Optimization of sensory attention focused exercise for the treatment of Parkinson's disease

The purpose of this thesis was to investigate if gains might be accomplished through the combination of traditional exercise techniques (i.e. aerobic and resistance training) and the Parkinson's disease (PD) SAFEx™ program. More specifically to see if the different combinations of exercise techniques have an additional improvement compared to just PD SAFEx™ on clinical motor symptom severity, aerobic capacity, gait and functional leg strength in PD.;The first comparison was PD SAFEx™ compared to Express PD SAFEx™. Sixty minutes of PD SAFEx™ was compared to thirty minutes of PD SAFEx™ (Express) to determine if the treatment time per session of the PD SAFEx™ program influences the treatment of symptom severity. The primary measure was change of motor symptom severity, measured by the change score of the UPDRS III. At the end of this section it will be determined which treatment time (60 minutes vs. 30 minutes) has a larger change of motor symptom severity in PD.;The second section compared PD SAFEx™ to A+PD SAFEx. Aerobic was combine with PD SAFEx™ with the primary goal to improve gait impairments in PD. Despite improvements to clinical motor symptom severity induced by PD SAFEx™ program, there is minimal evidence of improvements to spatiotemporal aspects of gait (Sage & Almeida, 2009). On the other hand, aerobic exercise has been shown to improve movement initiation and gait in PD. The purpose of the study was to evaluate if the combination of PD SAFEx™ and aerobic training would change spatiotemporal aspects of gait. The primary objective measure was spatiotemporal aspects of gait via the GAITRite® electronic walkway. Secondary variables measured changes to motor symptom severity, functional changes and changes to self-report symptom severity. This comparison will evaluate if the combination of aerobic exercise and PD SAFEx™ will change in gait and other symptoms in PD.;The third comparison was PD SAFEx™ compared to R+PD SAFEx. Resistance training was combined with PD SAFEx™ with the goal to improve functional lower limb strength in PD. Resistance training has been shown to improve muscle strength and gait in PD. It focused on increasing muscle strength to improve balance and treat symptoms such as bradykinesia. Alternatively, changes to muscle strength are unproven for the PD SAFEx™ exercise program. The purpose of this section was to combine resistance training with PD SAFEx™ to compare changes in lower limb functional strength between both groups. The primary objective measure was the functional lower limb strength using the 30 second chair stand. This section will evaluate function strength changes in PD in both exercise interventions, and which type of exercise shows a larger change.;The last component investigated changes in aerobic capacity in all 4 groups. Inactivity in PD is a common complication in PD, as PD patients struggle with gait and mobility. This leads to diminished aerobic capacity causing further inactivity. As such, aerobic capacity is an important factor to consider when optimizing an exercise rehabilitation program for the treatment of PD. Maximum oxygen consumption (VO2 max) was the primary objective to determine aerobic changes in all 4 groups, and which of the interventions will induce the largest change in aerobic capacity, as measured by VO 2 max.;A common objective measure throughout all components was clinical motor symptom severity evaluated by the Unified Parkinson's Disease Rating Scale motor section (UPDRS III). The UPDRS III gives clinical context of the effectiveness of the exercise programs for the change of PD motor symptoms. Furthermore, the UPDRS III was analyzed in head to head comparisons in chapter 2-4 and included all groups in one analysis in chapter 5. The two types of analyses determined which group showed the largest change in motor symptom severity overall and during specific comparisons. (Abstract shortened by UMI.).