Department of Exercise, Sport and Lifestyle Medicine

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Browsing Department of Exercise, Sport and Lifestyle Medicine by Author "Atterbury, Elizabeth Maria"

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    Exploring therapeutic neurogenic tremors with exercise as a treatment for selective motor and non-motor Parkinson's disease symptoms
    (Stellenbosch : Stellenbosch University, 2019-04) Atterbury, Elizabeth Maria; Welman, Karen Estelle; Stellenbosch University. Faculty of Education. Dept. of Sport Science.
    ENGLISH ABSTRACT: Intro: Parkinson‘s disease (PD) is a chronic neurological progressive disorder accompanied by a wide range of symptoms that affect independence and quality of life (QoL) [1]. Individuals with PD (IwPD) experience motor symptoms, including postural instability and gait disturbances, and non-motor symptoms (NMS), including depressive moods, anxiety and autonomic dysregulation [2]. Daily stress further exacerbates PD symptoms [3]. Therefore stress management is of particular importance for IwPD. Relaxation-based exercises might be a viable option, and recently the addition of therapeutic neurogenic tremors (TNT) to exercise have been shown to aid in the reduction of perceived stress as well as improvement in QoL [4–6]. These tremors are theorised to be a genetically-encoded mechanism part of the stress response [7], and a necessary process for the body to function optimally after stressful and traumatic events [8,9]. Therefore, the current study set out to investigate the effects of relaxation-based exercises with and without TNT on selective motor and non-motor symptoms of IwPD. Methods: Thirty-six individuals with idiopathic PD participated in this experimental study, with a double-blinded randomised time-series design. Participants were randomly allocated to three groups: 1)Exercises with TNT (TRE), 2) Exercises without TNT (EAR), and 3) a non-exercising waitlist controlgroup (n = 12, 69.6 ± 8.3 years). Group 1 (n = 14, 72.7 ± 7.5 years) participated in a Trauma and Tension Releasing Exercises (TRE) intervention, while Group 2 (n = 10, 70.3 ± 5.7 years) participated in the Exercise and Relaxation (EAR) intervention. Both interventions followed the same protocol except for the addition of TNT in the TRE group, and took place with tapered supervision over nine weeks. Participants, in all three groups, were tested every three weeks (i.e. baseline, 3, 6 and 9 weeks), and after a three week retention period. Primary outcome measures included postural instability, gait disturbances, domains of NMS, depressive moods, general anxiety, and somatisation. Assessments included the Mini Balance Evaluation Systems Test (BESTest), instrumented 2-Minute Walk (2MW), NMS Questionnaire (NMSQuest) and NMS Symptoms Scale (NMSS), as well as the Patient Health Questionnaire for somatic, anxiety and depressive symptoms (PHQ-SADS). Secondary outcome measures included disease severity (assessed with the Movement Disorder Society’s – Unified Parkinson’s Disease Rating Scale (MDS-UPDRS)), perceived balance confidence (assessed with the Activity-specific Balance Confidence (ABC) scale) and QoL (assessed by the 8-item Parkinson’s disease Questionnaire (PDQ-8)). Results: Groups did not differ in descriptive characteristics or outcome variables at baseline (p > 0.05), except for variability of trunk rotation, mood/cognition and attention/memory domains of NMSS between TRE and CON groups (p < 0.05). An interaction effect was observed for PDQ-8 (p = 0.01) with improvements seen for EAR group (p = 0.002, Hedges’ g = 0.45M) and a tendency for the TRE group to improve (p = 0.07, Hedges’ g = 0.35S) over time. The main findings with practical significance after the intervention period were improvements in gait speed of the EAR group (p = 0.005, Hedges’ g = 0.39S), and variability of trunk rotation during 2MW for TRE group (p = 0.048, Hedges’ g = 0.39S). The EAR and TRE groups showed improvement in gastrointestinal complaints and the severity of stress-related items in the mood/cognition domain of NMSS (p < 0.03, Hedges’ g > 0.48M), while TRE showed additional improvements for frequency stress-related items of NMSS (p < 0.05, Hedges’ g > 0.49M). Additionally significant practical improvements were observed for MDS-UPDRS II (motor experience of daily living) for TRE (p = 0.02, Hedges’ g = 0.29S) and control group (p = 0.01, Hedges’ g = 0.33S). The retention period showed improvements in Mini BESTest domains for EAR (p =0.04, Hedges’ g = 0.57M) and control (p = 0.02, Hedges’ g = 0.65M) groups, and improvement in NMSQuest for TRE (p = 0.04, Hedges’ g = 0.56M). Conclusion: This exploratory study shows promising preliminary results for relaxation-based exercises with TNT. The findings suggest that relaxation-based exercises were beneficial towards improving gait performance, decreasing the severity of selective NMS and possibly improving QoL. The addition of TNT could have the potential of further improvements in the motor experience of daily living, quality of gait, and the frequency of stress-related NMS. Therapies utilizing TNT could be an essential tool for IwPD to reduce the impact of motor and NMS, and manage stress. However, more research is needed to investigate the effects of TNT on populations vulnerable to stress.
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    Home-based balance training for dynamic balance in independent-living individuals with Parkinson’s disease
    (Stellenbosch : Stellenbosch University, 2016-03) Atterbury, Elizabeth Maria; Welman, Karen Estelle; Stellenbosch University. Faculty of Education. Dept. of Sport Science
    ENGLISH ABSTRACT : Background: Individuals with Parkinson‘s disease (PD), are presented with a variety of motor and nonmotor symptoms which progressively affect their independence. As a result surgical and pharmacological interventions are often ineffective, especially for postural instability. Poor locomotion and balance dysfunction in PD ultimately leads to disability, which includes the loss of their ability to perform automated movements in a controlled manner (Floriano et al., 2015, Rinalduzzi et al., 2015). Accordingly dynamic balance and gait are considered to be one of the most relevant rehabilitation outcomes, and non-pharmacological interventions like exercise should be explored. Home-based balance exercises might be a viable mode of exercise delivery for PD individuals. However research on PD exercise interventions rarely indicate best practices to deliver exercises (King et al., 2015). Aim: The aim of this study was to compare an eight-week home-based balance programme with an equivalent therapist-supervised programme on dynamic balance, functional gait, and self-perceived measures of fall risk and balance confidence, disease severity, and motivation regarding the exercise interventions in individuals with mild to moderate PD. Methods: Forty participants with idiopathic PD (Hoehn and Yahr stage I–III; age: 65.0±7.7 years) were divided into a Therapist-supervised group (n=24) and Home-based group (n=16). Groups received eight weeks of balance training that including somatosensory cues, three times a week for an hour, either with an exercise therapist or via a DVD. Outcome measures were dynamic balance (FGA), gait and mobility (ITUG), dual-tasking gait and mobility (CTUG), freezing of gait (FoGQ), self-perceived balance confidence (ABC), self-perceived fall risk (FES-I), disease severity (MDS-UPDRS II & III) and intrinsic motivation (IMI). Results: Treatment effects were observed for the Home-based group with MDS-UPDRS total, subscore II and III (p < 0.01), and for the Therapist-supervised group for cadence (p = 0.047). Both groups improved (p < 0.05) in FGA (>9%, medium effect sze), stride length (>4%, small to medium effect size) and FoGQ (>16%, small effect size). Over the 8 weeks the Therapist-supervised group furthermore improved cadence and balance confidence (p < 0.05) with small effect size, stride and turn velocity (p < 0.05) with medium effect size, and turn-to-sit duration (p < 0.0001) with a huge effect size. The Home-based group improved by 23% in MDS-UPDRS III (p < 0.001), but gait deteriorated with dual-tasking. No significant differences observed for FES-I (p > 0.05). The therapist supervised group perceived the intervention to be 17% more enjoyable/interesting than Home-based (IMI; p = 0.002). Conclusion: An eight-week balance training programme with somatosensory cues at home may improve dynamic balance, stride length and freezing of gait. However greater improvements are achieved when exercising under supervision of a trained exercise therapist. Therapist-supervised training showed superior improvement in dynamic balance, gait, dual-tasking, balance confidence and motivation.