Article

It may be possible to use attention-based exercise to decrease
demands associated with walking in Parkinson's disease (PD),
and thus improve
dual task walking ability. For example, an external focus of attention (focusing
on the effect of an action on the environment) may recruit automatic control
processes degenerated in PD, whereas an internal focus (limb movement) may
recruit conscious (nonautomatic) control processes. Thus, we aimed to investigate
how externally and internally focused exercise influences dual task walking and
symptom severity in PD. METHODS: Forty-seven participants with PD were randomized
to either an Externally (n = 24) or Internally (n = 23) focused group and
completed 33 one-hour attention-based exercise sessions over 11 weeks. In
addition, 16 participants were part of a control group. Before, after, and 8
weeks following the program (pre/post/washout), gait patterns were measured
during single and dual task walking (digit-monitoring task, ie, walking while
counting numbers announced by an audio-track), and symptom severity (UPDRS-III)
was assessed ON and OFF dopamine replacement. Pairwise comparisons (95%
confidence intervals [CIs]) and repeated-measures analyses of variance were
conducted. RESULTS: Pre to post: Dual task step time decreased in the external
group (Delta = 0.02 seconds, CI 0.01-0.04). Dual task step length (Delta = 2.3
cm, CI 0.86-3.75) and velocity (Delta = 4.5 cm/s, CI 0.59-8.48) decreased (became
worse) in the internal group. UPDRS-III scores (ON and OFF) decreased (improved)
in only the External group. Pre to washout: Dual task step time ( P = .005) and
percentage in double support ( P = .014) significantly decreased (improved) in
both exercise groups, although only the internal group increased error on the
secondary counting task (ie, more errors monitoring numbers). UPDRS-III scores in
both exercise groups significantly decreased ( P = .001). CONCLUSIONS: Since dual
task walking improvements were found immediately, and 8 weeks after the cessation
of an externally focused exercise program, we conclude that externally focused
exercise may improve on functioning of automatic control networks in PD.
Internally focused exercise hindered dual tasking ability. Overall, externally
focused exercise led to greater rehabilitation benefits in dual tasking and motor
symptoms compared with internally focused exercise.

Langue : ANGLAIS