Article

Deficits in step-to-step symmetry and trunk muscle activations have
been linked to falls in Parkinson disease. Given such symptoms are poorly managed
with anti-parkinsonian medications, alternate therapies are needed. This blind
phase II randomized controlled trial sought to establish whether exercise can
improve step-to-step symmetry in Parkinson disease. DESIGN: Twenty-four Parkinson
disease patients with a falls history completed baseline assessments of symptom
severity, balance confidence, mobility, and quality of life. Step-to-step
symmetry was assessed by deriving harmonic ratios from three-dimensional
accelerations collected for the head and trunk. Patients were randomly assigned
to either 12 wks of exercise and falls prevention education or falls prevention
education only. Both groups repeated the baseline tests 12 and 24 wks after the
initial assessment. The Australian and New Zealand Clinical Trials Registry
number is ACTRN12613001175763. RESULTS: At 12 wks, the exercise group had
statistically significant and clinically relevant improvements in
anterior-posterior step-to-step trunk symmetry. In contrast, the education group
recorded statistically significant and clinically meaningful reductions in
medial-lateral and vertical step-to-step trunk symmetry at 12 wks. CONCLUSIONS:
Given that step-to-step symmetry improved for the exercise group and declined for
the education group after intervention, active interventions seem more suited to
increasing independence and quality of life for people with Parkinson disease. TO
CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at
http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this
article, the reader should be able to do the following: (1) Describe the effect
deficits in trunk muscle function have on gait in individuals with Parkinson
disease; (2) Identify the benefits of targeted trunk exercises on step-to-step
symmetry; and (3) Discuss the benefits of improving step-to-step symmetry in
individuals with Parkinson disease. LEVEL: Advanced ACCREDITATION: The
Association of Academic Physiatrists is accredited by the Accreditation Council
for Continuing Medical Education to provide continuing medical education for
physicians.The Association of Academic Physiatrists designates this Journal-based
CME activity for a maximum of 0.5 AMA PRA Category 1 Credit(s). Physicians should
only claim credit commensurate with the extent of their participation in the activity.

Langue : ANGLAIS