EXERCISE AND PARKINSON'S: COMPARING INTERVENTIONS AND EXPLORING NEURAL MECHANISMS

运动和帕金森病：比较干预措施和探索神经机制

• 批准号: 8866486
• 负责人: GAMMON M. EARHART
• 金额: $ 38万
• 依托单位: WASHINGTON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-30 至 2016-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8866486
• 关键词: Address; Affect; American; Area; Brain; Brain imaging; Brain region; Caring; Cerebellum; Communities; Control Groups; Dancing; Deep Brain Stimulation; Development; Equilibrium; Exercise; Expenditure; Freezing; Functional Magnetic Resonance Imaging; Functional disorder; Future; Gait; Health Care Costs; Hour; Imaging Techniques; Intervention; Knowledge; Lead; Length; Literature; Magnetic Resonance Imaging; Measures; Methods; Motor; Neurodegenerative Disorders; Operative Surgical Procedures; Parkinson Disease; Participant; Performance; Pharmaceutical Preparations; Physical therapy exercises; Quality of life; Questionnaires; Randomized; Reporting; Rest; Severity of illness; Signal Transduction; Social Controls; Somatosensory Cortex; Speed; Stretching; Symptoms; Techniques; Testing; Time; United States; Walking; Work; base; behavior measurement; blood oxygen level dependent; cost; design; disability; effective therapy; flexibility; head-to-head comparison; improved; innovation; insight; interest; intervention effect; locomotor control; mortality; neuroimaging; neuromechanism; novel; programs; putamen; therapy development; treadmill training

DESCRIPTION (provided by applicant): Parkinson disease (PD) is characterized by substantial disability and reduced quality of life, both of which can be attributed in large part t difficulties with walking. Evidence suggests that exercise may be an important adjunct to traditional treatments, particularly with respect to locomotor function. In particular, dance and treadmill training have been individually shown to improve walking performance and quality of life. At present it is not clear whether dance or treadmill training have similar effects or if oneis superior to the other. Moreover, our understanding of the mechanisms by which these exercise interventions convey benefits is extremely limited. This study aims to address these knowledge gaps by directly comparing dance, treadmill training and stretching (control group). The primary area of interest is the effects on gait, with secondary measures of disease severity, balance, and quality of life. We will determine not only the effects of the interventions on locomotor performance, but will also investigate the effects of the interventions on brain connectivity and brain function at rest and during imagined walking tasks. Participants will be randomly assigned to dance, treadmill training, or a stretching/flexibility control group. Participants will be assesed over a period of 6 months at 3 different time points. We hypothesize that both dance and treadmill training will lead to improvements in forward walking, but that dance will result in greater improvements in backward walking compared to treadmill training. Furthermore, we hypothesize that the tango and treadmill interventions will have different effects of brain functio and connectivity. We expect dance to enhance the activity and connectivity of the premotor and supplementary motor areas. We expect treadmill training to enhance activity and connectivity of the primary somatosensory cortex and the cerebellum. We do not expect changes in brain activity or connectivity in the control group. Relevance PD affects 1-1.5 million Americans, leading to substantial disability, reduced quality of life, and an annual expenditure of more than $34 billion in health care costs. Difficulties with walking are a major contributor to disability ad walking speed is a strong predictor of mortality. Exercise therapies hold promise for improving walking as well as quality of life. In particular, dance and treadmill training have been reported o improve walking, but head to head comparisons of these methods have not been made and the neurophysiologic effects of these interventions remain unknown. This study will directly compare the effects of dance, treadmill training and stretching (control group) and will utilize neuroimaging techniques to explore the neurophysiologic effects of these interventions on brain function and connectivity. The results obtained will help us to better understand whether and how exercise influences function in PD and which brain regions are involved. The knowledge gained has the potential to alter our approach to the treatment of gait difficulties in PD, as it my assist in the development of new or improved exercise interventions and/or identification of new surgical targets for deep brain stimulation.

描述（由申请人提供）：帕金森病（PD）的特征是严重的残疾和生活质量降低，这两者都可以在很大程度上归因于步行的困难。证据表明，运动可能是传统治疗的重要辅助手段，特别是在运动功能方面。特别是，已经显示出舞蹈和跑步机训练可以提高步行表现和生活质量。目前，尚不清楚舞蹈或跑步机训练是否具有相似的效果，或者是彼此优于另一个。此外，我们对这些运动干预措施传达益处的机制的理解极为有限。这项研究旨在通过直接比较舞蹈，跑步机训练和拉伸（对照组）来解决这些知识差距。感兴趣的主要领域是对步态的影响，并采取了疾病严重性，平衡和生活质量的次要措施。我们不仅将确定干预措施对运动性能的影响，还将研究干预措施对脑连通性和大脑功能在休息和想象中的步行任务期间的影响。参与者将被随机分配参加舞蹈，跑步机训练或伸展/灵活性控制组。参与者将在6个月的时间内在3个不同的时间点进行评估。我们假设舞蹈和跑步机训练都将导致前进步行的改善，但是与跑步机训练相比，这种舞蹈将导致向后步行的进步。此外，我们假设探戈和跑步机的干预措施将对大脑功能和连通性具有不同的影响。我们希望舞蹈能够增强前运动和补充运动区域的活动和连通性。我们预计跑步机训练可以增强主要体感皮质和小脑的活动和连通性。我们预计对照组的大脑活动或连通性不会发生变化。相关性PD影响1-150万美国人，导致大量残疾，生活质量降低以及每年支出超过340亿美元的医疗保健费用。步行困难是导致残疾广告步行速度的主要贡献者，是死亡率的有力预测指标。运动疗法有望改善步行以及生活质量。特别是，据报道，舞蹈和跑步机训练o改善步行，但尚未进行这些方法的头部比较，并且这些干预措施的神经生理效应尚不清楚。这项研究将直接比较舞蹈，跑步机训练和拉伸（对照组）的影响，并将利用神经影像学技术来探索这些干预措施对脑功能和连通性的神经生理影响。获得的结果将有助于我们更好地理解运动以及如何影响PD的功能以及涉及哪些大脑区域的功能。获得的知识有可能改变我们治疗PD步态困难的方法，因为我有助于开发新的或改进的运动干预措施和/或鉴定新的手术目标，以实现深脑刺激。