The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease.
OBJECTIVE
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).


METHODS
Cohort (prospective), randomized controlled trial.


METHODS
University-based clinical and research facilities.


METHODS
Thirty people with PD, within 3 years of diagnosis with Hoehn and Yahr stage 1 or 2.


METHODS
Subjects were randomized 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.


METHODS
Unified Parkinson's Disease Rating Scales (UPDRS), biomechanic analysis of self-selected and fast walking and sit-to-stand tasks; corticomotor excitability was assessed with cortical silent period (CSP) durations 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-stand tasks. Improvements in gait and sit-to-stand 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.
Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA 90089-9006, USA. bfisher@usc.edu
Beth E
BE
Fisher
Allan D
AD
Wu
George J
GJ
Salem
Jooeun
J
Song
Chien-Ho Janice
CH
Lin
Jeanine
J
Yip
Steven
S
Cen
James
J
Gordon
Michael
M
Jakowec
Giselle
G
Petzinger
D000368:Aged; D005081:Exercise Therapy; D005240:Feasibility Studies; D005260:Female; D020233:Gait Disorders, Neurologic / Q000534:rehabilitation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009044:Motor Cortex / Q000503:physiopathology*; D009473:Neuronal Plasticity / Q000502:physiology; D010300:Parkinson Disease / Q000503:physiopathology* / Q000532:radiotherapy*; D004856:Postural Balance / Q000502:physiology; D011446:Prospective Studies; D013647:Task Performance and Analysis; D050781:Transcranial Magnetic Stimulation; D016896:Treatment Outcome; D016138:Walking