Chinese Exercise Modalites in Parkinson's Disease

本项目的长期目标是研究不同运动方式对帕金森病（PD）的影响。 PD是一种主要残疾源于运动功能障碍（包括平衡）的疾病。 最近的研究表明，老年人跌倒的风险可以通过中国CAM的做法，如太极拳（TCC）减少。 这一发现可能对PD具有重要意义。尽管Emory最近的一份报告表明PD患者可以很好地进行有氧（步行-跑步）运动训练（AET），但仍不清楚此类方式的潜在抗帕金森病作用是否继发于改善体能（CRF）、运动控制或两者兼而有之。 CAM干预措施，如TCC可能提供独特的机会来研究这些基本问题。在PD中，我们假设运动训练将减少原发性和继发性残疾，其中一些变化代表了中枢运动通路的重新编程。 我们将进行一项对照、双盲、为期16周的运动剂量反应研究，研究的基础是热量消耗，从而研究运动对心肺功能的影响（CRF）。 治疗将是气功（最低热量消耗）。 TCC（低支出）和步行循环AET（中等支出）。我们将使用运动残疾的定量测量方法（包括动态步态和稳定性测量）来检查运动引起的运动控制变化。 我们还将研究运动对帕金森病运动障碍的中枢和外周指标的影响。运动的热量“剂量反应”效应表明CRF是运动抗帕金森病作用的主要决定因素。然而，如果中国模式与AET一样有效或上级，这将表明其他机制，如中枢运动程序的改变可能发挥作用（例如，放松效应，中枢运动程序的加强？）。 更好地了解运动诱导的神经可塑性和运动控制将提供一个显着的，迄今尚未开发的PD康复潜力。

The long-term goal of this project is to study the effects of different exercise modalities on Parkinson's disease (PD). PD is a disorder whose primary disability stems from motor dysfunction including balance. Recent studies have shown that the risk of falling in the elderly can be reduced through the practice of the Chinese CAMs such as T' ai Chi Chuan (TCC). This finding may be highly significant to PD. Although a recent report from Emory suggests PD patients can do well with aerobic (walk-run) exercise training (AET), it is still unclear whether the potential anti- parkinsonian effect of such modalities is secondary to improved physical fitness (CRF), motor control or both. CAM interventions such as TCC may offer unique opportunity to examine these fundamental questions. In PD we hypothesize that exercise training will reduce primary and secondary disability and that some of these changes represent reprogramming of central motor pathways. We will conduct a controlle, double-blind 16-week dose-response study of exercise based on caloric expenditure and thus on the cardiorespiratory fitness effects of exercise (CRF). The treatments will be Qi Gong (minimal caloric expenditure). TCC (low expenditure), and a walk-cycle AET (moderate expenditure). We will examine exercise-induced change in motor control using quantitative measures of motor disability, including dynamic gait and stability measures. We will also examine exercise effects on central and peripheral indices of parkinsonian motor disability. A caloric "dose-response" effect of exercise would suggest CRF is a major determinant of the antiparkinsonian effects of exercise. If the Chinese modalities are as effective or superior to AET, however, this would suggest that other mechanism such as change in central motor programming may by playing a role (e.g, relaxation effects, reinforcement of central motor programs?). A better understanding of exercise-induced neural plasticity and motor control would offer a significant, and heretofore unexploited rehabilitative potential in PD.