Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. Effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity: a randomized controlled trial A predominantly home-based progressive resistance exercise program increases knee extensor strength in the short-term in people with chronic obstructive pulmonary disease: a randomised controlled trial. Resistance Training with Instability for Patients with Parkinson's Disease. Feasibility and Impact of a Function Focused Care Intervention for Parkinson's Disease in the Community Exercise for falls prevention in Parkinson disease Falls and mobility in Parkinson's disease: protocol for a randomised controlled clinical trial
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 ABSTRACT Background Sarcopenic obesity is associated with disability in older people , especially in women .  Resistance exercises are recommended for this population , but their efficacy is not clear . Objective To evaluate the effects of a progressive resistance exercise program with high-speed component on the physical function of older women with sarcopenic obesity . Method Twenty-eight women 65 to 80 years old , with a body mass index ≥30kg/m2 and h and grip strength ≤21 kg were r and omly allocated to two groups . The experimental group underwent a 10-week resistance exercise program design ed to improve strength , power , and endurance of lower-limb muscles , with open chain and closed chain exercises . The control group had their health status monitored through telephone calls . The primary outcomes were lower limb muscle performance measured by knee extensor strength , power and fatigue by isokinetic dynamometry , and mobility measured by the Short Physical Performance Battery and by gait velocity . The secondary outcome was health-related quality of life assessed by the SF-36 Question naire . Results The average rate of adherence was 85 % , with few mild adverse effects . There were no significant between-group differences for any of the outcomes . Conclusion In this study , a progressive resistance exercise program with high-speed component was not effective for improving the physical function of older women with sarcopenic obesity QUESTIONS Does a 12-week , predominantly home-based program of progressive resistance exercises reduce impairments , activity limitations , and participation restrictions in people with chronic obstructive pulmonary disease ? Are any gains maintained 12 weeks after the cessation of the program ? DESIGN R and omised controlled trial with concealed allocation , assessor blinding , and intention-to-treat analysis . PARTICIPANTS 54 people with moderately severe chronic obstructive pulmonary disease not undergoing pulmonary rehabilitation . INTERVENTION The experimental group performed six progressive resistance exercises three times per week ( once a week hospital-based , twice a week home-based ) for 12 weeks . Exercise intensity was three sets of 8 to 12 repetition maximum progressed against elasticised b and s of increasing resistance . The control group received no intervention . OUTCOME MEASURES Primary outcomes were strength ( knee extensor , hip abductor , shoulder horizontal flexor , shoulder flexor ) measured using h and -held dynamometry , and walking capacity measured by the 6-minute Walk Test performed before and after intervention and again at 12 weeks after the cessation of intervention . RESULTS The experimental group increased their knee extensor strength by 4.9 kg ( 95 % CI 1.1 to 8.7 ) more than the control group by Week 12 . However , this gain was not maintained at Week 24 . No difference between the groups was found for any of the other primary outcomes . CONCLUSIONS A predominantly home-based progressive resistance exercise program led to modest improvements in knee extensor strength in people with chronic obstructive pulmonary disease . However , 44 % of the experimental group were unable to complete the exercise program , highlighting the need to underst and factors influencing adherence to exercise in this population PURPOSE This r and omized controlled trial compared the effects of resistance training ( RT ) and RT with instability ( RTI ) on the timed up and go test ( TUG ) , on-medication Unified Parkinson 's Disease Rating Scale part III motor subscale score ( UPDRS-III ) , Montreal Cognitive Assessment ( MoCA ) score , Parkinson 's Disease Question naire ( PDQ-39 ) score , and muscle strength in the leg press exercise ( one-repetition maximum ) of patients with Parkinson 's disease ( PD ) . METHODS Thirty-nine patients with moderate to severe PD were r and omly assigned to a nonexercising control group ( C ) , RT group , and RTI group . The RT and RTI groups performed progressive RT twice a week for 12 wk . However , only the RTI group used high motor complexity exercises ( i.e. , progressive RT with unstable devices ) , for example , half squat exercise on the BOSU ® device . The primary outcome was mobility ( TUG ) . The secondary outcomes were on-medication motor signs ( UPDRS-III ) , cognitive impairment ( MoCA ) , quality of life ( PDQ-39 ) , and muscle strength ( one-repetition maximum ) . RESULTS There were no differences between RTI and RT groups for any of the outcomes at posttraining ( P > 0.05 ) . However , there were differences between RTI and C groups in the TUG , MoCA , and muscle strength values at posttraining ( P < 0.05 ) . Only the RTI group improved the TUG ( -1.9 s ) , UPDRS-III score ( -4.5 score ) , MoCA score ( 6.0 score ) , and PDQ-39 score ( -5.2 score ) from pre- to posttraining ( P < 0.001 ) . Muscle strength improved for both training groups ( P < 0.001 ) . No adverse events were reported during the trial . CONCLUSIONS Both training protocol s improved muscle strength , but only RTI improved the mobility , motor signs , cognitive impairment , and quality of life , likely because of the usage of high motor complexity exercises . Thus , RTI may be recommended as an innovative adjunct therapeutic intervention for patients with PD Background : Parkinson 's disease ( PD ) results in a progressive loss of function such that family caregivers provide a large percentage of the personal care to PD patients living in the home setting . Objectives : The aim of this study was to test the feasibility and impact of function-focused care for PD ( FFC-PD ) developed to optimize function and physical activity among people with PD who live in the community . Methods : This pilot study was a single-group , 2 pretest , 3 posttest repeated- measures design to investigate the impact of the FFC-PD intervention over a 12-month period . Measurements included the Self-Efficacy and Outcome Expectations for Exercise and Functional Activities , Yale Physical Activity Scale , Unified Parkinson 's Disease Rating Scale , Barthel Index , Schwab & Engl and , Timed Chair Rise , Parkinson 's Disease Question naire-39 , and Geriatric Depression Scale . Results : The impact of FFC-PD on a person with PD showed a statistically significant increase in outcome expectations for exercise , F(3 , 60 ) = 3.09 , p = .034 ; hours a week exercising , F(1 , 24 ) = 4.95 , p = .004 ; mean weekly energy expenditure , F(2,43 ) = 4.32 , p = .017 ; hours spent in overall activities , F(3 , 60 ) = 6.06 , p = .001 ; decreased disability based on the Unified Parkinson 's Disease Rating Scale , F(2 , 40 ) = 9.48 , p < .001 ; improved Parkinson 's Disease Question naire-39 score , F(3 , 60 ) = 3.81 , p = .014 ; and a trend toward significance on Barthel Index , F(1.6 , 31 ) = 3.47 , p = .055 . Discussion : Function-focused care for PD has a significant effect on increasing and on strengthening outcome expectations related to exercise , time spent in exercise , and physical activity and in improving functional performance in people with PD . Further research is needed to explore the use of objective measurements of functional performance and activity and to test FFC-PD in a r and omized controlled trial Objective : To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors , i.e. , poor balance , reduced leg muscle strength , and freezing of gait , in people with Parkinson disease . Methods : Two hundred thirty-one people with Parkinson disease were r and omized into exercise or usual-care control groups . Exercises were practice d for 40 to 60 minutes , 3 times weekly for 6 months . Primary outcomes were fall rates and proportion of fallers during the intervention period . Secondary outcomes were physical ( balance , mobility , freezing of gait , habitual physical activity ) , psychological ( fear of falling , affect ) , and quality -of-life measures . Results : There was no significant difference between groups in the rate of falls ( incidence rate ratio [ IRR ] = 0.73 , 95 % confidence interval [ CI ] 0.45–1.17 , p = 0.18 ) or proportion of fallers ( p = 0.45 ) . Preplanned subgroup analysis revealed a significant interaction for disease severity ( p < 0.001 ) . In the lower disease severity subgroup , there were fewer falls in the exercise group compared with controls ( IRR = 0.31 , 95 % CI 0.15–0.62 , p < 0.001 ) , while in the higher disease severity subgroup , there was a trend toward more falls in the exercise group ( IRR = 1.61 , 95 % CI 0.86–3.03 , p = 0.13 ) . Postintervention , the exercise group scored significantly ( p < 0.05 ) better than controls on the Short Physical Performance Battery , sit-to-st and , fear of falling , affect , and quality of life , after adjusting for baseline performance . Conclusions : An exercise program targeting balance , leg strength , and freezing of gait did not reduce falls but improved physical and psychological health . Falls were reduced in people with milder disease but not in those with more severe Parkinson disease . Classification of evidence : This study provides Class III evidence that for patients with Parkinson disease , a minimally supervised exercise program does not reduce fall risk . This study lacked the precision to exclude a moderate reduction or modest increase in fall risk from exercise . Trial registration : Australian New Zeal and Clinical Trials Registry ( ACTRN12608000303347 ) Background Although physical therapy and falls prevention education are argued to reduce falls and disability in people with idiopathic Parkinson 's disease , this has not yet been confirmed with a large scale r and omised controlled clinical trial . The study will investigate the effects on falls , mobility and quality of life of ( i ) movement strategy training combined with falls prevention education , ( ii ) progressive resistance strength training combined with falls prevention education , ( iii ) a generic life-skills social program ( control group ) . Methods / Design People with idiopathic Parkinson 's disease who live at home will be recruited and r and omly allocated to one of three groups . Each person shall receive therapy in an out-patient setting in groups of 3 - 4 . Each group shall be scheduled to meet once per week for 2 hours for 8 consecutive weeks . All participants will also have a structured 2 hour home practice program for each week during the 8 week intervention phase . Assessment s will occur before therapy , after the 8 week therapy program , and at 3 and 12 months after the intervention . A falls calendar will be kept by each participant for 12 months after outpatient therapy . Consistent with the recommendations of the Prevention of Falls Network Europe group , three falls variables will be used as the primary outcome measures : the number of fallers , the number of multiple fallers and the falls rate . In addition to quantifying falls , we shall measure mobility , activity limitations and quality of life as secondary outcomes . Discussion This study has the potential to determine whether outpatient movement strategy training combined with falls prevention education or progressive resistance strength training combined with falls prevention education are effective for reducing falls and improving mobility and life quality in people with Parkinson 's disease who live at home . Trial registration Australia and New Zeal and Clinical Trials Register ( ANZCTR ) :
However , most physical performance outcomes did not show clinical ly worthwhile improvement after progressive resistance exercise .
CONCLUSION This review suggests that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson 's disease , but carryover of benefit does not occur for all measures of physical performance .
The current evidence suggests that progressive resistance training should be implemented in Parkinson 's disease rehabilitation , particularly when the aim is to improve walking capacity
QUESTION Does progressive resistance exercise improve strength and measures of physical performance in people with Parkinson 's disease ?