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 Opportunities: Scholarships in Brazil - Post-Doctoral
• Start date: October 01, 2016
• End date: November 30, 2020
• Field of knowledge: Health Sciences - Physical Education
• Principal Investigator: Carlos Ugrinowitsch
• Grantee: Carla da Silva Batista
• Host 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

Abstract

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

(13)

(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)

RAMOS, GUILHERME SILVA; SILVA-BATISTA, CARLA; PALMA, BARTIRA PEREIRA; UGRINOWITSCH, CARLOS; DA CUNHA, TELMA FATIMA. Risk of falls using the Biodex Balance System in non-faller patients with Parkinson Disease. SOMATOSENSORY AND MOTOR RESEARCH, DEC 2021. (16/13115-9, 13/04970-4)

LIRA, JUMES LEOPOLDINO OLIVEIRA; UGRINOWITSCH, CARLOS; COELHO, DANIEL BOARI; TEIXEIRA, LUIS AUGUSTO; DE LIMA-PARDINI, ANDREA CRISTINA; MAGALHAES, FERNANDO HENRIQUE; BARBOSA, EGBERTO REIS; HORAK, FAY B.; SILVA-BATISTA, CARLA. Reply from Jumes Leopoldino Oliveira Lira, Carlos Ugrinowitsch, Daniel Boari Coelho, Luis Augusto Teixeira, Andrea Cristina de Lima-Pardini, Fernando Henrique Magalhaes, Egberto Reis Barbosa, Fay B. Horak, and Carla Silva-Batista RESPONSE. JOURNAL OF PHYSIOLOGY-LONDON, v. 600, n. 2, DEC 2021. (15/13096-1, 18/16909-1, 16/13115-9)

MOREIRA-NETO, ACACIO; MARTINS, BRUCE; MILIATTO, ANGELO; NUCCI, MARIANA PENTEADO; SILVA-BATISTA, CARLA. Can remotely supervised exercise positively affect self-reported depressive symptoms and physical activity levels during social distancing?. PSYCHIATRY RESEARCH, v. 301, JUL 2021. (16/13115-9)

SILVA-BATISTA, CARLA; DE LIMA-PARDINI, ANDREA CRISTINA; NUCCI, MARIANA PENTEADO; COELHO, DANIEL BOARI; BATISTA, ALANA; PIMENTEL PIEMONTE, MARIA ELISA; BARBOSA, EGBERTO REIS; TEIXEIRA, LUIS AUGUSTO; CORCOS, DANIEL M.; AMARO JR, EDSON; et al. A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait. MOVEMENT DISORDERS, v. 35, n. 9, p. 11-pg., 2020-06-18. (16/13115-9, 18/16909-1)

VIEIRA-YANO, BIANCA; MARTINI, DOUGLAS N.; HORAK, FAY B.; DE LIMA-PARDINI, ANDREA; ALMEIDA, FILIPE; SANTANA, VAGNER P.; LIMA, DANIEL; BATISTA, ALANA X.; MARQUESINI, RAQUEL; LIRA, JUMES; et al. The Adapted Resistance Training with Instability Randomized Controlled Trial for Gait Automaticity. MOVEMENT DISORDERS, v. 36, n. 1, p. 152-163, JAN 2021. (18/16909-1, 16/13115-9)

MOREIRA-NETO, ACACIO; UGRINOWITSCH, CARLOS; COELHO, DANIEL BOARI; DE LIMA-PARDINI, ANDREA CRISTINA; BARBOSA, EGBERTO REIS; TEIXEIRA, LUIS AUGUSTO; AMARO JR, EDSON; HORAK, FAY B.; MANCINI, MARTINA; NUCCI, MARIANA PENTEADO; et al. Freezing of gait, gait initiation, and gait automaticity share a similar neural substrate in Parkinson's disease. HUMAN MOVEMENT SCIENCE, v. 86, p. 11-pg., 2022-11-02. (16/13115-9, 18/16909-1)

SANTOS FILHO, SOLIVAL; COELHO, DANIEL BOARI; UGRINOWITSCH, CARLOS; DE SOUZA, CAROLINE RIBEIRO; MAGALHAES, FERNANDO HENRIQUE; DE LIMA-PARDINI, ANDREA CRISTINA; BRAGA DE OLIVEIRA, EDEN MARCOS; MATTOS, EUGENIA; TEIXEIRA, LUIS AUGUSTO; SILVA-BATISTA, CARLA. Age-Related Changes in Presynaptic Inhibition During Gait Initiation. JOURNALS OF GERONTOLOGY SERIES A-BIOLOGICAL SCIENCES AND MEDICAL SCIENCES, v. 76, n. 4, p. 8-pg., 2021-01-11. (16/13115-9)

SILVA-BATISTA, CARLA; DE LIMA-PARDINI, ANDREA CRISTINA; NUCCI, MARIANA PENTEADO; COELHO, DANIEL BOARI; BATISTA, ALANA; PIMENTEL PIEMONTE, MARIA ELISA; BARBOSA, EGBERTO REIS; TEIXEIRA, LUIS AUGUSTO; CORCOS, DANIEL M.; AMARO JR, EDSON; et al. A Randomized, Controlled Trial of Exercise for Parkinsonian Individuals With Freezing of Gait. MOVEMENT DISORDERS, JUN 2020. (18/16909-1, 16/13115-9)

LIRA, JUMES LEOPOLDINO OLIVEIRA; UGRINOWITSCH, CARLOS; COELHO, DANIEL BOARI; TEIXEIRA, LUIS AUGUSTO; DE LIMA-PARDINI, ANDREA CRISTINA; MAGALHAES, FERNANDO HENRIQUE; BARBOSA, EGBERTO REIS; HORAK, FAY B.; SILVA-BATISTA, CARLA. Loss of presynaptic inhibition for step initiation in parkinsonian individuals with freezing of gait. JOURNAL OF PHYSIOLOGY-LONDON, v. 598, n. 8, p. 1611-1624, APR 2020. (18/16909-1, 15/13096-1, 16/13115-9)

COELHO, DANIEL BOARI; DE SOUZA, CAROLINE RIBEIRO; DE LIMA-PARDINI, ANDREA CRISTINA; TREZA, RENATA DE CASTRO; FUJIOKA SHIDA, THIAGO KENZO; SILVA-BATISTA, CARLA; TEIXEIRA, LUIS AUGUSTO. Is freezing of gait correlated with postural control in patients with moderate-to-severe Parkinson's disease?. European Journal of Neuroscience, v. 53, n. 4, NOV 2020. (18/16909-1, 16/13115-9)

DE OLIVEIRA LIRA, JUMES LEOPOLDINO; UGRINOWITSCH, CARLOS; FECCHIO, RAFAEL; COELHO, DANIEL BOARI; MOREIRA-NETO, ACACIO; GERMANO, RENAN; DE LIMA MILIATTO, ANGELO CORREA; DOS SANTOS VIEIRA YANO, BIANCA CRISTINA; SILVA-BATISTA, CARLA. Minimal Detectable Change for Balance Using the Biodex Balance System in Patients with Parkinson Disease. PM&R, v. 12, n. 3, p. 281-287, MAR 2020. (13/04970-4, 16/13115-9)

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. (18/16909-1, 16/13115-9)

DE ALMEIDA, FILIPE OLIVEIRA; UGRINOWITSCH, CARLOS; BRITO, LEANDRO C.; MILLIATO, ANGELO; MARQUESINI, RAQUEL; MOREIRA-NETO, ACACIO; BARBOSA, EGBERTO REIS; HORAK, FAY B.; MANCINI, MARTINA; SILVA-BATISTA, CARLA. Poor sleep quality is associated with cognitive, mobility, and anxiety disability that underlie freezing of gait in Parkinson's disease. GAIT & POSTURE, v. 85, p. 7-pg., 2021-02-09. (13/04970-4, 16/13115-9, 18/16909-1)