Jung Se Hee, Hasegawa Naoya, Mancini Martina, King Laurie A, Carlson-Kuhta Patricia, Smulders Katrijn, Peterson Daniel S, Barlow Nancy, Harker Graham, Morris Rosie, Lapidus Jodi, Nutt John G, Horak Fay B
Department of Neurology, Oregon Health & Science University, Portland, OR, USA.
Department of Rehabilitation Medicine, Seoul Natl. Univ. Boramae Medical Center, Seoul, Republic of Korea.
NPJ Parkinsons Dis. 2020 Nov 2;6(1):31. doi: 10.1038/s41531-020-00132-z.
Few exercise interventions practice both gait and balance tasks with cognitive tasks to improve functional mobility in people with PD. We aimed to investigate whether the Agility Boot Camp with Cognitive Challenge (ABC-C), that simultaneously targets both mobility and cognitive function, improves dynamic balance and dual-task gait in individuals with Parkinson's disease (PD). We used a cross-over, single-blind, randomized controlled trial to determine efficacy of the exercise intervention. Eighty-six people with idiopathic PD were randomized into either an exercise (ABC-C)-first or an active, placebo, education-first intervention and then crossed over to the other intervention. Both interventions were carried out in small groups led by a certified exercise trainer (90-min sessions, 3 times a week, for 6 weeks). Outcome measures were assessed Off levodopa at baseline and after the first and second interventions. A linear mixed-effects model tested the treatment effects on the Mini-BESTest for balance, dual-task cost on gait speed, SCOPA-COG, the UPDRS Parts II and III and the PDQ-39. Although no significant treatment effects were observed for the Mini-BESTest, SCOPA-COG or MDS-UPDRS Part III, the ABC-C intervention significantly improved the following outcomes: anticipatory postural adjustment sub-score of the Mini-BESTest (p = 0.004), dual-task cost on gait speed (p = 0.001), MDS-UPDRS Part II score (p = 0.01), PIGD sub-score of MDS-UPDRS Part III (p = 0.02), and the activities of daily living domain of the PDQ-39 (p = 0.003). Participants with more severe motor impairment or more severe cognitive dysfunction improved their total Mini-BESTest scores after exercise. The ABC-C exercise intervention can improve specific balance deficits, cognitive-gait interference, and perceived functional independence and quality of life, especially in participants with more severe PD, but a longer period of intervention may be required to improve global cognitive and motor function.
很少有运动干预措施会将步态和平衡任务与认知任务结合起来，以改善帕金森病（PD）患者的功能性移动能力。我们旨在研究同时针对移动能力和认知功能的认知挑战敏捷训练营（ABC-C）是否能改善帕金森病（PD）患者的动态平衡和双任务步态。我们采用交叉、单盲、随机对照试验来确定运动干预的效果。86名特发性PD患者被随机分为先进行运动（ABC-C）干预组或先进行积极的、安慰剂对照的教育干预组，然后交叉接受另一种干预。两种干预均由认证运动教练以小组形式进行（每次90分钟，每周3次，共6周）。在基线以及第一次和第二次干预后，在未服用左旋多巴的状态下评估结果指标。采用线性混合效应模型测试治疗对Mini-BESTest平衡量表、步态速度双任务成本、SCOPA-COG、UPDRS第二部分和第三部分以及PDQ-39的影响。虽然在Mini-BESTest、SCOPA-COG或MDS-UPDRS第三部分未观察到显著的治疗效果，但ABC-C干预显著改善了以下结果：Mini-BESTest的预期姿势调整子评分（p = 0.004）、步态速度双任务成本（p = 0.001）、MDS-UPDRS第二部分评分（p = 0.01）、MDS-UPDRS第三部分的姿势不稳和步态障碍子评分（p = 0.02）以及PDQ-39的日常生活活动领域（p = 0.003）。运动障碍或认知功能障碍更严重的参与者在运动后其Mini-BESTest总分有所提高。ABC-C运动干预可以改善特定的平衡缺陷、认知-步态干扰以及感知到的功能独立性和生活质量，尤其是在PD更严重的参与者中，但可能需要更长时间的干预来改善整体认知和运动功能。
