From the Australian Catholic University, School of Exercise Science, Banyo, Queensland, Australia (RPH, MHC); Australian Catholic University, School of Exercise Science, Fitzroy, Victoria, Australia (GN); and Asia-Pacific Centre for Neuromodulation, Queensland Brain Institute, The University of Queensland, Brisbane, Queensland, Australia (PAS).
Am J Phys Med Rehabil. 2018 Mar;97(3):151-159. doi: 10.1097/PHM.0000000000000858.
Deficits in step-to-step symmetry and trunk muscle activations have been linked to falls in Parkinson disease. Given such symptoms are poorly managed with anti-parkinsonian medications, alternate therapies are needed. This blind phase II randomized controlled trial sought to establish whether exercise can improve step-to-step symmetry in Parkinson disease.
Twenty-four Parkinson disease patients with a falls history completed baseline assessments of symptom severity, balance confidence, mobility, and quality of life. Step-to-step symmetry was assessed by deriving harmonic ratios from three-dimensional accelerations collected for the head and trunk. Patients were randomly assigned to either 12 wks of exercise and falls prevention education or falls prevention education only. Both groups repeated the baseline tests 12 and 24 wks after the initial assessment. The Australian and New Zealand Clinical Trials Registry number is ACTRN12613001175763.
At 12 wks, the exercise group had statistically significant and clinically relevant improvements in anterior-posterior step-to-step trunk symmetry. In contrast, the education group recorded statistically significant and clinically meaningful reductions in medial-lateral and vertical step-to-step trunk symmetry at 12 wks.
Given that step-to-step symmetry improved for the exercise group and declined for the education group after intervention, active interventions seem more suited to increasing independence and quality of life for people with Parkinson disease.
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to do the following: (1) Describe the effect deficits in trunk muscle function have on gait in individuals with Parkinson disease; (2) Identify the benefits of targeted trunk exercises on step-to-step symmetry; and (3) Discuss the benefits of improving step-to-step symmetry in individuals with Parkinson disease.
Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
在帕金森病患者中，步长对称性和躯干肌肉活动的缺陷与跌倒有关。鉴于抗帕金森病药物对此类症状的治疗效果不佳，需要寻求替代疗法。这项盲法二期随机对照试验旨在确定运动是否可以改善帕金森病患者的步长对称性。
24 名有跌倒史的帕金森病患者完成了症状严重程度、平衡信心、移动能力和生活质量的基线评估。通过从头部和躯干采集的三维加速度中得出谐波比来评估步长对称性。患者被随机分配到运动和跌倒预防教育组或跌倒预防教育组。两组均在初始评估后 12 周和 24 周重复基线测试。澳大利亚和新西兰临床试验注册中心编号为 ACTRN12613001175763。
在 12 周时，运动组在前-后方向的躯干步长对称性方面有统计学意义和临床相关的改善。相比之下，教育组在 12 周时在中-外侧和垂直方向的躯干步长对称性方面有统计学意义和临床意义的降低。
鉴于干预后运动组的步长对称性改善，而教育组的步长对称性下降，积极的干预措施似乎更适合提高帕金森病患者的独立性和生活质量。
索取 CME 学分：在 http://www.physiatry.org/JournalCME 上完成自我评估活动和评估在线。CME 目标：完成本文后，读者应能够做到以下几点：（1）描述躯干肌肉功能缺陷对帕金森病患者步态的影响；（2）确定针对躯干的运动对步长对称性的益处；（3）讨论改善帕金森病患者步长对称性的益处。
高级
学术物理治疗医师协会由继续教育医学认证委员会认可，可为医生提供继续医学教育。学术物理治疗医师协会将此基于期刊的 CME 活动指定为最多 0.5 个 AMA PRA 类别 1 学分。医生只能要求与他们参与活动的程度相符的学分。
