Inbal Maidan1, Keren Rosenberg-Katz1, Yael Jacob1, Nir Giladi1, Jeffrey M Hausdorff1, Anat Mirelman2. 1. From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL. 2. From the Center for the Study of Movement, Cognition, and Mobility, Neurological Institute (I.M., K.R.-K., Y.J., N.G., J.M.H., A.M.), and Laboratory of Early Markers of Neurodegeneration (A.M.), Tel Aviv Sourasky Medical Center; Sagol School of Neuroscience (N.G., J.M.H., A.M.) and Departments of Neurology & Neurosurgery (N.G., A.M.) and Physical Therapy (J.M.H.), Sackler Faculty of Medicine, Tel Aviv University, Israel; and Rush Alzheimer's Disease Center and Department of Orthopaedic Surgery (J.M.H.), Rush University Medical Center, Chicago, IL. anatmi@tlvmc.gov.il.
Abstract
OBJECTIVE: To compare the effects of 2 forms of exercise, i.e., a 6-week trial of treadmill training with virtual reality (TT + VR) that targets motor and cognitive aspects of safe ambulation and a 6-week trial of treadmill training alone (TT), on brain activation in patients with Parkinson disease (PD). METHODS: As part of a randomized controlled trial, patients were randomly assigned to 6 weeks of TT (n = 17, mean age 71.5 ± 1.5 years, disease duration 11.6 ± 1.6 years; 70% men) or TT + VR (n = 17, mean age 71.2 ± 1.7 years, disease duration 7.9± 1.4 years; 65% men). A previously validated fMRI imagery paradigm assessed changes in neural activation pretraining and post-training. Participants imagined themselves walking in 2 virtual scenes projected in the fMRI: (1) a clear path and (2) a path with virtual obstacles. Whole brain and region of interest analyses were performed. RESULTS:Brain activation patterns were similar between training arms before the interventions. After training, participants in the TT + VR arm had lower activation than the TT arm in Brodmann area 10 and the inferior frontal gyrus (cluster level familywise error-corrected [FWEcorr] p < 0.012), while the TT arm had lower activation than TT + VR in the cerebellum and middle temporal gyrus (cluster level FWEcorr p < 0.001). Changes in fall frequency and brain activation were correlated in the TT + VR arm. CONCLUSIONS: Exercise modifies brain activation patterns in patients with PD in a mode-specific manner. Motor-cognitive training decreased the reliance on frontal regions, which apparently resulted in improved function, perhaps reflecting increased brain efficiency.
RCT Entities:
OBJECTIVE: To compare the effects of 2 forms of exercise, i.e., a 6-week trial of treadmill training with virtual reality (TT + VR) that targets motor and cognitive aspects of safe ambulation and a 6-week trial of treadmill training alone (TT), on brain activation in patients with Parkinson disease (PD). METHODS: As part of a randomized controlled trial, patients were randomly assigned to 6 weeks of TT (n = 17, mean age 71.5 ± 1.5 years, disease duration 11.6 ± 1.6 years; 70% men) or TT + VR (n = 17, mean age 71.2 ± 1.7 years, disease duration 7.9 ± 1.4 years; 65% men). A previously validated fMRI imagery paradigm assessed changes in neural activation pretraining and post-training. Participants imagined themselves walking in 2 virtual scenes projected in the fMRI: (1) a clear path and (2) a path with virtual obstacles. Whole brain and region of interest analyses were performed. RESULTS: Brain activation patterns were similar between training arms before the interventions. After training, participants in the TT + VR arm had lower activation than the TT arm in Brodmann area 10 and the inferior frontal gyrus (cluster level familywise error-corrected [FWEcorr] p < 0.012), while the TT arm had lower activation than TT + VR in the cerebellum and middle temporal gyrus (cluster level FWEcorr p < 0.001). Changes in fall frequency and brain activation were correlated in the TT + VR arm. CONCLUSIONS: Exercise modifies brain activation patterns in patients with PD in a mode-specific manner. Motor-cognitive training decreased the reliance on frontal regions, which apparently resulted in improved function, perhaps reflecting increased brain efficiency.
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