/sec to 0.42+/-0.11 steps/sec ) . CONCLUSION Gait and step perturbation training result ed in a reduction in falls and improvements in gait and dynamic balance . This is a promising approach to reduce falls for patients with PD BACKGROUND Gait impairment in Parkinson 's disease ( PD ) patients is characterized by the inability to generate appropriate stride length . Treadmill training has been proposed as a therapeutic tool for PD patients . However , it remains unknown whether treadmill training effects are different from overground walking training . Thus , our goal was to explore the effects of two training programs , walking on a treadmill and walking overground , in PD patients . METHODS 22 PD patients were r and omly assigned to a treadmill or overground training group . The training program consisted of 5 weeks ( 3 sessions/week ) . Before and after the program we evaluated gait kinematics during walking at preferred and maximal speed ; Timed Up and Go ( TUG ) ; static posturography and knee extensors strength . Gait parameters were reevaluated in the treadmill training group one month after the cessation of the training . RESULTS Preferred speed walking improved in both groups after the training program . The treadmill training program , but not the overground , led to an improvement in the stride length at the preferred and maximal walking speed in the PD patients . In addition , the treadmill training group showed improvement of the TUG and static posturography tests . The improvement in gait parameters was maintained one month after the cessation of the treadmill training . CONCLUSIONS This study provides evidence of a specific therapeutic effect of treadmill training on Parkinsonian gait and balance . Walking on a treadmill may be used as an easy , effective and accessible way to improve the stride length and balance in PD patients Background Exercise confers short-term benefits for individuals with Parkinson disease ( PD ) . Objective The purpose of the study was to compare short- and long-term responses among 2 supervised exercise programs and a home-based control exercise program . Design The 16-month r and omized controlled exercise intervention investigated 3 exercise approaches : flexibility/balance/function exercise ( FBF ) , supervised aerobic exercise ( AE ) , and home-based exercise ( control ) . Setting This study was conducted in outpatient clinics . Patients The participants were 121 individuals with PD ( Hoehn & Yahr stages 1–3 ) . Interventions The FBF program ( individualized spinal and extremity flexibility exercises followed by group balance/functional training ) was supervised by a physical therapist . The AE program ( using a treadmill , bike , or elliptical trainer ) was supervised by an exercise trainer . Supervision was provided 3 days per week for 4 months , and then monthly ( 16 months total ) . The control group participants exercised at home using the National Parkinson Foundation Fitness Counts program , with 1 supervised , clinic-based group session per month . Measurements Outcomes , obtained by blinded assessors , were determined at 4 , 10 , and 16 months . The primary outcome measures were overall physical function ( Continuous Scale — Physical Functional Performance [ CS-PFP ] ) , balance ( Functional Reach Test [ FRT ] ) , and walking economy ( oxygen uptake [ mL/kg/min ] ) . Secondary outcome measures were symptom severity ( Unified Parkinson 's Disease Rating Scale [ UPDRS ] activities of daily living [ ADL ] and motor subscales ) and quality of life ( 39-item Parkinson 's Disease Quality of Life Scale [ PDQ-39 ] ) . Results Of the 121 participants , 86.8 % , 82.6 % , and 79.3 % completed 4 , 10 , and 16 months , respectively , of the intervention . At 4 months , improvement in CS-PFP scores was greater in the FBF group than in the control group ( mean difference=4.3 , 95 % confidence interval [CI]=1.2 to 7.3 ) and the AE group ( mean difference=3.1 , 95 % CI=0.0 to 6.2 ) . Balance was not different among groups at any time point . Walking economy improved in the AE group compared with the FBF group at 4 months ( mean difference=−1.2 , 95 % CI=−1.9 to −0.5 ) , 10 months ( mean difference=−1.2 , 95 % CI=−1.9 to −0.5 ) , and 16 months ( mean difference=−1.7 , 95 % CI=−2.5 to −1.0 ) . The only secondary outcome that showed significant differences was UPDRS ADL subscale scores : the FBF group performed better than the control group at 4 months ( mean difference=−1.47 , 95 % CI=−2.79 to −0.15 ) and 16 months ( mean difference=−1.95 , 95 % CI=−3.84 to −0.08 ) . Limitations Absence of a non-exercise control group was a limitation of the study . Conclusions Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy ( up to 16 months ) in the AE group PEDro is a data base of clinical trials design ed to assist the practice of evidence -based physiotherapy . When complete , it will contain bibliographic details , abstract s and quality assessment scores of all published r and omised controlled trials in physiotherapy . Trials on the data base will be rated on the basis of their method ological quality , so that users of the data base can be guided to those trials which provide the most method ologically sound sources of evidence . The data base has been made freely available on the world wide web , where it can be search ed with a powerful and user-friendly search engine We examined the adaptation and generalization effect of one familiarization treadmill walking session on gait in patients with Parkinson 's disease ( PD ) with different degrees of disease severity . Eight moderate PD patients ( Hoehn and Yahr stage 2 - 2.5 ) , eight advanced PD patients ( Hoehn and Yahr 3 ) , and eight matched control subjects participated in this study . Subjects first walked overground on a 10-m walkway at a self-selected speed ( pretreadmill ) . They then performed a 20-min treadmill training session , followed by three trials of overground walking ( Post1 , Post2 , Post3 ) . Cadence , step length , speed , and coefficient of variation of stride time ( CV ) were recorded . During the treadmill session the advanced PD patients significantly decreased their cadence ( t = 3.9 , P < or= 0.01 ) and increased their step length ( t = 4.27 , P < or= 0.01 ) compared with pretreadmill walking . After the treadmill , all subjects walked overground significantly faster ( F = 16.51 P < or= 0.001 ) and with a larger step length ( F = 13.03 P < or= 0.01 ) than pretreadmill walking . The present study shows a specific adaptation to walk over the treadmill for the advanced PD patients . Moreover , this confirms the potential therapeutic use of the treadmill for PD gait rehabilitation since a single familiarization session lead to an increase in the step length and thus to the improvement of the main gait impairment in PD Background . The use of robots for gait training in Parkinson disease ( PD ) is growing , but no evidence points to an advantage over the st and ard treadmill . Methods . In this r and omized , single-blind controlled trial , participants aged < 75 years with early-stage PD ( Hoehn-Yahr <3 ) were r and omly allocated to 2 groups : either 30 minutes of gait training on a treadmill or in the Lokomat for 3 d/wk for 4 weeks . Patients were evaluated by a physical therapist blinded to allocation before and at the end of treatment and then at the 3- and 6-month follow-up . The primary outcome measure was the 6-minute walk test . Results . Of 334 screened patients , the authors r and omly allocated 30 to receive gait training with treadmill or the Lokomat . At baseline , the 2 groups did not differ . At the 6-month follow-up , both groups had improved significantly in the primary outcome measure ( treadmill : mean = 490.95 m , 95 % confidence interval [ CI ] = 448.56 - 533.34 , P = .0006 ; Lokomat : 458.6 m , 95 % CI = 417.23 - 499.96 , P = .01 ) , but no significant differences were found between the 2 groups ( P = .53 ) . Discussion . Robotic gait training with the Lokomat is not superior to treadmill training in improving gait performance in patients with PD . Both approaches are safe , with results maintained for up to 6 months Background Partial weight supported treadmill gait training ( PWSTT ) is widely used in rehabilitation of gait in patient with Parkinson ’s Diseases ( PD ) . However , its effect on blood pressure variability ( BPV ) and baroreflex sensitivity ( BRS ) in PD has not been studied . Aim To evaluate the effect of conventional and treadmill gait training on BPV components and BRS . Methods Sixty patients with idiopathic PD were r and omized into three groups . Twenty patients in control group were on only stable medication , 20 patients in conventional gait training ( CGT ) group ( Stable medication with CGT ) and 20 patients in PWSTT group ( Stable medication with 20 % PWSTT ) . The CGT and PWSTT sessions were given for 30 min per day , 4 days per week , for 4 weeks ( 16 sessions ) . Groups were evaluated in their best ‘ ON ’ states . The beat-to-beat finger blood pressure ( BP ) was recorded for 10 min using a Finometer instrument ( Finapres Medical Systems , The Netherl and s ) . BPV and BRS results were derived from artifact-free 5-min segments using Nevrocard software . Results BRS showed a significant group with time interaction ( F = 6.930 ; p = 0.003 ) . Post-hoc analysis revealed that PWSTT group showed significant improvement in BRS ( p < 0.001 ) after 4 weeks of training . No significant differences found in BPV parameters ; systolic BP , diastolic BP , co-variance of systolic BP and low frequency component of systolic BP . Conclusions Four weeks of PWSTT significantly improves BRS in patients with PD . It can be considered as a non-invasive method of influencing BRS for prevention of orthostatic BP fall in patients with PD Yang YR , Lee YY , Cheng SJ , Wang RY : Downhill walking training in individuals with Parkinson 's disease . Objective : The purpose of this study was to examine the effects of downhill walking training on gait and thoracic kyphosis in patients with Parkinson 's disease . Design : Thirty-three patients with Parkinson 's disease were r and omized into an experimental group ( n = 16 ) or a control group ( n = 17 ) . Subjects in the experimental group underwent 4-wks of downhill walking training , whereas subjects in the control group received conventional therapy for 4 wks . Gait parameters , thoracic kyphosis , and muscle strength of knee were measured at pretraining , posttraining , and at 1-mo follow-up . Results : There were significant interaction effects between group and time of evaluation on gait parameters and thoracic kyphotic curve . There was also a significant group effect for muscle strength of knee extensors . Conclusions : Our results suggest that downhill walking training is beneficial for improving gait performance in patients with Parkinson 's disease and may contribute to maintenance of thoracic posture in these subjects Objective : To investigate whether gait training with treadmill improves functional tasks of lower extremities in patients with Parkinson disease ( PD ) . Design : R and omized controlled trial including two groups , the treadmill training group and the nonintervention group . Setting : University hospital . Patients : Thirty consecutive patients diagnosed with idiopathic PD , who were on stable regimens of antiparkinsonian medication , able to walk independently , and had not participated in a rehabilitation program in the previous 3 months . Patients with severe cognitive impairments or severe musculoskeletal , cardiopulmonary , neurologic , or other systemic disorders were excluded . Twenty-four patients completed the study . Interventions : Group I attended a training program on a treadmill for 6 weeks , and group II served as the control group . Both groups were instructed in home mobility exercises . Main Outcome Measurements : The primary study outcome measures were timed functional lower-extremity tasks ( walking at a corridor , U-turn , turning around a chair , stairs , st and ing on one foot , st and ing from a chair ) , and secondary outcome measures were exercise test and patient 's global assessment . Assessment s were performed at baseline and at the end of the study . Results : There were significant improvements in functional lower-extremity tests , exercise test parameters , and patients ' global assessment in group I , whereas no significant improvements were observed in group II . Conclusions : Even though long-term effects remain unknown and the study sample was small , it was concluded that  treadmill training in PD patients led to improvements in lower-extremity tasks , thus improving patients ' physical well-being in daily life OBJECTIVE To test whether body weight-supported treadmill training ( BWSTT ) is effective in improving functional outcome of patients with Parkinson 's disease . DESIGN Prospect i ve crossover trial . Patients were r and omized to receive either a 4-week program of BWSTT with up to 20 % of their body weight supported followed by 4 weeks of conventional physical therapy ( PT ) , or the same treatments in the opposite order . Medications for parkinsonism were not modified throughout the study . SETTING Inpatient rehabilitation unit for neurologic diseases . SUBJECTS Ten patients ( 5 men , 5 women ) with Hoehn and Yahr stage 2.5 or 3 parkinsonism ; mean age 67.6 years , mean duration of Parkinson 's disease 4.2 years . MAIN OUTCOME MEASURES The Unified Parkinson 's Disease Rating Scale ( UPDRS ) , ambulation endurance and speed ( sec/10 m ) , and number of steps for 10-meter walk . RESULTS The mean total UPDRS before/after BWSTT was 31.6/25.6 , and before/after PT was 29.1/28.0 . Analysis of covariance for improvement of UPDRS demonstrated a significant effect of type of therapy ( F(1 , 16 ) = 42.779 , p < .0001 ) but not order of therapy ( F(1 , 16 ) = 0.157 , p = .697 1 ) . Patients also had significantly greater improvement with BWSTT than with PT in ambulation speed ( BWSTT , before/after = 10.0/8.3 ; PT , 9.5/8.9 ) , and number of steps ( BWSTT , 22.3/19.6 ; PT , 21.5/20.8 ) . CONCLUSIONS In persons with Parkinson 's disease , treadmill training with body weight support produces greater improvement in activities of daily living , motor performance , and ambulation than does physical therapy PURPOSE Recent studies suggest that walking on a treadmill improves gait , mobility , and quality of life of patients with Parkinson 's disease ( PD ) . Still , there is a need for larger-scale r and omized controlled studies that demonstrate the advantages of treadmill training ( TT ) with control groups that receive similar amounts of attention . Moreover , to date , no study has combined speed and incline as parameters of progression . The aim of the study was to evaluate the effects of 24 wk of TT , with and without the use of incline , on gait , mobility and quality of life in patients with PD . METHODS The sample comprised 34 patients with PD , at the Hoehn and Yahr stage 1.5 or 2 . Participants were r and omized to speed TT , mixed TT , and control groups .  The intervention consisted of 72 one-hour exercise sessions for 24 wk . The main outcome measures are the Movement Disorder Society-Unified Parkinson 's Disease Rating Scale , the 39-item Parkinson 's Disease Question naire , spatiotemporal parameters of gait and 6-min walking distance . The measures were taken at baseline , mid-term and after 6 months . RESULTS Both TT groups improved in terms of speed , cadence , and stride length during self-selected walking conditions at the study end point . Both groups also showed improvements in distance traveled . Only the Mixed TT group improved their quality of life . The Control group showed no progress . CONCLUSIONS Participants in this study showed significant improvements in walking speed and walking endurance after 6 months of TT . Improvements were observed after 3 months of intensive TT and persisted at 6 months . It appears that individuals with poorer baseline performance may benefit most from TT BACKGROUND There is a lack of evidence about the most effective strategy for training gait in mild to moderate Parkinson 's disease . The aim of this study was to compare the effects of robotic gait training versus equal intensity treadmill training and conventional physiotherapy on walking ability in patients with mild to moderate Parkinson 's disease . METHODS Sixty patients with mild to moderate Parkinson 's disease ( Hoehn & Yahr stage 3 ) were r and omly assigned into three groups . All patients received twelve , 45-min treatment sessions , three days a week , for four consecutive weeks . The Robotic Gait Training group ( n = 20 ) underwent robot-assisted gait training . The Treadmill Training group ( n = 20 ) performed equal intensity treadmill training without body-weight support . The Physical Therapy group ( n = 20 ) underwent conventional gait therapy according to the proprioceptive neuromuscular facilitation concept . Patients were evaluated before , after and 3 months post-treatment . Primary outcomes were the following timed tasks : 10-m walking test , 6-min walking test . RESULTS No statistically significant difference was found on the primary outcome measures between the Robotic Gait Training group and the Treadmill Training group at the after treatment evaluation . A statistically significant improvement was found after treatment on the primary outcomes in favor of the Robotic Gait Training group and Treadmill Training group compared to the Physical Therapy group . Findings were confirmed at the 3-month follow-up evaluation . CONCLUSIONS Our findings support the hypothesis that robotic gait training is not superior to equal intensity treadmill training for improving walking ability in patients with mild to moderate Parkinson 's disease BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . In a r and omized , single-blind , crossover study , we evaluated physical disability in moderately advanced Parkinson 's disease ( PD ) patients after 4 weeks of normal physical activity and 4 weeks of an intensive physical rehabilitation program .  We used a  timed motor task  and a st and  ard assessment of PD severity ( the Unified Parkinson 's Disease Rating Scale [ UPDRS ] with subscales for mentation , activities of daily living [ ADL ] , and motor function ) completed by an investigator blinded to the physical rehabilitation status of the patient . Following physical rehabilitation , there was significant improvement in the UPDRS ADL and motor scores , but no change in mentation score . During the 6 months following physical rehabilitation , patients did not regularly exercise , and the UPDRS scores returned to baseline . We conclude that physical disability in moderately advanced PD objective ly improves with a regular physical rehabilitation program , but this improvement is not sustained when normal activity is resumed We have previously demonstrated changes in dopaminergic neurotransmission after intensive exercise in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse model of Parkinson ’s disease ( PD ) , including an increase in the dopamine D2 receptor ( DA-D2R ) , using noninvasive PET imaging with the radiolig and [18F]fallypride . The purpose of this feasibility and translational study was to examine whether intensive exercise leads to similar alterations in DA-D2R expression using PET imaging with [18F]fallypride in individuals with early-stage PD . In this pilot study , four patients with early-stage PD were r and omized to receive intensive exercise ( treadmill training sessions three times/week for 8 weeks ) or no exercise .  Two healthy age-matched individuals participated in treadmill training . Alterations in the DA-D2R binding potential ( BP ) as a marker for receptor expression were determined using PET imaging with [18F]fallypride . Turning performance in the patients with PD as a measure of postural control and the Unified Parkinson ’s Disease Rating Scale scores pre-exercise and postexercise were determined . Our data showed an exercise-induced increase in [18F]fallypride BP as well as improved postural control in patients with PD  who exercised . Changes in DA-D2R BP were not observed in patients with PD who did not exercise . These results suggest that exercise can lead to neuroplasticity in dopaminergic signaling and contribute to improved function that may be task specific ( postural control ) in early-stage PD OBJECTIVE To investigate the role of conventional gait training and partial weight-supported treadmill gait training ( PWSTT ) in improving the balance of patients with Parkinson disease ( PD ) . DESIGN Prospect i ve r and omized controlled design . SETTING National-level university tertiary hospital for mental health and neurosciences . PATIENTS Sixty patients with PD fulfilling the United Kingdom Brain Bank PD diagnostic criteria were recruited from the neurology outpatient department and movement disorder clinic . METHODOLOGY The patients were r and omly assigned into 3 equal groups : ( 1 ) a control group that only received a stable dosage of dopaminomimetic drugs ; ( 2 ) a conventional gait training ( CGT ) group that received a stable dosage of dopaminomimetic drugs and conventional gait training ; and ( 3 ) a PWSTT group that received a stable dosage of dopaminomimetic drugs and PWSTT with unloading of 20 % of body weight . The sessions for the CGT and PWSTT groups were provided for 30 minutes per day , 4 days per week , for 4 weeks ( 16 sessions ) . OUTCOME MEASURES The Unified Parkinson Disease Rating Scale ( UPDRS ) motor score , dynamic posturography , Berg Balance Scale , and Tinetti performance-oriented mobility assessment ( POMA ) were used as main outcome measures . RESULTS A significant interaction effect was observed in the UPDRS motor score , mediolateral index , Berg Balance Scale , limits of stability ( LOS ) total score , POMA gait score , and balance score . Post-hoc analysis showed that in comparison with the control group , the PWSTT group had a significantly better UPDRS motor score , balance indices , LOS in 8 directions , POMA gait , and balance score . The CGT group had a significantly better POMA gait score compared with control subjects . Compared with the CGT group , the PWSTT group had a significantly better UPDRS motor score , mediolateral index , POMA gait score , and LOS total score . CONCLUSION PWSTT may be a better interventional choice than CGT for gait and balance rehabilitation in patients with PD OBJECTIVE To compare the immediate effects of different training interventions on gait parameters in patients with early Parkinson 's disease ( PD ) . DESIGN R and omized , multiple intervention crossover pilot study . SETTING A rehabilitation center for adult persons with neurologic disorders . PARTICIPANTS Seventeen patients with early PD ( Hoehn and Yahr stages I through III ) and gait disturbances . INTERVENTION Patients were r and omly assigned to varying sequences of the following interventions over 4 consecutive days : structured speed-dependent treadmill training ( STT ) , limited progressive treadmill training ( LTT ) , conventional gait training ( CGT ) , and a control intervention . MAIN OUTCOME MEASURES Basic gait parameters ( overground walking speed and stride length at self-adapted speeds ) and parameters of gait analysis based on vertical ground reaction forces . RESULTS STT and LTT improved all basic gait parameters and the double stance duration compared with preintervention values ( P<.05 ) . No changes were found after CGT and the control intervention ( P<.05 ) . Significantly higher gains were observed in all basic gait parameters after STT and LTT when compared with CGT and the control intervention ( P<.05 ) . Additionally , a greater reduction of double stance duration was found after STT than after the control intervention ( P<.001 ) . No significant differences in gains were observed between STT and LTT , or between CGT and the control intervention , in all gait parameters . CONCLUSION The main disturbances of gait in PD , namely , speed and stride length , can be improved through a single intervention of STT or LTT , but not through CGT and the control intervention OBJECTIVES To obtain preliminary data on the effects of high-intensity exercise on functional performance in people with Parkinson 's disease ( PD ) relative to exercise at low and no intensity and to determine whether improved performance is accompanied by alterations in corticomotor excitability as measured through transcranial magnetic stimulation ( TMS ) . DESIGN Cohort ( prospect i ve ) , r and omized controlled trial . SETTING University-based clinical and research facilities . PARTICIPANTS Thirty people with PD , within 3 years of diagnosis with Hoehn and Yahr stage 1 or 2 . INTERVENTIONS Subjects were r and omized to high-intensity exercise using body weight-supported treadmill training , low-intensity exercise , or a zero-intensity education group . Subjects in the 2 exercise groups completed 24 exercise sessions over 8 weeks . Subjects in the zero-intensity group completed 6 education classes over 8 weeks . MAIN OUTCOME MEASURES Unified Parkinson 's Disease Rating Scales ( UPDRS ) , biomechanic analysis of self-selected and fast walking and sit-to-st and tasks ; corticomotor excitability was assessed with cortical silent period ( CSP ) duration s in response to single-pulse TMS . RESULTS A small improvement in total and motor UPDRS was observed in all groups . High-intensity group subjects showed postexercise increases in gait speed , step and stride length , and hip and ankle joint excursion during self-selected and fast gait and improved weight distribution during sit-to-st and tasks . Improvements in gait and sit-to-st and measures were not consistently observed in low- and zero-intensity groups . The high-intensity group showed lengthening in CSP . CONCLUSIONS The findings suggest the dose-dependent benefits of exercise and that high-intensity exercise can normalize corticomotor excitability in early PD OBJECTIVE To investigate whether body weight-supported treadmill training ( BWSTT ) is of long-term benefit for patients with Parkinson 's disease ( PD ) . DESIGN R and omized controlled trial . SETTING Inpatient rehabilitation unit for neurologic diseases in Japan . PARTICIPANTS Twenty-four patients ( Hoehn and Yahr stages 2.5 or 3 ) who were not demented ( Mini-Mental State Examination score , > 27 ) . INTERVENTIONS Patients were r and omized to receive either a 45-minute session of BWSTT ( up to 20 % of body weight supported ) or conventional physical therapy ( PT ) for 3 days a week for 1 month . MAIN OUTCOME MEASURES Outcome measures were evaluated at baseline and at 1 , 2 , 3 , and 6 months . Measures included the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , ambulation speed ( s/10 m ) , and number of steps taken for a 10-m walk as a parameter for stride length . RESULTS Four patients needed modification of medications in the follow-up period . Twenty patients ( BWSTT , n=11 ; PT , n=9 ) without modified medications were analyzed for functional outcome . Age , duration of PD , gender , and doses of medications were comparable . There was no difference in the baseline UPDRS ( BWSTT=33.3 ; PT=32.6 ) , speed ( BWSTT=10.8 ; PT=11.5 ) , and steps ( BWSTT=23.4 ; PT=22.8 ) . The BWSTT group had significantly greater improvement than the PT group ( Mann-Whitney U test , Bonferroni adjustment for multiple comparison ) in ambulation speed at 1 month ( BWSTT=8.5 ; PT=10.8 ; P<.005 ) ; and in the number of steps at 1 ( BWSTT=20.0 ; PT=22.7 ; P<.005 ) , 2 ( BWSTT=19.5 ; PT=22.4 ; P<.005 ) , 3 ( BWSTT=20.1 ; PT=23.1 ; P<.005 ) , and 4 months ( BWSTT=21.0 ; PT=23.0 ; P=.006 ) . CONCLUSIONS BWSTT has a lasting effect specifically on short-step gait in PD OBJECTIVES The purpose of this r and omized controlled study was to examine and compare the immediate and retention effects of speed-dependent treadmill training ( SDTT ) and rhythmic auditory-cued ( RAC ) overground walking on gait function and fall risk in individuals with Parkinson 's disease ( PD ) . METHODS Twenty participants ( mean age 66.1 yrs ) with idiopathic PD were r and omized into either SDTT ( n = 10 ) or RAC ( n = 10 ) progressive , interval-based locomotor training protocol s. Immediate and retention training effects on gait function and fall risk were measured by comfortable and fast gait speed ( CGS , FGS ) , 6-Minute Walk Test ( 6MWT ) , and Functional Gait Assessment ( FGA ) . RESULTS Immediate within-group training effects revealed significant gains in CGS , 6MWT , and FGA for the RAC group , and in FGS , 6-MinuteWalk Test , and FGA for the SDTT group . Retention effects were found at 3-month follow-up for all gait measures in the RAC group , and for FGS and FGA in the SDTT group . No statistically significant differences in immediate or retention training effects on gait measures were found between groups . CONCLUSIONS Externally-cued locomotor training with progressive and interval-based speed challenges , either with RAC overground or on a treadmill , produced significant improvements in walking speed , endurance , and dynamic balance during walking
BACKGROUND Treadmill training is used in rehabilitation and is described as improving gait parameters of patients with Parkinson 's disease .
OBJECTIVES To assess the effectiveness of treadmill training in improving the gait of patients with Parkinson 's disease and the acceptability and safety of this type of therapy .