Lack of Short-Term Effectiveness of Rotating Treadmill Training on Turning in People with Mild-to-Moderate Parkinson's Disease and Healthy Older Adults: A Randomized, Controlled Study

Abstract

Since turning is often impaired in Parkinson's disease (PD) and may lead to falls, it is important to develop targeted treatment strategies for turning. We determined the effects of rotating treadmill training on turning in individuals with PD. This randomized controlled study evaluated 180° in-place turns, functional turning (timed-up-and-go), and gait velocity before and after 15 minutes of rotating treadmill training or stepping in place in 26 people with PD and 27 age-matched controls. A subset of participants with PD (n = 3) completed five consecutive days of rotating treadmill training. Fast as possible gait velocity, timed-up-and-go time, 180° turn duration, and steps to turn 180° were impaired in PD compared to controls (P < 0.05) and did not improve following either intervention (P > 0.05). Preferred pace gait velocity and timing of yaw rotation onset of body segments (head, trunk, pelvis) during 180° turns were not different in PD (P > 0.05) and did not change following either intervention. No improvements in gait or turning occurred after five days of rotating treadmill training, compared to one day. The rotating treadmill is not recommended for short-term rehabilitation of impaired in-place turning in the general PD population.

Walking Along Curved Trajectories. Changes With Age and Parkinson's Disease. Hints to Rehabilitation

“…Huxham et al (139) have shown that stride length reduction appears to contribute more than downscaled rotation amplitude to inefficient turning in patients with PD, possibly because of reduced axial mobility. Compared to straight walking, during curved walking speed diminishes by about 20% (90) and by about 35% (82, 91) in less and more affected patients, respectively. Cadence also diminishes by more than 5% and step length diminishes by about 20% (82, 89) (Figure 1B).…”

“…(B) The effect of Parkinson's disease on walking along curved trajectories. Data are the sample-size-weighted mean of Cohen's d effect-size of the illustrated spatiotemporal gait variables [calculated from a (89); b (82, 90) d (91); e (92); f (85)]. Negative values in the x axis represent a decrease in the variable values in patients with PD compared to age-matched controls.…”

Positive Effects of Specific Exercise and Novel Turning-based Treadmill Training on Turning Performance in Individuals with Parkinson’s disease: A Randomized Controlled Trial

“…noted an improved turn time on the U-turn task after 6 weeks of treadmill training, but this improvement was not superior to that of home-mobility exercise 4 . McNeely and Earhart found that a rotating treadmill they designed did not exert beneficial effects on turning performance 5 . Previously, we found that balance ability and lower extremity muscle strength, especially of the extensors and abductors, influenced turning performance in individuals with PD 6 .…”

Curved Walking Rehabilitation with a Rotating Treadmill in Patients with Parkinson’s Disease: A Proof of Concept

“…Progressive-resistance exercises are known to improve motor performances in parkinsonian patients in the long run ( 93 ). Hence, it is not unlikely that more numerous, longer periods of circular treadmill rotation and higher angular velocities of imposed rotation would have produced larger improvements in overground circular walking ( 94 ). Previous studies have shown that angular velocity of treadmill rotation during PKS influences PKAR velocity ( 64 ).…”