Effect of Multimodal Exercise Training on Walking Economy in Individuals With Parkinson's Disease

NCT03864393 | Completed

• 1 other identifier: POSSabilities
• Study Type: interventional
• Target: 17
• Locations: 1 country
• Sites: 1

Brief Summary

Sustained ambulation is a challenge for individuals with Parkinson's disease (PD) as walking economy is frequently compromised. There are also various disease-related skeletal muscle alterations that may contribute to performance fatigability during ambulation. Concomitantly, individuals with PD experience substantial difficulty maintaining sustained forward progression at push-off during the gait cycle due to diminished force production. Exercise is commonly prescribed for these individuals, though traditional exercise approaches to PD have often applied a "one impairment-one modality" paradigm that addresses each impairment separately. Interventions to optimize movement should facilitate an individual's response to the challenge of responding to a complex interplay of constraints that are also specific to a task and its environmental context. Thus, there are multiple concurrent targets for exercise interventions that may not fit easily within a "one impairment-one modality" model. A multimodal intervention is designed to address an array of constraining impairments concurrently. However, the evidence-base for multimodal exercise approaches is still developing and far from conclusive. The purpose of this study is to demonstrate that multimodal overground locomotion training (OLT) can promote walking economy during sustained overground ambulation in individuals with PD, and produce concurrent secondary effects that decrease performance fatigability and increase propulsion. The aims of this study are to 1) Evaluate walking economy during sustained overground walking after 12 weeks of multimodal OLT, 2) Evaluate secondary effects of OLT.

Conditions

Parkinson Disease

Keywords

walking economy; fatigability; propulsion

Outcome Measures

Primary Outcomes (1)

• Change in Walking Economy

  measured as oxygen consumption (VO2) over distance walked (meters) during a 10-minute walk test

  pre and post 12 week intervention protocol

Secondary Outcomes (9)

• Change in Performance Fatigability

  pre and post 12 week intervention protocol

• Change in Propulsion

  pre and post 12 week intervention protocol

• Change in Interlimb Coordination

  pre and post 12 week intervention protocol

• Change in Muscle Activation

  pre and post 12 week intervention protocol

• Change in Perceived Fatigability

  pre and post 12 week intervention protocol

Study Arms (1)

Multimodal overground locomotor training

EXPERIMENTAL

Individuals with Parkinson's Disease that meet the inclusion/exclusion criteria and enrolled in the study will participate in a 12-week multimodal exercise training intervention performed twice per week.

Other: Multimodal overground locomotor training

Interventions

Multimodal overground locomotor training OTHER

Locomotor training sessions use various movement drills emphasizing power, stability, and stepping in a specific direction: forward, backward, lateral, rotational. Sessions also have an additional focus on gait initiation or steady-state walking. After circuit-style warm up exercises, participants perform overground movement drills that are specific to the emphasis of the individual training session, culminating in practicing everyday overground walking. Participants wear a heart rate monitor to ensure that the majority of the training session is performed at an aerobic intensity greater than 60% age predicted heart rate maximum (220-age +/- 5 bpm).

Multimodal overground locomotor training

Eligibility Criteria

• Age: 18 Years+
• Sex: all
• Healthy Volunteers: No
• Age Groups: Adult (18-64), Older Adult (65+)

You may qualify if:

• years of age or older
• diagnosis of idiopathic Parkinson's Disease, mild to moderate (Hoehn and Yahr score less than or equal to 3)
• speaks English
• able to ambulate without requiring an assistive device

You may not qualify if:

• neurological disease diagnosis other than PD
• uncontrolled cardiovascular, pulmonary, neurological, or metabolic disease which may impact the ability to exercise or in which exercise is contraindicated
• any medications, such as beta-blockers, that may alter HR or metabolic data
• cognitive or psychiatric impairment precluding informed consent or ability to following instructions
• mini-Mental State Examination score \<24
• pregnancy

Sponsors & Collaborators

• George Mason University: lead

Study Sites (1)

George Mason University

Fairfax, Virginia, 22030, United States

Location

Related Publications (3)

• Schnelle JF, Buchowski MS, Ikizler TA, Durkin DW, Beuscher L, Simmons SF. Evaluation of two fatigability severity measures in elderly adults. J Am Geriatr Soc. 2012 Aug;60(8):1527-33. doi: 10.1111/j.1532-5415.2012.04062.x. Epub 2012 Aug 2.

  PMID: 22860899 BACKGROUND

• Pugh RJ, Higgins RD, Min H, Wutzke CJ, Guccione AA. Turns while walking among individuals with Parkinson's disease following overground locomotor training: A pilot study. Clin Biomech (Bristol). 2024 Apr;114:106234. doi: 10.1016/j.clinbiomech.2024.106234. Epub 2024 Apr 3.

  PMID: 38582028 DERIVED

• Pechstein AE, Gollie JM, Keyser RE, Guccione AA. Walking Endurance and Oxygen Uptake On-Kinetics in Individuals With Parkinson Disease Following Overground Locomotor Training. J Neurol Phys Ther. 2023 Apr 1;47(2):99-111. doi: 10.1097/NPT.0000000000000423. Epub 2022 Dec 19.

  PMID: 36538418 DERIVED

Related Links

• Supporting literature for performance and perceived fatigability

MeSH Terms

Conditions

Parkinson Disease

Condition Hierarchy (Ancestors)

Parkinsonian Disorders; Basal Ganglia Diseases; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases

Study Officials

• Andrew A Guccione, PT, PhD, DPT

  George Mason University

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NA
• Masking: NONE
• Purpose: TREATMENT
• Intervention Model: SINGLE GROUP
• Sponsor Type: OTHER
• Responsible Party: SPONSOR

Study Record Dates

• First Submitted: February 26, 2019
• First Posted: March 6, 2019
• Study Start: May 1, 2019
• Primary Completion: March 30, 2020
• Study Completion: March 30, 2020
• Last Updated: July 27, 2021

Record last verified: 2021-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)