Feasibility Aspects of Exploring Exercise-Induced Neuroplasticity in Parkinson’s Disease: A Pilot Randomized Controlled Trial

Abstract

Background. Recent studies indicate that exercise can induce neuroplastic changes in people with Parkinson’s disease (PwPD). Reports of feasibility outcomes from existing pilot trials however are, of date, insufficient to enable replication by others in larger definitive trials. Objective. To evaluate trial design for a definitive trial by exploring process and scientific feasibility. Methods. The trial design was a parallel-group RCT pilot with a 1 : 1 allocation ratio to either HiBalance or an active control group (HiCommunication). Both groups received one-hour sessions twice weekly, plus home exercises weekly, for 10 weeks. Participants with mild-to-moderate Parkinson’s disease (PD) were recruited via advertisement. Assessment included physical performance, structural and functional MRI, blood sampling, neuropsychological assessment, and speech/voice assessment. Process and scientific feasibility were monitored throughout the study. Process feasibility involved recruitment, participant acceptability of assessments and interventions, assessment procedures (focus on imaging, blood sampling, and dual-task gait analysis), and blinding procedures. Scientific feasibility involved trends in outcome response and safety during group training and home exercises. Data are presented in median, minimum, and maximum values. Changes from pre- to postintervention are reported descriptively. Results. Thirteen participants were included (4 women, mean age 69.7 years), with a recruitment rate of 31%. Attendance rates and follow-up questionnaires indicated that both groups were acceptable to participate. Image quality was acceptable; however, diplopia and/or sleepiness were observed in several participants during MRI. With regard to dual-task gait performance, there appeared to be a ceiling effect of the cognitive tasks with seven participants scoring all correct answers at pretest. Blinding of group allocation was successful for one assessor but was broken for half of participants for the other. Conclusions. The overall trial design proved feasible to perform, but further strengthening ahead of the definitive RCT is recommended, specifically with respect to MRI setup, cognitive dual-tasks during gait, and blinding procedures. This trial is registered with NCT03213873.

Dual-Task Effects During a Motor-Cognitive Task in Parkinson’s Disease: Patterns of Prioritization and the Influence of Cognitive Status

“…The auditory Stroop task was selected as it has been previously proven valid 33 and reliable (gait speed intraclass correlation coefficient [ICC] .91, and reaction time ICC .82) 34 during DT gait assessments in PD. The auditory Stroop task has been proven feasible to perform within the current context, 35 and also allows for the analysis of multiple performance outcomes (such as reaction times, intraindividual variability of reaction times, as well as accuracy). Participants were presented with the Swedish words for “high” and “low” in congruent and incongruent high and low tones via wireless headphones (RazerTM ManO’War).…”

Treatment Options for Motor and Non-Motor Symptoms of Parkinson’s Disease

“…Either along with or alternative to dopamine replacement, complementary and alternative medicine (CAM) and integrative medicine approaches are used by many to improve brain and overall health in PwP [ 16 , 17 , 18 , 19 , 20 , 21 ]. Lifestyle modifications can provide therapeutic benefits, as different forms of strenuous aerobic exercise are neuroprotective, on top of the general quality-of-life (QoL) benefits offered by regular exercise [ 10 , 12 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. PD is a complicated disorder such that two PwP might have different symptoms with varied rates of progression and likely follow different treatment strategies, despite diagnosis with the same disease.…”

“…The potential for exercise to be neuroprotective in PD has been widely studied [ 10 , 12 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. There is emerging evidence that neuroinflammation contributes to the progression of PD [ 101 , 102 ].…”

Exercise for Older Adults Improves the Quality of Life in Parkinson’s Disease and Potentially Enhances the Immune Response to COVID-19

“…Persistent moderate-intensity exercise by PwP is a treatment strategy to improve the QoL and likely reduce neuroinflammation. Using more demanding moderate- to high-intensity exercise programs (examples include PWR!Moves, Rock Steady Boxing, Dance for PD, stationary bike, and power-walking with walking poles) [ 10 , 87 , 88 , 90 , 91 , 92 , 101 , 103 , 104 , 105 , 106 , 109 ], with sustained use, could eventually promote neuroplasticity in PwP.…”

“…A few obstacles include which biological markers are the most useful for measuring neuroplasticity and what imaging techniques/tools would be most helpful to document changes in the neural networks [107]. A clinical trial [108] and a feasibility study [109] for exercise-induced neuroplasticity in PD are currently underway.…”