Division of Physiotherapy, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.
Division of Clinical Geriatrics, Department of Neurobiology, Care sciences and Society, Karolinska Institutet, Stockholm, Sweden.
J Parkinsons Dis. 2021;11(4):2057-2071. doi: 10.3233/JPD-212801.
Parkinson's disease (PD) is characterized by motor deficits and brain alterations having a detrimental impact on balance, gait, and cognition. Intensive physical exercise can induce changes in the neural system, potentially counteracting neurodegeneration in PD and improving clinical symptoms.
This randomized controlled trial investigated effects of a highly challenging, cognitively demanding, balance and gait training (HiBalance) program in participants with PD on brain structure.
95 participants were assigned to either the HiBalance or an active control speech training program. The group-based interventions were performed in 1-hour sessions, twice per week over a 10-week period. Participants underwent balance, gait, cognitive function, and structural magnetic resonance imaging assessments before and after the interventions. Voxel-based morphometry was analyzed in 34 HiBalance and 31 active controls. Additionally, structural covariance networks were assessed.
There was no significant time by group interaction between the HiBalance and control training in balance, gait, or brain volume. Within-HiBalance-group analyses showed higher left putamen volumes post-training. In repeated measures correlation a positive linear, non-significant relationship between gait speed and putamen volume was revealed. In the HiBalance group we found community structure changes and stronger thalamic-cerebellar connectivity in structural covariance networks. Neither brain volume changes nor topology changes were found for the active controls after the training.
Thus, subtle structural brain changes occur after balance and gait training. Future studies need to determine whether training modifications or other assessment methods lead to stronger effects.
帕金森病（PD）的特征是运动功能障碍和大脑改变，对平衡、步态和认知能力产生不利影响。强化体育锻炼可以引起神经系统的变化，可能抵消 PD 中的神经退行性变并改善临床症状。
本随机对照试验研究了一项高挑战性、认知要求高的平衡和步态训练（HiBalance）方案对 PD 患者大脑结构的影响。
95 名参与者被分配到 HiBalance 或积极对照组的言语训练方案。基于小组的干预措施在 10 周的时间内，每周进行两次，每次 1 小时。参与者在干预前后接受平衡、步态、认知功能和结构磁共振成像评估。在 34 名 HiBalance 和 31 名积极对照组中进行基于体素的形态测量学分析。此外，还评估了结构协变网络。
HiBalance 和对照组训练在平衡、步态或大脑体积方面没有显著的时间与组间交互作用。HiBalance 组内分析显示，左壳核体积在训练后增加。在重复测量相关分析中，步态速度和壳核体积之间存在正线性但无统计学意义的关系。在 HiBalance 组中，我们发现结构协变网络中的社区结构变化和更强的丘脑-小脑连接。在训练后，积极对照组没有发现大脑体积变化或拓扑变化。
因此，平衡和步态训练后会出现细微的大脑结构变化。未来的研究需要确定训练的改变或其他评估方法是否会导致更强的效果。
