Evidence for Differential Effects of 2 Forms of Exercise on Prefrontal Plasticity During Walking in Parkinson's Disease
Evidence for Differential Effects of 2 Forms of Exercise on Prefrontal Plasticity During Walking in Parkinson's Disease
复制标题
DOI：
10.1177/1545968318763750
复制
发表时间：
2018-03-01
影响因子：
4.2
通讯作者：
Mirelman, Anat
中科院分区：
文献类型：
--
作者：
Maidan, Inbal;Nieuwhof, Freek;Mirelman, Anat
背景资料。在对帕金森氏症患者进行的一项随机对照试验中，与单独进行跑步机训练相比，针对安全行走的运动和认知方面的跑步机训练计划与虚拟现实相结合，导致摔倒的次数更少。目标。调查两种类型的训练是否对前额叶激活有不同的影响，以及这是否可能解释干预后跌倒发生率的差异。方法：研究方法。将64例帕金森病患者随机分为跑台训练组(34例，平均年龄73.1±1.1岁，男性%，病程9.7±1.0年)和平板训练加虚拟现实组(30例，平均年龄70.1±1.3岁，71%男性，病程8.9±1.1年)。在训练前和训练后6周，使用功能性近红外光谱系统评估正常、双重任务和越障行走过程中的前额叶激活情况。结果。使用和不使用虚拟现实的跑步机训练减少了行走过程中的前额叶激活(P<；.001)，与训练手臂(P=.01)、偏侧(P=.05)和行走条件(P=.001)有关的特定交互作用。例如，在单独进行跑步机训练的受试者中，双任务行走和越障时的前额叶激活在训练后增加，而在联合训练组中，激活减少。结论。在平时和更具挑战性的步行条件下，前额叶的激活可以根据两种不同类型的训练而改变。在跑步机运动计划中加入认知训练部分，显然可以改变训练对前额叶激活和跌倒的幅度和侧化的影响，扩大对帕金森病患者大脑可塑性的理解。
Background. In a randomized control trial conducted in patients with Parkinson's disease, a treadmill training program combined with virtual reality that targeted motor and cognitive aspects of safe ambulation led to fewer falls, compared with treadmill training alone. Objective. To investigate if the 2 types of training differentially affected prefrontal activation and if this might explain differences in fall rates after the intervention. Methods. Sixty-four patients with Parkinson's disease were randomized into the treadmill training arm (n = 34, mean age 73.1 +/- 1.1 years, 64% men, disease duration 9.7 +/- 1.0 years) or treadmill training with virtual reality arm (n = 30, mean age 70.1 +/- 1.3 years, 71% men, disease duration 8.9 +/- 1.1 years). Prefrontal activation during usual, dual-task, and obstacle negotiation walking was assessed before and after 6 weeks of training, using a functional near-infrared spectroscopy system. Results. Treadmill training with and without virtual reality reduced prefrontal activation during walking (P < .001), with specific interactions related to training arm (P = .01), lateralization (P = .05), and walking condition (P = .001). For example, among the subjects who trained with treadmill training alone, prefrontal activation during dual-task walking and obstacle negotiation increased after training, while in the combined training arm, activation decreased. Conclusions. Prefrontal activation during usual and during more challenging walking conditions can be altered in response to 2 different types of training. The addition of a cognitive training component to a treadmill exercise program apparently modifies the effects of the training on the magnitude and lateralization of prefrontal activation and on falls, extending the understanding of the plasticity of the brain in PD.