Impairments of spinal and extremity range of motion occur as sequelae to Parkinson's disease (PD) and contribute significantly to difficulties with balance. While subtle impairments of balance may not be obvious on routine clinical examination, they clearly are present early in the disease when appropriately evaluated. If diagnosed early in the disease process, impairments of balance can be remediated with exercise, delaying functional limitations. Coupled with functional retraining, exercise may improve overall physical functional ability and quality of life. Additionally, patients with mild PD have been found to have poor economy of movement during walking. Improvements of economy of movement have not been evaluated with exercise; it is likely that improved range of motion and balance will improve economy of movement. This investigation will examine whether: (1) balance, functional abilities and quality of life improve with improvements of spinal range of motion and balance; (2) physical intervention improves economy of movement, (3) general aerobic conditioning improves functional ability; (4) exercise targeting impairments associated with PD (e.g., range of motion and balance) is more effective than general endurance training and both are more effective than 'standard-of-care' treatments; (5) an ongoing home program, following a supervised exercise program, maintains increased spinal range of motion, balance, and functional ability. The proposed study is a randomized clinical trial, with 3 treatment arms and 4 repeated measures (before and after treatment, with follow-up at 10 and16 months). Specifically we will compare usual care based on a booklet provided by the American Parkinson Foundation, general endurance training, and PD specific flexibility and functional training. The primary outcomes (4 and 10 months) are measures of: (1) overall functional ability (Continuous-Scale Physical Functional Performance test; (2) balance, (Functional Reach); and (3) economy of movement (rate of oxygen consumption at a set walking speed, [(O2 consumption]). We postulate that PD-targeted flexibility and functional training will improve physical functional ability, in part, by improving balance & walking economy. Further, we expect the PD-specific targeted intervention to be more effective than general endurance training or 'standard-of-care' at improving overall physical function.

Agency
National Institute of Health (NIH)
Institute
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Type
Research Project (R01)
Project #
5R01HD043770-02
Application #
6736305
Study Section
Special Emphasis Panel (ZRG1-OBM-2 (02))
Program Officer
Nitkin, Ralph M
Project Start
2003-04-11
Project End
2008-03-31
Budget Start
2004-04-01
Budget End
2005-03-31
Support Year
2
Fiscal Year
2004
Total Cost
$338,090
Indirect Cost
Name
University of Colorado Denver
Department
Physical Medicine & Rehab
Type
Schools of Medicine
DUNS #
041096314
City
Aurora
State
CO
Country
United States
Zip Code
80045
Kluger, Benzi M; Brown, R Preston; Aerts, Shanae et al. (2014) Determinants of objectively measured physical functional performance in early to mid-stage Parkinson disease. PM R 6:992-8
Stevens-Lapsley, Jennifer; Kluger, Benzi M; Schenkman, Margaret (2012) Quadriceps muscle weakness, activation deficits, and fatigue with Parkinson disease. Neurorehabil Neural Repair 26:533-41
Schenkman, Margaret; Hall, Deborah A; BarĂ³n, Anna E et al. (2012) Exercise for people in early- or mid-stage Parkinson disease: a 16-month randomized controlled trial. Phys Ther 92:1395-410
Schenkman, Margaret; Ellis, Terry; Christiansen, Cory et al. (2011) Profile of functional limitations and task performance among people with early- and middle-stage Parkinson disease. Phys Ther 91:1339-54
Ene, Heather; McRae, Cynthia; Schenkman, Margaret (2011) Attitudes toward exercise following participation in an exercise intervention study. J Neurol Phys Ther 35:34-40
Morris, Meg E; Martin, Clarissa L; Schenkman, Margaret L (2010) Striding out with Parkinson disease: evidence-based physical therapy for gait disorders. Phys Ther 90:280-8
Schenkman, Margaret; McFann, Kimberly; Baron, Anna E (2010) PROFILE PD: profile of function and impairment level experience with Parkinson disease--clinimetric properties of a rating scale for physical therapist practice. J Neurol Phys Ther 34:182-92
Christiansen, Cory L; Schenkman, Margaret L; McFann, Kim et al. (2009) Walking economy in people with Parkinson's disease. Mov Disord 24:1481-7
Schenkman, Margaret; Hall, Deborah; Kumar, Rajeev et al. (2008) Endurance exercise training to improve economy of movement of people with Parkinson disease: three case reports. Phys Ther 88:63-76
Hearty, Thomas M; Schenkman, Margaret L; Kohrt, Wendy M et al. (2007) Continuous scale physical functional performance test: appropriateness for middle-aged adults with and without Parkinson's disease. J Neurol Phys Ther 31:64-70

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