PDF herunterladen
CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(06): 511-520
DOI: 10.1590/0004-282X-ANP-2020-0285
Articles

Effects of resistance training on postural control in Parkinson’s disease: a randomized controlled trial

Efeitos de um treinamento de resistência muscular no controle postural em indivíduos com doença de Parkinson: um estudo aleatorizado controlado
Janini CHEN 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil.
2   Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil.
3   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo SP, Brazil.
,
Hsin Fen CHIEN 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil.
2   Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil.
3   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Ortopedia e Traumatologia, São Paulo SP, Brazil.
,
Debora Cristina Valente FRANCATO 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil.
2   Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil.
,
Alessandra Ferreira BARBOSA 
2   Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil.
4   Universidade de São Paulo, Departamento de Fisioterapia, Terapia Ocupacional e Fonoaudiologia, São Paulo SP, Brazil.
,
Carolina de Oliveira SOUZA 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil.
2   Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil.
,
Mariana Callil VOOS 
2   Grupo de Pesquisa em Reabilitação em Distúrbios do Movimento, São Paulo SP, Brazil.
4   Universidade de São Paulo, Departamento de Fisioterapia, Terapia Ocupacional e Fonoaudiologia, São Paulo SP, Brazil.
,
Julia Maria D'Andréa GREVE 
5   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Instituto de Ortopedia e Traumatologia, Laboratório de Estudo do Movimento, São Paulo SP, Brazil.
,
Egberto Reis BARBOSA 
1   Universidade de São Paulo, Hospital das Clínicas, Faculdade de Medicina, Departamento de Neurologia, Clínica de Distúrbios do Movimento, São Paulo SP, Brazil.
› Institutsangaben
› Weitere Informationen
Auch verfügbar auf
   Lizenzen und Reprints

ABSTRACT

Background: Postural instability affects Parkinson’s disease (PD) patients’ postural control right from the early stages of the disease. The benefits of resistance training (RT) for balance and functional capacity have been described in the literature, but few studies have been conducted showing its effects on PD patients’ postural control. Objective: To investigate the effects of a three-month RT intervention on static posturography (SP) measurements and clinical functional balance assessment among PD patients. Methods: Seventy-four patients were randomly assigned to a three-month RT intervention consisting of using weightlifting machines at a gym (gym group) or RT consisting of using free weights and elastic bands (freew group), or to a control group. The participants were evaluated at baseline, three months and six months. We evaluated changes of SP measurements under eyes-open, eyes-closed and dual-task conditions (primary endpoint), along with motor performance and balance effects by means of clinical scales, dynamic posturography and perceptions of quality of life (secondary endpoints). Results: There were no significant interactions in SP measurements among the groups. Unified Parkinson Disease Rating Scale (UPDRS-III) motor scores decreased in both RT groups (p<0.05). Better perceived quality of life for the mobility domain was reported in the gym group while functional balance scores improved in the freew group, which were maintained at the six-month follow-up (p<0.05). Conclusions: This study was not able to detect changes in SP measurements following a three-month RT intervention. Both RT groups of PD patients showed improved motor performance, with positive balance effects in the freew group and better perceived quality of life in the gym group.

RESUMO

Introdução: A instabilidade postural afeta o controle postural desde os estágios iniciais da doença de Parkinson (DP). A literatura descreve benefícios do programa de fortalecimento muscular no equilíbrio, na capacidade funcional, porém poucos estudos investigaram seus efeitos no controle postural na DP. Objetivo: Investigar os efeitos de um programa de três meses de fortalecimento nas medidas da posturografia estática (PE) e nos testes clínicos na DP. Métodos: Participaram do ensaio aleatório controlado 74 pacientes, designados em um dos seguintes grupos: fortalecimento utilizando aparelhos de musculação (gmusc); fortalecimento com pesos livres e elásticos (gpeso); e grupo controle. As avaliações ocorreram antes da intervenção, 3 e 6 meses após intervenção. Foram avaliados alterações nas medidas da PE nas condições de olhos abertos, olhos fechados e dupla tarefa (desfecho primário), efeitos sobre sintomas motores, equilíbrio por meio de escalas clínicas, posturografia dinâmica e percepção da qualidade de vida (desfechos secundários). Resultados: Não houve interações significativas nas medidas da PE entre os grupos. As pontuações motoras da Escala Unificada de Avaliação da Doença de Parkinson (UPDRS-III) diminuíram em ambos os grupos de fortalecimento (p<0,05). Houve melhora da percepção da qualidade de vida para o domínio mobilidade no gmusc, assim como ganhos nas pontuações dos testes funcionais no gpeso, mantido no seguimento após seis meses (p<0,05). Conclusões: O programa de fortalecimento não altera o controle postural medida pela PE. Apesar disso, ambos os grupos de fortalecimento apresentaram melhor desempenho motor, efeitos positivos a médio prazo no equilíbrio no gpeso e melhor desempenho na qualidade de vida no gmusc.

Keywords:

Resistance Training - Parkinson Disease - Postural Balance - Rehabilitation - Quality of Life

Palavras-chave:

Treinamento de Resistência - Doença de Parkinson - Equilíbrio Postural - Reabilitação - Qualidade de Vida

Authors’ contributions:

JC: conception/data collection/data analysis and interpretation/drafting the article/critical revision of the article/final approval of the version to be published. HFC: conception/data analysis and interpretation/drafting the article/critical revision of the article/final approval of the version to be published. DCVF and AFB: data collection/drafting the article/critical revision of the article/final approval of the version to be published. COS and MCV: drafting the article/critical revision of the article/final approval of the version to be published. JMDG: critical revision of the article/final approval of the version to be published. ERB: conception/drafting the article/critical revision of the article/final approval of the version to be published.




Publikationsverlauf

Eingereicht: 17. Juni 2020

Angenommen: 17. September 2020

Artikel online veröffentlicht:
04. Juli 2023

© 2021. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Revinter Publicações Ltda.
Rua do Matoso 170, Rio de Janeiro, RJ, CEP 20270-135, Brazil

 

  • References

  • 1 Sousa AS, Silva A, Tavares JM. Biomechanical and neurophysiological mechanisms related to postural control and efficiency of movement: a review. Somatosens Mot Res. 2012 Oct;29(4):131-43. https://doi.org/10.3109/08990220.2012.725680
  • 2 Boonstra TA, van der Kooij H, Munneke M, Bloem BR. Gait disorders and balance disturbances in Parkinson’s disease: clinical update and pathophysiology. Curr Opin Neurol. 2008 Aug;21(4):461-71. https://doi.org/10.1097/wco.0b013e328305bdaf
  • 3 Grill S. Postural instability in Parkinson diseases. Md Med J. 1999 Jul-Aug;48(4):179-81.
  • 4 Wood BH, Bilclough JA, Bowron A, Walker RW. Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study. J Neurol Neurosurg Psychiatry. 2002 Jun;6(72):721-5. https://doi.org/10.1136/jnnp.72.6.721
  • 5 Barbosa AF, Souza C de O, Chen J, Francato DV, Caromano FA, Chien HF, et al. The competition with a concurrent cognitive task affects posturographic measures in patients with Parkinson disease. Arq Neuro-Psiquiatr. 2015 Nov;73(11):906-12. https://doi.org/10.1590/0004-282x20150153
  • 6 Błaszczyk JW, Orawiec R. Assessment of postural control in patients with Parkinson's disease: sway ratio analysis. Hum Mov Sci. 2011 Apr;30(2):396-404. https://doi.org/10.1016/j.humov.2010.07.017
  • 7 Rocchi L, Chiari L, Horak FB. Effects of deep brain stimulation and levodopa on postural sway in Parkinson's disease. J Neurol Neurosurg Psychiatry. 2002 Sep;73(3):267-74. https://doi.org/10.1136/jnnp.73.3.267
  • 8 Mancini M, Carlson-Kuhta P, Zampieri C, Nutt JG, Chiari L, Horak FB. Postural sway as a marker of progression in Parkinson's disease: a pilot longitudinal study. Gait Posture. 2012 Jul;36(3):471-6. https://doi.org/10.1016/j.gaitpost.2012.04.010
  • 9 Ickenstein GW, Ambach H, Klöditz A, Koch H, Isenmann S, Reichmann H, et al. Static posturography in aging and Parkinson's disease. Front Aging Neurosci. 2012 Aug;4:20. https://doi.org/10.3389/fnagi.2012.00020
  • 10 Paul SS, Canning CG, Song J, Fung VS, Sherrington C. Leg muscle power is enhanced by training in people with Parkinson's disease: a randomized controlled trial. Clin Rehabil. 2014 Mar;28(3):275-88. https://doi.org/10.1177/0269215513507462
  • 11 Schilling BK, Karlage RE, LeDoux MS, Pfeiffer RF, Weiss LW, Falvo MJ. Impaired leg extensor strength in individuals with Parkinson disease and relatedness to functional mobility. Parkinsonism Relat Disord. 2009 Dec;15(10):776-80. https://doi.org/10.1016/j.parkreldis.2009.06.002
  • 12 Schlenstedt C, Paschen S, Kruse A, Raethjen J, Weisser B, Deuschl G. Resistance versus balance training to improve postural control in Parkinson's disease: a randomized rater blinded controlled study. PLoS One. 2015 Oct;10(10):e0140584. https://doi.org/10.1371/journal.pone.0140584
  • 13 Corcos DM, Robichaud JA, David FJ, Leurgans SE, Vaillancourt DE, Poon C, et al. A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease. Mov Disord. 2013 Aug;28(9):1230-40. https://doi.org/10.1002/mds.25380
  • 14 Brienesse LA, Emerson MN. Effects of resistance training for people with Parkinson's disease: a systematic review. J Am Med Dir Assoc. 2013 Apr;14(4):236-41. https://doi.org/10.1016/j.jamda.2012.11.012
  • 15 Chung CL, Thilarajah S, Tan D. Effectiveness of resistance training on muscle strength and physical function in people with Parkinson's disease: a systematic review and meta-analysis. Clin Rehabil. 2016 Jan;30(1):11-23. https://doi.org/10.1177/0269215515570381
  • 16 Ramazzina I, Bernazzoli B, Costantino C. Systematic review on strength training in Parkinson's disease: an unsolved question. Clin Interv Aging. 2017 Mar;12:619-28. https://doi.org/10.2147/cia.s131903
  • 17 Roeder L, Costello JT, Smith SS, Stewart IB, Kerr GK. Effects of resistance training on measures of muscular strength in people with Parkinson's disease: a systematic review and meta-analysis. PLoS One. 2015 Jul;10(7):e0132135. https://doi.org/10.1371/journal.pone.0132135
  • 18 Hughes AJ, Daniel SE, Kilford L, Lees AJ. UK Parkinson's Disease Society Brain Bank Clinical Diagnostic Criteria. J Neurol Neurosurg Psychiatry. 1992 Mar;55:181-4. https://doi.org/10.1136/jnnp.55.3.181
  • 19 American College of Sports Medicine Position Stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009 Mar;41(3):687-708. https://doi.org/10.1249/mss.0b013e3181915670
  • 20 Benatru I, Vaugoyeau M, Azulay JP. Postural disorders in Parkinson’s disease. Neurophysiol Clin. 2008;38:459-65. https://doi.org/10.1016/j.neucli.2008.07.006
  • 21 van der Burg JC, van Wegen EE, Rietberg MB, Kwakkel G, van Dieën JH. Postural control of the trunk during unstable sitting in Parkinson’s disease. Parkinsonism Relat Disord. 2006 Dec;12(8):492-8. https://doi.org/10.1016/j.parkreldis.2006.06.007
  • 22 Cianci H. Parkinson disease: fitness counts. 3. ed. Miami, FL: National Parkinson Foundation; 2006.
  • 23 Li F, Harmer P, Fitzgerald K, Eckstrom E, Stock R, Galver J, et al. Tai chi and postural stability in patients with Parkinson's disease. N Engl J Med. 2012 Feb;366(6):511-9. https://doi.org/10.1056/nejmoa1107911
  • 24 Stylianou AP, McVey MA, Lyons KE, Pahwa R, Luchies CW. Postural sway in patients with mild to moderate Parkinson's disease. Int J Neurosci. 2011 Nov;121(11):614-21. https://doi.org/10.3109/00207454.2011.602807
  • 25 Santos L, Fernandez-Rio J, Winge K, Barragán-Pérez B, González-Gómez L, Rodríguez-Pérez V, et al. Effects of progressive resistance exercise in akinetic-rigid Parkinson's disease patients: a randomized controlled trial. Eur J Phys Rehabil Med. 2017 Oct;53(5):651-63. https://doi.org/10.1080/09638288.2016.1207104
  • 26 Hass CJ, Buckley TA, Pitsikoulis C, Barthelemy EJ. Progressive resistance training improves gait initiation in individuals with Parkinson's disease. Gait Posture. 2012 Apr;35(4):669-73. https://doi.org/10.1016/j.gaitpost.2011.12.022
  • 27 Santos SM, da Silva RA, Terra MB, Almeida IA, de Melo LB, Ferraz HB. Balance versus resistance training on postural control in patients with Parkinson's disease: a randomized controlled trial. Eur J Phys Rehabil Med. 2017 Apr;53(2):173-83. https://doi.org/10.23736/S1973-9087.16.04313-6
  • 28 Nocera JR, Horvat M, Ray CT. Impaired step up/over in persons with Parkinson's disease. Adapt Phys Activ Q. 2010 Apr;27(2):87-95.
  • 29 Shen X, Mak MK. Balance and gait training with augmented feedback improves balance confidence in people with Parkinson's disease: a randomized controlled trial. Neurorehabil Neural Repair. 2014 Jul;28(6):524-35. https://doi.org/10.1177/1545968313517752
  • 30 Shulman LM, Gruber-Baldini AL, Anderson KE, Fishman PS, Reich SG, Weiner WJ. The clinically important difference on the unified Parkinson's disease rating scale. Arch Neurol. 2010 Jan;67(1):64-70. https://doi.org/10.1001/archneurol.2009.295
  • 31 Dibble LE, Hale TF, Marcus RL, Parry Gerber J, LaStayo PC. High intensity eccentric resistance training decreases bradykinesia and improves quality of life in persons with Parkinson’s disease: a preliminary study. Parkinsonism Relat Disord. 2009 Dec;15:752-7. https://doi.org/10.1016/j.parkreldis.2009.04.009
  • 32 Saltychev M, Bärlund E, Paltamaa J, Katajapuu N, Laimi K. Progressive resistance training in Parkinson's disease: a systematic review and meta-analysis. BMJ Open. 2016 Jan;6(1):e008756. https://doi.org/10.1136/bmjopen-2015-008756
  • 33 Huang SL, Hsieh CL, Wu RM, et al. Minimal detectable change of the timed “up & go” test and the dynamic gait index in people with Parkinson disease. Phys Ther. 2011 Jan;91(1):114-21. https://doi.org/10.2522/ptj.20090126.cx
  • 34 King LA, Priest KC, Salarian A, Pierce D, Horak FB. Comparing the Mini-BESTest with the berg balance scale to evaluate balance disorders in Parkinson's disease. Parkinsons Dis. 2012;2012:375419. https://doi.org/10.1155/2012/375419
  • 35 Carvalho A, Barbirato D, Araujo N, Martins JV, Cavalcanti JL, Santos TM, et al. Comparison of strength training, aerobic training, and additional physical therapy as supplementary treatments for Parkinson's disease: pilot study. Clin Interv Aging. 2015 Jan;10:183-91. https://doi.org/10.2147/cia.s68779