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.

Public Health Relevance

Parkinson disease (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. Problems with walking are a major contributor to disability in PD and the development of treatments to address gait dysfunction is critical to reduce mortality, improve quality of life and reduce costs for care. Exercise is a promising adjunct therapy that may provide important benefits with respect to walking and other aspects of function, but knowledge is lacking regarding which form of exercise is best. Additionally, we have a very limited understanding of the underlying neurophysiologic mechanisms of exercise and its effects on locomotor control. This study will directly compare the two exercise programs, tango dancing and treadmill training, to each other and to a control group that participates in a stretching program to determine their effects on gait and function in people with PD. We will utilize brain imaging techniques to examine how participation in these exercise programs modifies brain function. The information gained will inform the development of optimal exercise interventions, and perhaps other treatment approaches, designed to specifically target walking problems in PD.

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
1R01NS077959-01A1
Application #
8436714
Study Section
Musculoskeletal Rehabilitation Sciences Study Section (MRS)
Program Officer
Galpern, Wendy R
Project Start
2012-09-30
Project End
2017-07-31
Budget Start
2012-09-30
Budget End
2013-07-31
Support Year
1
Fiscal Year
2012
Total Cost
$380,000
Indirect Cost
$130,000
Name
Washington University
Department
Other Health Professions
Type
Schools of Medicine
DUNS #
068552207
City
Saint Louis
State
MO
Country
United States
Zip Code
63130
Myers, Peter S; McNeely, Marie E; Koller, Jonathan M et al. (2017) Cerebellar Volume and Executive Function in Parkinson Disease with and without Freezing of Gait. J Parkinsons Dis 7:149-157
Harrison, Elinor C; McNeely, Marie E; Earhart, Gammon M (2017) The feasibility of singing to improve gait in Parkinson disease. Gait Posture 53:224-229
Duncan, Ryan P; McNeely, Marie E; Earhart, Gammon M (2017) Maximum Step Length Test Performance in People With Parkinson Disease: A Cross-sectional Study. J Neurol Phys Ther 41:215-221
Christofoletti, Gustavo; McNeely, Marie E; Campbell, Meghan C et al. (2016) Investigation of factors impacting mobility and gait in Parkinson disease. Hum Mov Sci 49:308-14
Paul, Serene S; Thackeray, Anne; Duncan, Ryan P et al. (2016) Two-Year Trajectory of Fall Risk in People With Parkinson Disease: A Latent Class Analysis. Arch Phys Med Rehabil 97:372-379.e1
Cameron, Daniel J; Pickett, Kristen A; Earhart, Gammon M et al. (2016) The Effect of Dopaminergic Medication on Beat-Based Auditory Timing in Parkinson's Disease. Front Neurol 7:19
Pilgram, Laura M; Earhart, Gammon M; Pickett, Kristen A (2016) Impact of limiting visual input on gait: Individuals with Parkinson disease, age-matched controls, and healthy young participants. Somatosens Mot Res 33:29-34
McNeely, Marie E; Mai, Marina M; Duncan, Ryan P et al. (2015) Differential Effects of Tango Versus Dance for PD in Parkinson Disease. Front Aging Neurosci 7:239
McNeely, M E; Duncan, R P; Earhart, G M (2015) A comparison of dance interventions in people with Parkinson disease and older adults. Maturitas 81:10-6
Duncan, Ryan P; Cavanaugh, James T; Earhart, Gammon M et al. (2015) External validation of a simple clinical tool used to predict falls in people with Parkinson disease. Parkinsonism Relat Disord 21:960-3

Showing the most recent 10 out of 24 publications