Characterizing the Effects of High-intensity Exercise on Balance and Gait under Dual-task Conditions in Parkinson’s Disease

Parkinson’s disease (PD) is a neurodegenerative disorder, characterized by four cardinal motor symptoms including bradykinesia, tremor, rigidity, and postural instability, and non-motor symptoms including cognitive impairment. Daily activities, such as walking and maintaining balance, are impacted due to impairments in motor function, and are further exacerbated with the addition of cognitive loading, or dual-tasking (DT). High-intensity exercise has demonstrated centrally-mediated improvements of PD symptoms, with additional positive effects on overall health. The goal of this project was to identify changes in dynamic balance recovery and gait function under conditions with and without increased cognitive load after a high-intensity exercise intervention in a PD population. Participants included people with PD who completed an eight-week cycling intervention (PDE), people with Parkinson’s disease who did not complete the intervention (PDC), and healthy age-matched controls (HC), with 14 subjects per group. In Aim 1, while participants underwent a series of destabilizing balance tests, the time taken to regain balance and the center of pressure movement during balance recovery were measured. The PDE group demonstrated greater improvement in balance recovery after exercise compared with the PDC group. In Aim 2, participants completed a series of gait and cognitive tasks, both separately and concurrently. Outcome measures included spatiotemporal and kinematic gait parameters of the lower and upper extremities. The PDE group demonstrated significant improvement in gait measures and DT abilities compared to PDC, while no changes were found in cognitive function for any group. The standard clinical methods of measuring motor function can be subjective, and may not capture subtle motor characteristics. Force plate and motion-capture technologies can provide detailed, objective outcome data, therefore improving the understanding of how exercise affects motor symptoms of Parkinson’s disease. The Motek Computer Assisted Rehabilitation Environment (CAREN) system at the Cleveland Clinic was used to create the testing environment and for data collection. These results of this project suggest global changes in motor function demonstrated by changes in balance recovery and lower and upper extremity gait function. Quantitative gait analysis has shown to be an important metric in assessing effectiveness of an exercise intervention in PD