Abstract
Introduction Parkinson’s Disease (PD) is the second most common neurological disease following Alzheimer’s Disease. It is progressive in nature involving neurodegeneration and neuronal death primarily in the basal ganglia. Among the many sequella of the disease, one of the most debilitating is the development of an Parkinsonian gait: hunched posture, muscular tremors, shuffling, increased gait velocity and a decrease or lack of arm swing. Current management of the disease involves the use of pharmaceuticals mimicking the neurotransmitter dopamine. Management of the disease may also come from other sources alongside pharmaceuticals in the form of exercise. Recent research on the effects of high intensity exercise training on the brain in both the normal aging population (Colcombe et al, 2003; Colcombe et al, 2006) and in Parkinson’s patients (Fisher et al, 2008; Hirsch et al, 2003; Ridgel et al, 2009) have found that high intensity exercise increases brain plasticity, blood flow and brain volume. The purpose of this study was to determine whether intense exercise, at a predetermined target heart rate, on a stationary bicycle improves rhythmic gait immediately post activity in persons with early staged Parkinson’s Disease. It was predicted that exercise will improve gait rhythmicity as evidenced by consistent stride length, gait velocity and increased toe clearance during the testing period. Methodology Testing protocol was approved by the Sacramento State University (CSUS) IRB department and the Kinesiology Graduate department. Three mild to moderate idiopathic Parkinson’s diagnosed adults were recruited and cleared via a local primary care physician. Prior to participation subjects completed a Health History Questionnaire and a Mini-Mental Examination. Functional mobility was tested with a Timed Up and Go test. Gait Analysis was tested in the Biomechanics Laboratory at CSUS. Protocol involved riding a stationary Monarch bicycle with a 5 min warm-up, an exercise set of 20 minutes, and a 2 minute cool down. The heart rate reserve method was used to measure target heart rate was calculated based on prior stress test for clearance. Immediate post exercise, gait was once again tested motion capture cameras in the laboratory. A repeated measures test (dependent t-tests) was used to help determine the effect of intense exercise on comparing toe clearance, stride length, gait speed during level walking. Mean and standard deviation between pre and post trials are listed. Results Subjects were classified in stage 2.3 of the Hoehn and Yahr scale. Average years of diagnoses at 6.33±1.6 years. All subjects reached target heart rate percent of 60-80% predetermined max heart rate(100.23±11.77)% heart rate reserve. Average gait velocity pre exercise intervention was 0.802m/s, post average gait velocity was 0.798m/s. Average percent change in gait velocity -5.488%. Average stride length pre exercise intervention 0.942m. Average stride length post exercise intervention was 0.959m. Stride length percent change was 1.655%. Mean toe clearance pre exercise intervention was 0.0853m. Post exercise intervention, mean toe clearance was 0.079m. Toe clearance percent change was -8.98%. Conclusion All subjects were able to meet the demands of the exercise intensity for the length of the exercise protocol. All subjects had an increase in stride length. Lack of access to MRI scanners leaves the conclusions for the changes seen in gait as hypothetical changes in the brain. Changes in gait from pre to post exercise have been proposed to be a result of a ‘carry-over’ of a smooth cyclical rhythm from movement to another. Changes gait strategy are also proposed as possible means of change. This research study is a pilot study and has opened the door to more questions to be answered.