Elsevier

Gait & Posture

Volume 39, Issue 1, January 2014, Pages 648-651
Gait & Posture

Short communication
Effects of two different exercise programs on gait parameters in individuals with Parkinson's disease: A pilot study

https://doi.org/10.1016/j.gaitpost.2013.08.019Get rights and content

Highlights

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    Land and water plus land based exercises have similar effects on gait parameters.

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    Both exercise programs improved stride length and single/double support time.

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    Biomechanical analysis is not essential for testing the exercise effect on the gait.

Abstract

To date, little attempt has been made to compare or evaluate the effects of different physical exercise programs on gait disorders in people with Parkinson's disease (PD). This pilot study is aimed at obtaining preliminary data of the effects of two different exercise programs on gait parameters in people with PD by means of a biomechanical three-dimensional motion analysis. Twenty-five individuals with idiopathic PD participated either in a land-based (LB) or in a LB plus water-based (LWB) exercise program for 16 weeks. The efficacy of both exercise programs was quantified by means of a biomechanical gait analysis from which spatiotemporal and sagittal plane kinetic (gait speed, stride length, cadence, stride time, simple support time, double support time) and kinematic (angles of the hip, knee, and ankle joints) variables were recorded. Once the intervention ended, significant changes were observed in stride length and single/double support time variables in all the patients. The intergroup analysis revealed the existence of significant differences only in the gait Speed and hip Angle parameters. Few significant improvements in the amplitude of lower limb joints were found. These results suggest that land-based and land-plus-water-based exercise programs can be considered as a useful physical rehabilitation alternative, both equally capable of improving gait impairment on Parkinson's disease.

Introduction

Physical exercise is a useful therapy to manage gait disorders in advanced Parkinson's disease (PD) [1], [2]. Nevertheless, there is a need for research which compare and assess the effects of different exercise programs and which include a biomechanical examination of gait parameters. Indeed, although gait analysis is an important and valid tool for evaluating and quantifying the improvements in PD patients after a motor rehabilitation program [3], few studies of this kind have included the aforementioned methodology. Furthermore, biomechanical data obtained from this type of research are generally limited to spatiotemporal gait parameters and do not usually include kinematic data related to angular parameters, especially joint angle curves, which provide relevant information in PD [4]. For instance, Vivas et al. [5] compared the effects of a water-based vs. a land-based exercise program on gait impairment in PD patients. However, sample size was limited and they did not use a biomechanical analysis to assess those variables. In this line, a recently published study, which included a proper biomechanical evaluation, has found that water-based exercise seems to have positive effects on gait kinematic parameters in patients with PD [6]. However, the small sample size and the absence of a different exercise program which would enable a comparative analysis proved the need for a more comprehensive study.

Under these circumstances, this preliminary study aims to analyze and compare the effects of two different exercise programs on gait parameters in PD patients by means of a three-dimensional biomechanical analysis.

Section snippets

Participants

Patients with PD were recruited through personal letters from the Bueu-Galicia Parkinson Association, using the following inclusion criteria: stages 1 through 3 on the Hoehn and Yahr Staging Scale [7] and a stable reaction to anti-Parkinson medication, which remained consistent throughout the testing and intervention protocol.

Persons with PD who were not able to ambulate independently or presented any comorbidities other than PD or any acute illness that would make training inappropriate were

Results

Twenty-five participants volunteered and completed the intervention after attending over 80% of the sessions (Table 1). After the intervention, significant changes were observed in stride length and single/double support time variables in all the patients, whereas only those in the LB group improved their gait speed significantly. The intergroup analysis revealed the existence of significant differences only in the gait speed and hip angle parameters (60–70%) (Table 2).

The angle values of PD

Discussion

Both programs had positive effects on stride length, which is the main parameter that is reduced in PD [10]. This reduction may be caused by complex disease related factors, including reduced muscle power, which seems to positively correlate to gait velocity in old persons [11]. Therefore, the aforementioned results could be due to the fact that the patients experienced an improvement in their lower limbs strength level, as it has been previously observed [12]. This increase in potential

Conclusion

Land-based exercise is useful for improving gait impairment in Parkinson's disease. Adding water-based exercise sessions to this kind of therapy does not have any additional value. The biomechanical analysis does not provide more information to this type of studies than other more simple field-based tests.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

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