Exercise as it relates to Disease/Improving strength and function in Parkinson's Disease through eccentric resistance training

Background to the research Parkinson's Disease Parkinson's disease (PD) is a progressive, degenerative disorder of the central neural system (CNS), causing a loss of mobility and difficulty controlling movements.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. The disease does not cause death, and can be lived with for a number of years, however, a person's quality of life is degraded.Lees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066. There is no definitive cause of PD, and there is no cure for the neurodegenerative process.Lees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066.Connolloy, B.S., Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a review. The Journal of the American Medical Association, 331(16), 1670-1683. Prevalence In Australia currently, approximately 80,000 people have PD, with the average age of diagnosis around 65.Parkinson's Australia. (2015). What is Parkinson's? Retrieved from http://www.parkinsons.org.au/what-is-parkinsons Worldwide, it is the second most common neurological disease.Connolloy, B.S., Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a review. The Journal of the American Medical Association, 331(16), 1670-1683. The incidence of the disease increases with age, and the ageing population is likely to cause an increased frequency of the disease.Lees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066. Effects Loss of or damage to dopamine secreting neurons in the substansia nigra, resulting in bradykinesiaConnolloy, B.S., Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a review. The Journal of the American Medical Association, 331(16), 1670-1683.Samii, A., Nutt, J. G., Ransom, B. R. (2004). Parkinson’s disease. The Lancet, 363(9423), 1783-1793. Bradykinesia: One of the most recognisable and debilitating symptoms of Parkinson's, as it involves a slowing of movement and difficulty controlling movement.Berardelli, A, Rothwell, J.C., Thompson, P. D., Hallett, M. (2001). Pathophysiology of bradykinesia in Parkinson’s disease. Brain, 124(11), 2131-2146. Speech difficultiesLees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066. Rapid eye movement disordersLees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066. FatigueLees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066. Impaired memoryParkinson's Australia. (2015). What is Parkinson's? Retrieved from http://www.parkinsons.org.au/what-is-parkinsons Sleep problemsLees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066. PainLees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066. DepressionLees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066. Why resistance training? There is currently no cure for PD, however there are treatments to help people deal with symptoms.Lees, A. J., Hardy, J., Revesz, T. (2009). Parkinson’s disease. The Lancet, 373(9680), 2055-2066.Connolloy, B.S., Lang, A. E. (2014). Pharmacological treatment of Parkinson disease: a review. The Journal of the American Medical Association, 331(16), 1670-1683. Recently, research into the impact that high-intensity resistance training has on people with PD has shown positive evidence for its use as a method of treatment.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. The goal of resistance training is to achieve muscle hypertrophy, which should aid in increasing functional strength in people with PDDibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. Resistance training has the potential to slow the loss of strength due to bradykinesia through this hypertrophy, and therefore improve a person's quality of lifeDibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. Bradykinesia is likely to amplify the effects of age induced sarcopenia, resulting in a positive feedback response which increases strength deficits. Resistance training can help to reduce these deficits.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. There is a strong relationship between poor lower body strength, poor balance, and falls. Increasing lower body strength through resistance training can help to reduce the incidence of fallsHirsch, M. A., Toole, T., Maitland, C. G., Rider, R. A. (2003). The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson’s disease. Archives of Physical Medicine and Rehabilitation, 84(4), 1109-1117. High intensity resistance training as a treatment method Where is the research from? The research, conducted by Dibble et al., was reviewed and approved by the University of Utah Health Services Centre Institutional Board. Funding was received from the University of Utah and the Foundation for Physical Therapy.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. What kind of research was this? Dibble et al.'s study was exploratory research, which is appropriate in this situation given how few studies had been conducted prior to this research on this particular topic.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. What did the research involve? Participants were recruited on a voluntary basis through local hospitals based on their involvement in movement disorder programs.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. Exclusion criteria included unpredictable motor fluctuations which were not being controlled by medicine, and existing conditions that were likely to limit participation in the exercise program.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. 20 people were initially recruited, however one person dropped out due to unrelated health problems.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. Participants were between 40 and 85 years of age and suffered from mild to moderate idiopathic PD.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. Baseline information about muscle volume and mobility was gained through MRI scans and measures of mobility which have been proven to be appropriate by previous research (6 minute walk, stair ascent and descent).Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. Participants were assigned to either the eccentric exercise group or the standard care control group.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. The two groups performed the same programs, including light stretching, walking on a treadmill, riding a standard cycle ergometer, and lifting weights with upper exptremities for 45–60 minutes 3 days a week for 12 weeks.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. The eccentric exercise group performed lower extremity resistance training in addition to this program.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. Basic results There were no significant differences between the groups before the intervention, however, both groups showed a significant difference in muscle volume in the quadriceps between the affect and non affected legs.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. The training returned several significant results:Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. An increase in muscle volume in both legs in the eccentric exercise group, greater than in the standard care group Increased average torque in both legs in the eccentric exercise group, which exceeded the standard care group Significant improvements in 6 minute walk and stair descent in eccentric exercise group How did the researchers interpret the results? Dibble et al. reported that their research demonstrates that quadriceps hypertrophy is clinically significant due to the association between muscle mass and strength and mobility limitations in older people.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. Further, their results are in line with previous studies which have demonstrated increases in muscle volume in older people who engage in strength training.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. The improvements in stair descent results indicate the functional benefit of eccentric training.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. While the eccentric exercise group showed positive results, members of the standard care control group experienced minimal changes, and some worsened.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. This was of concern to the researchers because the exercise protocol used for the control group exceeded the guidelines recommend by various PD patient advocacy groups.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. What conclusions should be taken away from this research? Dibble et al. concluded that a 12 week eccentric resistance training program can produce hypertrophy, increase strength, and improve mobility in people with PD.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. However, because this was an exploratory study, further research is needed before results of this research can be generalised beyond the sample population.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. Further research needs to be conducted to determine the relative contribution of neural processes to muscle hypertrophy in people with PD. Dibble et al. acknowledge that the gains experienced by the eccentric group are still far smaller than those experienced by younger people with no neurological conditions undertaking a similar program.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. This is likely to be related to an altered neural drive to skeletal muscle, however more information is needed.Dibble, L. E., Hale, T. F., Robin, L. M., Droge, J., Gerber, J. P., LaStayo, P. C. (2006). High-Intensity Resistance Training Amplifies Muscle Hypertrophy and Functional Gains in Persons with Parkinson’s Disease. Movement Disorders, 21(9), 1444-1452. What are the implications of this research? The results of this study imply that muscle volume and strength is important for elderly populations and those with PD. Therefore, if muscle hypertrophy can be achieved through a training program, their mobility is likely to be improved. Dibble et al.'s research demonstrates that eccentric training may be a suitable form of treatment for people with PD, however further research involving larger groups is needed to validate their findings and overcome the issues with their study format. References