[논문]The Effects of Walking and Turning and Treadmill Training on Postural Balance and Walking in People with Parkinson's Disease

Bang, Dae-Hyouk; Jeong, Wang-Mo

doi:10.21598/jkpnfa.2019.17.2.189

The Effects of Walking and Turning and Treadmill Training on Postural Balance and Walking in People with Parkinson's Disease 원문보기

Bang, Dae-Hyouk (Department of Physical Therapy, WonKwang University Oriental Hospital) , Jeong, Wang-Mo (Jeong In Body Exercise Trading Center)

Purpose: The aim of our study was to evaluate the therapeutic effects of walking and turning plus treadmill training on the functional balance and walking ability of individuals with Parkinson's disease (PD). Methods: Twenty-four participants with Stage 1 to 3 ($2.13{\pm}0.64$) PD based on the Hoehn and Yahr scale were randomly allocated to the experimental group (EG) and control group (CG), with 12 participants in each group. The measured outcomes included the motor subscale of the unified Parkinson's disease rating scale (UPDRS-M), the Berg balance scale (BBS), the Timed Up and Go (TUG) test, the 10-meter walk test (10MWT), and the 6-minute walk test (6MWT). Results: Pre-to-post intervention improvements were noted for all the outcome measures for both groups (p < 0.05). Post intervention, there was a significant improvement in the EG compared to the CG for the following measured outcomes (p < 0.05): UPDRS-M (p = 0.021; 95% CI, 0.081-6.519), BBS (p = 0.042; 95% CI, 1.375-4.541), TUG (p = 0.034; 95% CI, -3.315--0.143), 10MWT (p = 0.011; 95% CI, -2.032--0.289), and 6MWT (p = 0.002; 95% CI, 24.39-91.273). Conclusion: Our study suggests that walking and turning plus treadmill training improves balance and walking compared to treadmill training only in patients with PD.

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문제 정의

This study highlights the importance of turning motion in patients with PD. Our randomized controlled pilot trial provided evidence of the effectiveness of walking turns training to improve balance and walking ability in people with PD.
However, there is a paucity of literature on turn training in patients with PD. Thus, the aim of the present study was to examine the effect of walking turns plus treadmill training on postural balance and walking for patients with PD. The research hypotheses for this study are as follows: (1) walking turns plus treadmill training will improve balance and walking ability, and (2) walking turns plus treadmill training will be superior to conventional plus treadmill training in patients with PD.

가설 설정

We hypothesized that walking turns plus treadmill training was superior to conventional training plus treadmill training in improving balance and walking ability. The results showed that both groups (EG and CG) had improvement in balance and walking ability after 4 weeks when compared to baseline.

제안 방법

Participants in the CG performed the conventional training for 30 minutes. Each session included 5 minutes of muscle stretching (hamstring, quadriceps, and calves) and mobilization exercises (e.g., trunk rotation, hip adduction, flexion), followed by 25 minutes of balance and gait exercises any without turning motions. Participants executed the tasks as instructed by the physiotherapist.
Patients with a diagnosis of PD, confirmed by several neurologists to make a diagnosis, were recruited from the Wonkwang University Medical Center in the Republic of Korea. For eligibility, patients had to present with two or more of the four classic motor features of PD: resting tremor, bradykinesia, rigidity, and asymmetric onset, in which the resting tremor or bradykinesia had to be present (Gelb et al., 1999). The specific inclusion criteria were: (1) Hoehn and Yahr stages 1 to 3, (2) ability to walk independently without walking aids, (3) stable medication, and (4) a score of ≥24 on the mini-mental state examination.
The participants performed the tests after gaining sufficient familiarity with the test protocols. The primary outcomes were balance and self-selected gait speed, assessed with the Berg balance scale (BBS) (Wee et al.
After randomization, the interventions were carried out during regularly scheduled therapy sessions. The training program consisted of twenty 1-hour (30 min + 30 min), sessions, performed five days per week for 4 weeks.
This study was a single-blinded randomized controlled trial, with an analyst that was blinded to the treatment. Assessments were taken by an experienced physical therapist who was qualified to use the measurement tools and was also blinded to treatment groups.

대상 데이터

There were no between-group differences in terms of sex, age, height, weight, Mini-Mental State Examination score, and duration of PD (Table 1). A total of the 24 participants were documented during the 4-week study period (Table 2). There were no significant differences in the incidence rate of falls between groups (p>0.
Patients with a diagnosis of PD, confirmed by several neurologists to make a diagnosis, were recruited from the Wonkwang University Medical Center in the Republic of Korea. For eligibility, patients had to present with two or more of the four classic motor features of PD: resting tremor, bradykinesia, rigidity, and asymmetric onset, in which the resting tremor or bradykinesia had to be present (Gelb et al.
Patients were asked to walk as ‘fast’ as possible for 6 minutes. The test was performed in a 100-m long corridor, with the total distance walked(m) measured.
The exclusion criteria were: (1) any comorbidity or disability that precluded training, (2) a past history of a seizure, and (3) any uncontrolled health condition for which exercise is contraindicated. Twenty-four patients were recruited into our study and randomized to two groups: the walking turns plus treadmill training group (experimental group, EG) or the conventional plus treadmill training group (control group, CG). Randomization was done after baseline testing by a physical therapist who was blinded to the study.

데이터처리

Data were presented as a mean and standard deviation (SD). Between-group differences at the time points of measurement were evaluated using independent t-tests. Within-group changes from pre- to post-test measurements were evaluated using paired t-tests.
Between-group differences at the time points of measurement were evaluated using independent t-tests. Within-group changes from pre- to post-test measurements were evaluated using paired t-tests. Effect sizes were calculated as the difference between the means of the EG and CG divided by the mean SD at baseline (Cohen, 1988).

성능/효과

The total number of men was 19 (79%) and the total number of women was 5 (20%). At the end of the fourth weeks, mean scores significantly increased for several outcome measures (BBS, TUG, 10MWT, and 6MWT) in both groups. However, the mean values in the EG were greater than those in the CG, showing significantly better improvement in the EG (p<0.
For the secondary outcomes, the mean TUG change for dynamic balance was significantly greater in the EG than in the CG (4.13±1.60 seconds vs. 3.05±1.67 seconds, p=0.04); and the mean changes in the 6MWT for walking endurance was significantly greater in the EG than in the CG (58.83±20.54 vs. 32.08±16.58m, p=0.00).
In the primary outcomes, the mean change in balance function measure by BBS was significantly greater in the EG than in the CG (8.00±2.05 vs. 5.08±2.68 scores, p=0.01); and the mean change in walking speed measured by the 10MWT was significantly greater in the EG than in the CG (3.69±1.42 vs. 2.30±1.61 seconds, p=0.01).
62). In this study, both groups showed an increase in the walking speed and endurance, and the EG showed a more significant increase than the CG. We consider that the EG results impacted the qualitative aspect of gait (balance), as well as the quantitative aspect (walking speed and endurance).
Our randomized controlled pilot trial provided evidence of the effectiveness of walking turns training to improve balance and walking ability in people with PD. The major findings of this study were that the walking turns plus treadmill training group showed significantly more improvement than the conventional training plus treadmill training group in the UPDRS- M, BBS, TUG, 10MWT, and 6MWT, over time. These results indicate that walking turns plus treadmill training may be more effective than conventional plus treadmill training to improve balance and walking ability in people with PD.
The results of this study were that the walking turns plus treadmill training group showed significantly more improvement than the conventional training plus treadmill training group in the UPDRS- M, BBS, TUG, 10MWT, and 6MWT, over time. Our study indicates that a balance and walking disorder, which lead to immobility and disability in PD, can improve after walk turns training.
We hypothesized that walking turns plus treadmill training was superior to conventional training plus treadmill training in improving balance and walking ability. The results showed that both groups (EG and CG) had improvement in balance and walking ability after 4 weeks when compared to baseline. These results may be the direct result of the repetitive treadmill training applied in this study.
All participants completed all training and assessment sessions. There were no between-group differences in terms of sex, age, height, weight, Mini-Mental State Examination score, and duration of PD (Table 1). A total of the 24 participants were documented during the 4-week study period (Table 2).

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The Effects of Walking and Turning and Treadmill Training on Postural Balance and Walking in People with Parkinson's Disease 원문보기

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The Effects of Walking and Turning and Treadmill Training on Postural Balance and Walking in People with Parkinson's Disease 원문보기

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