Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson's Disease Patients
Forced, Not Voluntary, Exercise Improves Motor Function in Parkinson's Disease Patients
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DOI：
10.1177/1545968308328726
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发表时间：
2009-07-01
影响因子：
4.2
通讯作者：
Alberts, Jay L.
中科院分区：
文献类型：
--
作者：
Ridgel, Angela L.;Vitek, Jerrold L.;Alberts, Jay L.
背景。动物研究表明，强迫运动（FE）改善帕金森啮齿动物的整体运动功能。在人类帕金森病（PD）患者中，自愿运动（VE）后运动功能的全面改善尚未得到广泛报道。目标。本研究的目的是比较VE和FE对PD症状、运动功能和双手灵活性的影响。方法。10例轻度至中度PD患者被随机分配完成8周的FE或VE。在教练的帮助下，FE组的患者蹬车速度比他们喜欢的自愿蹬车速度高出30%，而VE组的患者蹬车速度则是他们喜欢的。两组的有氧运动强度相同，都是他们个性化训练心率的60%到80%。结果。两组的有氧适能都有所改善。在FE之后，统一帕金森病评定量表（UPDRS）运动评分提高了35%，而完成VE的患者没有表现出任何改善。在功能性双手灵巧任务中，FE组患者对抓握力的控制和协调有显著改善，而VE组患者的运动表现没有变化。僵硬和运动迟缓的临床指标以及双手灵巧的生物力学指标在FE停止后维持4周。结论。VE和FE干预均可改善PD患者的有氧适能。然而，只有FE能显著改善运动功能和双手灵活性。生物力学数据表明，FE导致了运动控制策略的转变，从反馈到更大程度上依赖前馈过程，这表明FE可能正在改变中央运动控制过程。
Background. Animal studies indicate forced exercise (FE) improves overall motor function in Parkinsonian rodents. Global improvements in motor function following voluntary exercise (VE) are not widely reported in human Parkinson's disease (PD) patients. Objective. The aim of this study was to compare the effects of VE and FE on PD symptoms, motor function, and bimanual dexterity. Methods. Ten patients with mild to moderate PD were randomly assigned to complete 8 weeks of FE or VE. With the assistance of a trainer, patients in the FE group pedaled at a rate 30% greater than their preferred voluntary rate, whereas patients in the VE group pedaled at their preferred rate. Aerobic intensity for both groups was identical, 60% to 80% of their individualized training heart rate. Results. Aerobic fitness improved for both groups. Following FE, Unified Parkinson's Disease Rating Scale (UPDRS) motor scores improved 35%, whereas patients completing VE did not exhibit any improvement. The control and coordination of grasping forces during the performance of a functional bimanual dexterity task improved significantly for patients in the FE group, whereas no changes in motor performance were observed following VE. Improvements in clinical measures of rigidity and bradykinesia and biomechanical measures of bimanual dexterity were maintained 4 weeks after FE cessation. Conclusions. Aerobic fitness can be improved in PD patients following both VE and FE interventions. However, only FE results in significant improvements in motor function and bimanual dexterity. Biomechanical data indicate that FE leads to a shift in motor control strategy, from feedback to a greater reliance on feedforward processes, which suggests FE may be altering central motor control processes.