Hi All!!
I received 14 responses to my original message asking about interest in the
results of my dissertation. I am including an abstract of the results plus a
training protocol. If you check past PARINSN list messages you may find I
have written quite a bit about the benefits of exercise for PD. This is the
abstract which can also be found on Dissertation Abstracts International
(DAI) once it gets microfiched, ok??
The dissertation is 200+ pages long so you will forgive me if I do not send
it all here...It's got alot of technical stuff which may/may not be of much
interest to anyone (ever again). No, seriously, here is the abstract.... I
am probably going to accept a postdoc position at Johns Hopkins University
(If they offer it to me in the next few days) in the department of Physical
Medicine and Rehabilitation. I will continue to work with PD and exercise
interventions but will now look at something a little different.
I would be delighted to answer questions...or respond to comments.
Mark
Abstract:
Activity-Dependent Enhancement of Balancein Persons with Parkinson's Disease
Following Strength and Balance Training.
A growing body of evidence points toward an increase in falls and fall
related injuries in persons with Parkinson's disease (PD). The role of high
intensity lower extremity strength training and balance training in the
reduction of falls for this population has not been thoroughly investigated
through controlled studies. The primary purpose of this study was (1) to
present to what extent falls could be reduced by strength and/or balance
training, (2) to present to what extent balance scores could improve, and
(3) to present to what extent daily activities (Activities of Daily Living)
were affected by the intervention. Sixteen persons (M age 72) with stage
I-III PD were randomized into one of two groups; one receiving strength and
balance training (Combined), the other receiving balance training only
(Balance). Balance was tested using the EquiTest, a dynamic posturography
device which measures posture sway under six sensory conditions. Subjects
were pre-tested, post-tested following 10 weeks of training, and tested
again after a one month follow up, during which time no training was
permitted. Data were analyzed using repeated measures MANOVA. Both groups
reduced the number of falls from pre to post-test. The Combined group
attained significant improvements in strength. There were no significant
changes in EquiTest equilibrium scores. Clinical improvements were noted
during sway-referenced support conditions, with eyes open, eyes closed and
vision sway-referenced. Falls were reduced from pre to posttest for both
groups and from post to followup test for the Combined group. The Combined
group maintained their falls reduction throughout the follow-up period,
while the Balance groups falls frequency returned to baseline. ADL were
unaffected by the intervention. This suggests that there may be a long term
training effect on falls reduction caused by a greater reliance on muscle
strength than on visual, vestibular or proprioceptive mechanisms, which is
not reflected in EquiTest equilibrium sway scores. Improvements in muscular
strength, balance and functional ability attributed to the intervention
support the importance of regular strength and balance training in the
prevention of fall-related injury for persons with Parkinson's disease.
Training Protocol:
TREATMENT
Warm up on exercise bike 5 minutes
Cool down on exercise bike 5 minutes
Strength Training
3 X per week for the Quads, Hamstrings, gastrocnemius and tibialis anterior
(shin muscles) at 80% of a 4 repetition Maximum using Nautilus Machines.
Other machines are fine too.
Balance Training 3 X per week.....each exercise is done 5 times for 20
seconds.
Firm Support, Eyes Open, Neck Neutral.
Firm Support, Eyes Closed, Neck Neutral.
Firm Support, Eyes Open, Neck Extended (look up at ceiling).
Firm Support, Eyes Closed, Neck Extended.
Foam Support (standing on a piece (or 2) of medium density foam, can be
purchased at a fabric store...cheap), Eyes Open, Neck Neutral.
Foam Support, Eyes Closed, Neck Neutral.
Foam Support, Eyes Open, Neck Extended.
Foam Support, Eyes Closed, Neck Extend.
Perturbation Exercises (getting pushed...gently from front and from
behind, pushed hard enough so that it is a challenge, use an ankle strategy
to control balance, i.e., control sway with ankle muscles, not with hips)
5 X Sternal Firm Eyes Open
5 X Dorsal Firm Eyes Closed
5 X Sternal Firm Eyes Open
5 X Dorsal Firm Eyes Closed
5 X Sternal Foam Eyes Open
5 X Dorsal Foam Eyes Closed
5 X Sternal Foam Eyes Open
5 X Dorsal Foam Eyes Closed
Limit of Stability Exercises (leaning forward, back, left, right, using
ankles, not hips, holding each position for 5 seconds)
Mark Alexander Hirsch, Ph.D.
1169 Brafforton Way
Tallahassee, Florida 32311
email: [log in to unmask]
If everyone is thinking alike, then someone is not thinking.--General George
Patton
