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）的特点是严重残疾和生活质量下降，这两者在很大程度上可归因于行走困难。有证据表明，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，舞蹈和跑步机训练已被单独证明可以改善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，或者是否优于另一种。此外，我们对这些运动干预带来益处的机制的理解极其有限。本研究旨在通过直接比较舞蹈、跑步机训练和伸展运动（对照组）来解决这些知识差距。主要关注领域是对步态的影响，其次是疾病严重程度、平衡和生活质量的测量。我们不仅将确定干预措施对运动表现的影响，还将研究干预措施对休息时和想象的步行任务期间大脑连接和大脑功能的影响。参与者将被随机分配到舞蹈组、跑步机训练组或伸展/灵活性对照组。参与者将在 6 个月的 3 个不同时间点接受评估。我们假设舞蹈和跑步机训练都会导致向前行走的改善，但与跑步机训练相比，舞蹈会导致向后行走的更大改善。此外，我们假设探戈和跑步机干预会对大脑功能和连接产生不同的影响。我们期望舞蹈能够增强运动前区和辅助运动区的活动和连通性。我们期望跑步机训练能够增强初级体感皮层和小脑的活动和连接。我们预计对照组的大脑活动或连接不会发生变化。相关性 PD 影响 1-150 万美国人，导致严重残疾、生活质量下降以及每年超过 340 亿美元的医疗保健费用。行走困难是导致残疾的主要原因，行走速度是死亡率的有力预测因素。运动疗法有望改善步行和生活质量。特别是，据报道舞蹈和跑步机训练可以改善步行，但尚未对这些方法进行直接比较，并且这些干预措施的神经生理学效果仍然未知。这项研究将直接比较舞蹈、跑步机训练和伸展运动（对照组）的效果，并将利用神经影像技术探索这些干预措施对大脑功能和连通性的神经生理学影响。获得的结果将帮助我们更好地了解运动是否以及如何影响帕金森病的功能以及涉及哪些大脑区域。所获得的知识有可能改变我们治疗帕金森病步态困难的方法，因为它有助于开发新的或改进的运动干预措施和/或识别深部脑刺激的新手术目标。