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Effects of resistance training with instability on clinical outcomes, spinal mechanisms, and brain metrics in individuals with freezing of gait in Parkinson's Disease

Grant number: 16/13115-9
Support type:Scholarships in Brazil - Post-Doctorate
Effective date (Start): October 01, 2016
Field of knowledge:Health Sciences - Physical Education
Principal Investigator:Carlos Ugrinowitsch
Grantee:Carla da Silva Batista
Home Institution: Escola de Educação Física e Esporte (EEFE). Universidade de São Paulo (USP). São Paulo , SP, Brazil
Associated scholarship(s):18/16909-1 - Effects of resistance training with instability on clinical outcomes, spinal mechanisms, and brain metrics in individuals with freezing of gait in Parkinson's disease, BE.EP.PD


Freezing of gait (FOG) in Parkinson's disease (PD) affects approximately 26% of individuals with moderate PD and 80% of individuals with severe PD, and it is one of the most common causes of falls, dependency, and poor quality of life. FOG is because of impaired coupling between postural and locomotor components that result in reduced connectivity in frontal motor regions, prefrontal cortices, and subcortical areas. Moreover, deficits in spinal control and cognitive dysfunction seem to contribute to FOG. Thus, studies should investigate the effects of powerful innovative therapeutic interventions on central, spinal and cognitive outcomes, as pharmacological, surgical and therapeutic interventions (e.g., use of external cues) do not seem to effectively decrease FOG episodes. Therefore, the objective of this randomized controlled trial will be to examine the effects of 12 weeks of resistance training with instability (RTI) on clinical outcomes, spinal mechanisms, and cerebral metrics of individuals with FOG between stages 3 and 4 of the PD. Thirty individuals (will be tested and trained in the "on" medication state) that meet the inclusion criteria will be randomized into two groups: non-exercising control group (CG) and RTI group (RTIG). Both groups will go twice a week on non-consecutive days to the exercise facility. While the CG will attend lectures on disease education, RTIG will perform only exercises with high motor complexity (i.e., five progressive resistance exercises concomitantly with progressive unstable devices). The following outcomes will be assessed before and after the intervention: 1) Clinical - frequency and duration of FOG - vertical acceleration of the lower limb (primary outcome), gait parameters - cadence, speed, toe clearance, stride length and gait variability, severity of FOG - scores of the New Freezing of Gait Questionnaire [NFOG-Q] and of the Unified Parkinson's Disease Rating Scale part 14 [UPDRS-14], amplitude and time of anticipatory postural adjustments during a step initiation task while standing on the force platform, attention and processing speed (score Digit Symbol Substitution Test), executive function (Trail Making Test score), and quality of life (score of Questionnaire Parkinson's disease [PDQ-39]); 2) Spinal Mechanisms - presynaptic and reciprocal inhibitions during a task of step initiating while standing on the force platform; 3) Brain Metrics - the BOLD (Blood Oxygenation Level Dependent) signal intensity and functional connectivity of cortical and subcortical areas during a leg lifting task, which simulates a step, as assessed by functional magnetic resonance imaging. Appropriate statistical analysis will be conducted to verify the effect of RTI on clinical outcomes, spinal mechanism, and brain metrics after 12 weeks.

Scientific publications
(References retrieved automatically from Web of Science and SciELO through information on FAPESP grants and their corresponding numbers as mentioned in the publications by the authors)
SILVA-BATISTA, CARLA; DE OLIVEIRA LIRA, JUMES LEOPOLDINO; DAVID, FABIAN J.; CORCOS, DANIEL M.; TAVARES MATTOS, EUGENIA CASELLA; COELHO, DANIEL BOARI; DE LIMA-PARDINI, ANDREA C.; TORRIANI-PASIN, CAMILA; DE FREITAS, TATIANA BELINE; UGRINOWITSCH, CARLOS. Short-term resistance training with instability reduces impairment in V wave and H reflex in individuals with Parkinson's disease. Journal of Applied Physiology, v. 127, n. 1, p. 89-97, JUL 2019. Web of Science Citations: 0.

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