Effects of strength training and strength training with instability on the symptoms, functionality, neuromuscular adaptations, and the quality of life of patients with parkinson\'s disease: a randomized controlled trial

Author(s)

Carla da Silva Batista

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Escola de Educação Física e Esportes (EEFE/BT)
• Defense date: 2016-03-10

Examining board members

Carlos Ugrinowitsch; Vanderci Borges; Cláudia Lúcia de Moraes Forjaz; Lilian Teresa Bucken Gobbi; Valmor Alberto Augusto Tricoli

• Advisor: Carlos Ugrinowitsch

Abstract

The aim of this study was to analyze and to compare the effects of 12 weeks of strength training (ST) with strength training with instability (STI) on clinical outcomes, muscle-force-production capacity, spinal inhibitory mechanisms and the total training volume (TTV) of individuals between stages 2 and 3 of Parkinson\'s disease (PD). For this, 39 individuals (assessed and trained in the clinically defined \"on\" state) met the inclusion criteria and were randomized into three groups: non-exercising control group (CG), ST group (STG) and STI group (STIG). The STG and STIG performed 12 weeks hypertrophy-oriented ST, twice a week, on non-consecutive days. Only STIG added unstable devices (e.g., BOSU®) to ST that progressed from the less to the more unstable devices. Before and after 12 weeks were assessed the following outcomes: a) clinical - mobility (primary outcome), motor symptoms, cognitive impairment, fear of falling, balance, dual-task gait performance (distance, cadence, and, velocity), and quality of life; b) muscle-force-production capacity - root mean square (RMS), mean spike frequency (MSF), and electromechanical delay (EMD) of the vastus lateralis, vastus medialis, and gastrocnemius medialis; peak torque, rate of torque development (RTD) and half-relaxation time (HRT) of the knee-extensors and plantar flexors; one repetition maximum (1-RM) of the lower limbs and quadriceps cross sectional area (QCSA) and; c) spinal inhibitory mechanisms - presynaptic inhibition and reciprocal inhibition of the soleus muscle. The TTV for each lower limb exercise (half-squat, plantar flexion, and leg-press) was determined during the experimental protocol. From pre- to post-training, only the STIG improved all of the clinical outcomes (P <0.05), the muscle-force-production capacity outcomes (P <0.05) with exception of the HRT of the knee-extensors (P = 0.068) and, improved the spinal inhibitory mechanisms outcomes (P <0.05). There were differences between the STIG and the CG for the following outcomes: mobility, cognitive impairment, balance, dual-task gait performance (distance, cadence, and speed), RMS all of the muscles assessed, MSF of the gastrocnemius medialis, peak torque and RTD of the plantar flexor, peak torque of the knee-extensors, 1RM of the lower limbs, presynaptic inhibition, and reciprocal inhibition at post-training (P <0.05). Moreover, the STIG showed better values than the STG for the following outcomes: dual-task gait performance (distance and speed), RMS of the vastus medialis, MSF of the gastrocnemius medialis, RTD of the plantar flexors, presynaptic inhibition, and reciprocal inhibition at post-training (P <0.05). The STIG showed a lower TTV than the STG (P <0.05). Finally, no adverse effects were observed. In conclusion, only the STIG improved all of the clinical outcomes and it was more effective than the STG to promote neuromuscular adaptations even the STIG has had a lower TTV than the STG. Thus, STI is recommended as a novel therapeutic intervention to minimize declines in mobility and in a wide spectrum of impairments without causing adverse effects in individuals with PD (AU)

• FAPESP's process: 13/04970-4 - Influence of functional and strength training on neuromuscular adaptations, functionality and quality of life in elderly with Parkinson's Disease
• Grantee: Carla da Silva Batista
• Support Opportunities: Scholarships in Brazil - Doctorate (Direct)