Physical Therapy for Parkinson’s Loses to Strength & Conditioning

Comparison of strength training, aerobic training, and additional physical therapy as supplementary treatments for Parkinson’s disease: pilot study. Carvalho A, Barbirato D, Araujo N, Martins JV, Cavalcanti JL, Santos TM, Coutinho ES, Laks J, Deslandes AC. Clin Interv Aging. 2015 Jan 7;10:183-91.

Abstract
INTRODUCTION:
Physical rehabilitation is commonly used in patients with Parkinson’s disease (PD) to improve their health and alleviate the symptoms.

OBJECTIVE:
We compared the effects of three programs, strength training (ST), aerobic training (AT), and physiotherapy, on motor symptoms, functional capacity, and electroencephalographic (EEG) activity in PD patients.

METHODS:
Twenty-two patients were recruited and randomized into three groups: AT (70% of maximum heart rate), ST (80% of one repetition maximum), and physiotherapy (in groups). Subjects participated in their respective interventions twice a week for 12 weeks. The assessments included measures of disease symptoms (Unified Parkinson’s Disease Rating Scale [UPDRS]), functional capacity (Senior Fitness Test), and EEG before and after 12 weeks of intervention.

RESULTS:
The PD motor symptoms (UPDRS-III) in the group of patients who performed ST and AT improved by 27.5% (effect size [ES]=1.25, confidence interval [CI]=-0.11, 2.25) and 35% (ES=1.34, CI=-0.16, 2.58), respectively, in contrast to the physiotherapy group, which showed a 2.9% improvement (ES=0.07, CI=-0.85, 0.99). Furthermore, the functional capacity of all three groups improved after the intervention. The mean frequency of the EEG analysis mainly showed the effect of the interventions on the groups (F=11.50, P=0.0001).

CONCLUSION:
ST and AT in patients with PD are associated with improved outcomes in disease symptoms and functional capacity.

KEYWORDS:
Parkinson’s disease; functional capacity; physical exercise; physical therapy; quality of life

My comments:

This was an interesting study confirming much what I would expect. Exercise principles of overload that work for increasing fitness in normal subjects work better than traditional “physical therapy” calisthenic type exercises.  So heel slides, straight leg raises, bridges, and mini-squats are about as useless as they appear to those of us with backgrounds in strength and conditioning. Supervision by a physical therapist in this study didn’t seem to help, which is evidence that intensity of effort, weights, treadmill speed, and incline are every bit as important as exercise technique. In short, effort/progression counts, and counts a lot and “physical therapy” exercises for Parkinson’s probably should include progressive harder aerobic treadmill training and progressive resistance exercise with weights.

The aerobic training program in this study was 30 minutes of treadmill walking at 70% of the max heart rate, with the speed and incline on the treadmill increased over time as fitness increased to maintain the required heart rate. The strength training group did just 2 sets of 12 reps on a number of isolation type exercise machines, that I think leaves a lot of room for improvement, but it still worked. Both the machine weight training and treadmill trounced the physical therapist led calisthenics, stretches, and gait training with regards to restoring motor function.

I’m sure I’m biased but I think if you have Parkinson’s disease and you enter a physical therapy clinic that has rows of massage tables, stretch bands, and balls instead of gym equipment you have probably made a mistake.  The good news is that exercise programs for Parkinson’s don’t have to be particularly complex and can often be maintained at fitness centers after formal physical therapy is over. The results of this study would also suggest that joining a gym after physical therapy treatment is over is the best idea, because calisthenic type home exercise programs likely won’t cut it. Last I think the main take home message for physical therapists is that they really don’t want to have their therapeutic exercise programs so weak as to be useless and those therapists backgrounds in yoga or Pilates really should be learning all they can about weight training and conditioning, maybe by getting their CSCS certification or joining a CrossFit gym.

As always, if you have any further questions or need for clarifications, please don’t hesitate to ask. Being aware that some of my blog ideas are contentious and occasionally a bit out of the field of my expertise, I encourage my readers to come forth with any questions/comments that are of interest or concern. Your comments are valued and welcomed.

Chad Reilly is a licensed physical therapist, located in North Phoenix, practicing science based medicine with treatment protocols unique and effective enough to proudly serve patients from Phoenix, Scottsdale, Mesa, Chandler, Tempe, Peoria, and Glendale.

 

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