Mechanisms of Motor Symptom Improvement by Long-Term Tai Chi Training in Parkinson's Disease Patients

Abstract

Background Tai Chi has been shown to improve motor symptoms in Parkinson’s disease (PD), but its long-term effects was not clear and the related mechanism was not elucidated. Therefore, we investigated the mechanism of long-term Tai Chi training on improving motor symptoms in PD. Methods 95 early-stage PD patients were enrolled and randomly divided into Tai Chi (N = 32), brisk walking (N = 31) and no-exercise group (N = 32). All subjects were assessed at baseline, 6 months and 12 months after one-year intervention. Motor symptoms were evaluated by Berg balance scale (BBS), Unified PD rating scale (UPDRS), Timed Up and Go test (TUG) and 3D gait analysis. Functional MRI, plasma cytokine and metabolomics, blood Huntingtin interaction protein 2 (HIP2) mRNA levels were analyzed to investigate the mechanisms of Tai Chi training at macro and molecular level. The longitudinal effects of self-changes were calculated using repeated measures ANOVA. Generalized estimating equations (GEE) was used to assess the association of longitudinal data of rating scales. Switch rates were used into the fMRI analysis. False discovery rate (FDR) correction was used to perform multiple correction. Results Tai Chi group had better performance in BBS, UPDRS, TUG and step width. Besides, Tai Chi had more advantages in improving BBS, step width than brisk walking. Improved BBS was correlated with enhanced visual network function and downregulation of IL-1β. Improvements in UPDRS were associated with enhanced default mode network function, decreased L-malic acid and 3-phosphoglyceric acid, increased adenosine and HIP2 mRNA levels. In addition, arginine biosynthesis, urea cycle, TCA cycle and beta oxidation of very long chain fatty acids were also improved by Tai Chi. Conclusions Long-term Tai Chi training improved motor function, especially gait and balance, in PD. Enhanced brain network function, reduced inflammation, improved amino acid metabolism, energy metabolism and neurotransmitters metabolism, decreased vulnerability to dopaminergic degeneration might be the mechanisms of Tai Chi effects. Trial registration: This study is registered at Chinese Clinical Trial Registry (Registration number: ChiCTR-OPC-16008074; Registration date: March 8, 2016).

Delivering Multidisciplinary Rehabilitation Care in Parkinson’s Disease: An International Consensus Statement

“…Systematic reviews identify several beneficial interventions for ADL such as multidisciplinary inpatient rehabilitation [16,21,74,75], group multimodal exercise programs [74,[76][77][78], and home-based hand exercise programs [74,79]. Cognitive behavioral therapy (CBT) focused on sleep hygiene and behaviors [80,81], resistance training, multimodal exercise, and mindfulness meditation combined with exercise can be used to improve sleep [74,[82][83][84]. Evidence supports interventions for IADL including education, mentoring, social support, and behavioral change techniques to increase activity levels and multimodal exercise programs that promote IADL participation, function, and social engagement [34,[85][86][87][88][89].…”