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Treadmill training with body weight support: Its effect on Parkinson's disease,☆☆,,★★

A preliminary version of this study was presented at the 51st annual meeting of the American Academy of Neurology, April 20, 1999, Toronto, Canada.
https://doi.org/10.1053/apmr.2000.4439Get rights and content

Abstract

Miyai I, Fujimoto Y, Ueda Y, Yamamoto H, Nozaki S, Saito T, Kang J. Treadmill training with body weight support: its effect on Parkinson's disease. Arch Phys Med Rehabil 2000;81:849-52. Objective: To test whether body weight–supported treadmill training (BWSTT) is effective in improving functional outcome of patients with Parkinson's disease. Design: Prospective crossover trial. Patients were randomized to receive either a 4-week program of BWSTT with up to 20% of their body weight supported followed by 4 weeks of conventional physical therapy (PT), or the same treatments in the opposite order. Medications for parkinsonism were not modified throughout the study. Setting: Inpatient rehabilitation unit for neurologic diseases. Subjects: Ten patients (5 men, 5 women) with Hoehn and Yahr stage 2.5 or 3 parkinsonism; mean age 67.6 years, mean duration of Parkinson's disease 4.2 years. Main Outcome Measures: The Unified Parkinson's Disease Rating Scale (UPDRS), ambulation endurance and speed (sec/10m), and number of steps for 10-meter walk. Results: The mean total UPDRS before/after BWSTT was 31.6/25.6, and before/after PT was 29.1/28.0. Analysis of covariance for improvement of UPDRS demonstrated a significant effect of type of therapy (F(1, 16) = 42.779, p <.0001) but not order of therapy (F(1, 16) = 0.157, p =.6971). Patients also had significantly greater improvement with BWSTT than with PT in ambulation speed (BWSTT, before/after = 10.0/8.3; PT, 9.5/8.9), and number of steps (BWSTT, 22.3/19.6; PT, 21.5/20.8). Conclusions: In persons with Parkinson's disease, treadmill training with body weight support produces greater improvement in activities of daily living, motor performance, and ambulation than does physical therapy. © 2000 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

Section snippets

Methods

Ten patients (5 men, 5 women) with Hoehn and Yahr stage 2.5 or 3 parkinsonism13 who were not demented (Mini-Mental Status Examination score greater than 2714) were enrolled in this study, which was approved by the local ethics committee. Demographic data are shown in table 1.

Table 1: Subjects' clinical characteristics

Empty CellEmpty CellRange
Sex (male/female)5/5
Age (yrs)67.6 ± 1.656-79
Hoehn and Yahr stage (2.5/3)3/7
Duration of PD (yrs)4.2 ± 0.73-11
MMSE score28.5 ± 0.327-30
Medications
 levodopa (mg)225.0 ± 80.3100-300

Results

All 10 patients completed the study. Total UPDRS scores before and after BWSTT were 31.6 ± 3.1 and 25.6 ± 2.9, respectively, and before and after PT were 29.1 ± 3.2 and 28.0 ± 3.2, respectively (table 2, fig 1).

. Changes of total Unified Parkinson's Disease Rating Scale scores (top) in the BWSTT group (n = 10) and (bottom) in the PT group (n = 10). Error bars are mean ± standard error of the mean.

ANCOVA for the improvement of UPDRS scores showed a significant main effect for type of therapy (F(1,

Discussion

The effectiveness of neuropharmacologic treatment of Parkinson's disease, using dopaminergic drugs, attenuates with prolonged drug intake.16 Exercise is thought to be an important adjunctive therapy for parkinsonism.17 It may be beneficial to establish specific rehabilitation strategies for patients with Parkinson's disease, since effective training might improve their long-term functional prognosis by minimizing incremental dosage increases.

Our study has shown that treadmill training with body

Conclusion

Treadmill training with body weight support is effective especially in patients with moderate gait difficulty whose gait speed is more than 8 seconds per 10 meters and whose number of steps was more than 15 per 10-meter walk. These patients stated that they felt more comfortable when they walked with their bodies lifted by the examiner holding their belts than without their bodies lifted. This simple bedside test might be a marker to predict the effectiveness of BWSTT for parkinsonism. It is

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    Supported by a fund for comprehensive research on aging and health from the Ministry of Health and Welfare, Japan.

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    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors or upon any organization with which the authors are associated.

    Reprint requests to Ichiro Miyai, MD, Department of Neurology, Toneyama National Hospital, 5-1-1, Toneyama, Toyonaka City, Osaka, 560-8552, Japan.

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