10 research outputs found

    Exercise as Disease-Modifying Strategy for Parkinson's: a Multidimensional Assessment of Acute and Long-Term Interventions

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    Parkinson's Disease (PD) is a complex and variable neurodegenerative condition. Due to its progressive nature and lack of effective treatments, a range of motor and non-motor symptoms develop and, usually, lead to disability and disengagement with active lifestyles. Exercise interventions have the potential of improving and sustaining physical and cognitive function in PD, as well as stimulating functional and structural neuroplasticity. Published research suggests that multi-modal (MM) exercise, that also includes cognitive tasks, may be more beneficial than single modalities in improving physical and/or cognitive function. However, there have been contrasting results between studies, owing to differences in study design (mode, timing, amount, and intensity of the exercise) and analytical methods used to measure biomarkers, which makes it difficult to generate conclusions and definitive exercise guidelines for people with PD (PwP). As a result of this, the overall objectives of this thesis were to propose acute and long-term interventions that are beneficial for PwP and can be implemented in real-world settings (at home or in the community), investigate associated functional and cognitive outcomes concurrently, and assess potential mechanisms underlying the neuroprotective effects of exercise interventions (MM, aerobic and combined exercise with cognitive tasks) completed in real-world or clinical environments. The first study (presented in Chapter 3) evaluates neurotrophins levels (i.e., BDNF and pro-BDNF) as candidate biomarkers for PwP in several sample types (plasma, serum, and saliva) with the aim of improving current inconsistent methodologies that compromise the reliability and validity of these measurements. Optimisation trials of ELISA assays were completed and revealed that the use of an appropriate combination of reagent diluent for each sample type and analyte is key to improve assay performance and measurement accuracy. The samples collected for the studies presented in Chapters 4 and 6 were subsequently analysed following the methodological steps reported in this study. Future work should include these methodological considerations and previous studies not reporting these details must be interpreted with caution. The second study (Chapter 4) presents the long-term implementation of a weekly community-based MM exercise programme for PwP and shows that exercise attendees improve and maintain function for up to 1, 2 or 3 years. Compared to non-active PwP, PD exercisers improve their mobility, lower extremity strength, cognition and BDNF levels, slowing down PD progression. Subsequently, focus groups were conducted in the studies presented in chapters 5 and 7 to gain in- depth understanding of participants' views about the MM exercise class and its change towards an online delivery due to the coronavirus 2019 (COVID-19) pandemic. Participant's discussions about the feasibility, practicality, and perceptions of the online class for PD, were gathered to develop guidelines for the online delivery of exercise for PwP. Finally, using an experimental laboratory setting, chapter 6 further explores the neuroprotective effects of acute bouts of aerobic exercise (alone or combined with cognitively challenging tasks) on cognitive function. This pilot study provides preliminary evidence of the beneficial effects that, both, a second bout of cycling 24h after the first session and cycling combined with cognitive tasks have on cognitive function. Taken together, both the optimisation and lab-based experimental studies provide directions for future research, such as methodological steps to ensure accurate BDNF and pro-BDNF measurements and exercise interventions that are suggested to elicit cognitive benefits. Furthermore, this thesis provides evidence that a community-based MM exercise programme is able to improve and maintain physical and cognitive functions in PwP. This intervention offered an evidence-based exercise class that had been running for over 4 years and, following COVID-19 pandemic, transitioned from the community towards an online-based setting where it has been successfully running for the last 2 years and is ongoing. Accordingly, this thesis also provides novel insights into the online delivery of MM exercise for PwP and presents guidelines for an appropriate setting-up and delivery of online exercise programmes for health-care professionals and researchers working with PwP

    Evaluation of Phase IV Cardiac Rehabilitation Exercise Training in Stroke Survivors

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    EVALUATION OF PHASE IV CARDIAC REHABILITATION EXERCISE TRAINING IN STROKE SURVIVORS S. Meadows and A. Ferrusola-Pastrana School of Sport and Exercise Sciences, University of Kent Abstract Aims To evaluate health and functional fitness parameters of stroke survivors participating in a Phase IV style cardiac rehabilitation circuit class. Introduction: Stroke is a leading cause of mortality and disability worldwide and the economic costs of treatment and post-stroke care are substantial. Therefore, interventions to help with risk factor management and aid stroke recovery are needed. Exercise training (cardiovascular & strength) offers a potential means to alleviate the burden associated with long-term disability and improve stroke survivor quality of life (QoL). Methods 25 stroke survivors (male = 11; female = 14; mean age 59.5 ± 14.3years) with at least 3-months engagement in a weekly Phase IV-style circuit exercise class completed anthropometric (body mass index [BMI] and waist circumference), health (resting blood pressure), and functional capacity measurements (6-minute shuttle walking distance [6MWD], timed up and go [TUG] and bilateral grip strength [GS]). Results Mean BMI did not significantly change (28.77 ± 4.89kg/m2 to 29.12 ± 5.32kg/m2). Regional weight distribution measured by waist circumference remained similar. Resting blood pressure decreased significantly (SBP p<0.001; DBP p<0.03) with mean SBP decreasing by 7.77% to achieve clinical significance to a normotensive value (131 ± 14mmHg). 6MWD improved (p<0.001) from a mean of 351 ± 100m to 432 ± 113m (19.80% improvement). TUG performance was 12.19% quicker (p<0.006), as was left (p<0.03) & right (p<0.02) GS (8.85% and 32.04%, respectively). Conclusion Circuit-based exercise training offers considerable health and functional capacity benefits to stroke survivors potentially helping to promote recovery, QoL and reduce the disability burden

    The therapeutic effects of multimodal exercise for people with Parkinson's: A longitudinal community-based study

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    Abstract Introduction Individuals with Parkinson’s Disease (PD) can develop a range of motor and non-motor symptoms due to its progressive nature and lack of effective treatments. Exercise interventions, such as multimodal (MM) programmes, may improve and sustain physical or cognitive function in PD. However, studies usually evaluate physical performance, cognition, and neuroprotective biomarkers separately and over short observation periods. Methods Part one evaluates the effects of a weekly community-based MM exercise class (60 min) on physical function in people with PD (PwP). Exercise participants (MM-EX; age 65 ± 9 years; Hoehn and Yahr (H&Y) scale ≤ IV) completed a battery of functional assessments every 4 months for one (n = 27), two (n = 20) and three years (n = 15). In part two, cognition and brain-derived neurotrophic factor (BDNF) levels were assessed over 6-to-8 months and compared to aged-matched non-active PwP (na-PD, n = 16; age 68 ± 7 years; H&Y scale ≤ III) and healthy older adults (HOA, n = 18; age 61 ± 6 years). Results MM-EX significantly improved walking capacity (5% improvement after 8 months), functional mobility (11% after 4 months), lower extremity strength (15% after 4 months) and bilateral grip strength (9% after 28 months), overall, maintaining physical function across 3 years. Group comparisons showed that only MM-EX significantly improved their mobility, lower extremity strength, cognition and BDNF levels. Conclusion Weekly attendance to a community-based MM exercise group session can improve and maintain physical and cognitive function in PD, with the potential to promote neuroprotection

    Group-based exercise for Parkinson’s: a qualitative study of participants and partners’ perceptions of an exercise class delivered through a community-university collaboration

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    Background Community-based exercise programmes (CBEPs) offer a practical and viable approach to providing people with Parkinson's disease (PwP) the opportunity to exercise as an ancillary therapeutic benefit to pharmacological management. This study explores the perceptions of exercising participants (PwP) and non-participating partners involved in an exercise class delivered through a community-university partnership. Methods Two separate focus group discussions were conducted: one with class participants (PwP: n = 7, H&Y scale I to III), and the other with non-participating partners of PwP (n = 4). Results Thematic analysis of the data identified that a range of physical, psychological and social factors were perceived to influence engagement: (1) actively taking control, (2) exercise is medicine for the mind and body, and (3) a community working together to promote exercise for parkinson's. Participants and partners felt that the support from the group, including the instructors and student volunteers, empowered and supported PwP to proactively self-manage their health, enjoy exercise in an inclusive group setting, and develop strong social connections with others in the local Parkinson's community. Support to exercise from healthcare professionals was identified as both an enabler and barrier to participation. Conclusions This study underscores the significance of a community-university partnership as a complementary therapeutic approach for PwP. It also provides critical reflections on its sustainability, including implications for how exercise is considered as medicine for PwP. Additionally, it offers practical recommendations to galvanise community participation and provide inclusive and viable exercise opportunities for PwP

    Group-based exercise for Parkinson’s: a qualitative study of participants and partners’ perceptions of an exercise class delivered through a community-university collaboration

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    Background Community-based exercise programmes (CBEPs) offer a practical and viable approach to providing people with Parkinson's disease (PwP) the opportunity to exercise as an ancillary therapeutic benefit to pharmacological management. This study explores the perceptions of exercising participants (PwP) and non-participating partners involved in an exercise class delivered through a community-university partnership. Methods Two separate focus group discussions were conducted: one with class participants (PwP: n = 7, H&Y scale I to III), and the other with non-participating partners of PwP (n = 4). Results Thematic analysis of the data identified that a range of physical, psychological and social factors were perceived to influence engagement: (1) actively taking control, (2) exercise is medicine for the mind and body, and (3) a community working together to promote exercise for parkinson's. Participants and partners felt that the support from the group, including the instructors and student volunteers, empowered and supported PwP to proactively self-manage their health, enjoy exercise in an inclusive group setting, and develop strong social connections with others in the local Parkinson's community. Support to exercise from healthcare professionals was identified as both an enabler and barrier to participation. Conclusions This study underscores the significance of a community-university partnership as a complementary therapeutic approach for PwP. It also provides critical reflections on its sustainability, including implications for how exercise is considered as medicine for PwP. Additionally, it offers practical recommendations to galvanise community participation and provide inclusive and viable exercise opportunities for PwP

    Can exercise preserve motor and non-motor function in Parkinson’s?

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    Abstract for 5th World Parkinson Congress Title: Can exercise preserve motor and non-motor function in Parkinson’s? Authors: Arthur Waters, Steve Meadows, Glen Davison, Anna Ferrusola-Pastrana, Chris Fullerton Background: Parkinson’s is a chronic neurodegenerative disease, which usually leads to disability and disengagement with active lifestyles. There is good evidence that exercise is effective at improving and sustaining cognitive and physical function in people with Parkinson’s (PwP). Few studies have assessed long-term effects of exercise and it remains unclear the optimal dose for PwP. In October 2016, a collaboration with Parkinson’s Equip and Medway Working Age Group (MWAG), a University of Kent Research Team started a community-based exercise programme for PwP. Using data collected over one-year, we evaluate the effects of multi-modal exercise on physical function, cognition, and wellbeing outcomes in PwP. We also describe the process evaluation of the venture to help understand its feasibility. Methods: 22 participants (18 male, 4 female: age 65 ± 8 years) attended a once-a-week multi-modal group exercise session (60 minutes). Health and functional assessments were completed at the start and repeated every three months for one year. Measurements: resting heart rate (RHR) & blood pressure (BP), height, weight, BMI, waist circumference, Six-minute walking test (6MWT), timed up and go (TUG), 1-minute sit-to-stands (STS) and bilateral grip strength (GS). Cognitive function was subsequently added and assessed with the Clock Drawing Test (CDT), Mini-Mental Parkinson’s (MMP), the Trail Making Test A (TMT-A) and B (TMT-B); plus quality of life with the brief Older Peoples Quality of Life Questionnaire (OPQOL-Brief). Process evaluation was conducted using focus group interviews and questionnaires. Results: Scores for 6MWT, TUG and bilateral GS did not significantly change (P = 0.175, 0.143 and 0.333, respectively). The number of STS significantly increased during one year, specifically between baseline and the first three months (P = 0.012). Scores for CDT, TMT-A, TMT-B and OPQOL-Brief did not significantly change across three different assessments, equivalent to half a year (P = 0.769, 0.205, 0.134 and 0.091, respectively). MMP increased significantly between baseline and the last assessment (P = 0.017). Conclusion: A once-a-week multi-modal group exercise programme for PwP showed an improvement in STS and MMP scores (notably, MMP scores significantly increased from 26.21 to 28.89), but no other significant changes (i.e. no decline) in health and physical function over one year. That functional and cognitive performance were increased or maintained is a positive outcome given the progressive nature of PD. Outcomes from qualitative data capture the psychosocial factors that support engagement with the programme, how exercise helps PwP, and evidence about ‘real-world’ feasibility. This project is ongoing (now running for 2–years), which is a testament to its sustainability as a collaboration between a support group for PwP and a higher education institute

    Should Exercise be Used as Medicine in Stroke Rehabilitation?

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    Background: Recent evidence identifies that there are more people surviving a stroke than ever before, however almost 67% leave hospital with a disability (Stroke Association, 2017). Therefore, there is a large population currently living with the effects of a stroke such as a reduction in activities of daily living, loss of independence and fatigue. Physical activity helps to reduce the impact of these effects. There is now overwhelming evidence of the benefits exercise provides towards modifiable risk factors for stroke, such as inactivity, high blood pressure, obesity (O’Donnell et al., 2016). Aims: To provide a once a week group exercise session for stroke survivors in a local community setting using a multi-modal format (circuit training, corrective strength and balance exercise). To investigate the chronic benefits of exercise has for individuals in stroke rehabilitation in terms of functional capacity and risk management. Recruitment: Individuals referred by stroke rehabilitation services, their GP or through local stroke support groups. Assessments: Health (resting heart rate (RHR), systolic (SBP) and diastolic (DBP) blood pressure (BP), height, weight, BMI, waist circumference) and functional assessments (six-minute walk distance (6MWD), timed up and go (TUG) and bilateral grip strength (GS)) were completed before attendance & repeated after 12 exercise sessions. Additional follow-ups completed at 6 monthly intervals. Results: A weekly exercise session for stroke survivors significantly improved both health and functional outcomes. BP significantly decreased [particularly SBP (p =.001) and DBP by trend (p=.061)] from hypertensive to a normotensive range. Participants also performed significantly better in 6MWD, TUG and Left-GS (p<.001, p=.025 and p=.033, respectively), right-GS increased by trend (p=.061). None of the measured outcomes showed any performance deterioration and there were no deleterious effects of the exercise reported. Conclusion: Attendance at a weekly community stroke rehabilitation exercise session promotes continued recovery of function and improved exercise capacity (as measured by the 6MWD and effective risk factor management

    Group-based exercise for Parkinson’s: a qualitative study of participants and partners’ perceptions of an exercise class delivered through a community-university collaboration

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    Background: Community-based exercise programmes (CBEPs) offer a practical and viable approach to providing people with Parkinson’s disease (PwP) the opportunity to exercise as an ancillary therapeutic benefit to pharmacological management. This study explores the perceptions of exercising participants (PwP) and non-participating partners involved in an exercise class delivered through a community-university partnership. Methods: Two separate focus group discussions were conducted: one with class participants (PwP: n = 7, H&Y scale I to III), and the other with non-participating partners of PwP (n = 4). Results: Thematic analysis of the data identified that a range of physical, psychological and social factors were perceived to influence engagement: (1) actively taking control, (2) exercise is medicine for the mind and body, and (3) a community working together to promote exercise for parkinson’s. Participants and partners felt that the support from the group, including the instructors and student volunteers, empowered and supported PwP to proactively self-manage their health, enjoy exercise in an inclusive group setting, and develop strong social connections with others in the local Parkinson’s community. Support to exercise from healthcare professionals was identified as both an enabler and barrier to participation. Conclusions: This study underscores the significance of a community-university partnership as a complementary therapeutic approach for PwP. It also provides critical reflections on its sustainability, including implications for how exercise is considered as medicine for PwP. Additionally, it offers practical recommendations to galvanise community participation and provide inclusive and viable exercise opportunities for PwP

    Group-based exercise for Parkinson’s: a qualitative study of participants’ and partners’ experiences from a community-university collaboration

    No full text
    Community-based exercise programmes (CBEPs) are a practical and viable approach for providing people with Parkinson’s disease (PwP) with the opportunity to exercise as an ancillary therapeutic benefit to pharmacological management. This study aimed to explore the views and experiences of exercising participants (PwP) and non-participating partners involved in an exercise class delivered through a community-university partnership. Two separate focus group discussions were conducted: one with class participants (PwP: n = 7, H&Y scale I to III), and the other with non-participating partners of PwP (n = 4). The data were then thematically analyzed. Results suggest that a range of physical, psychological, and social factors were perceived to influence engagement: 1) Actively taking control, 2) Exercise is medicine for the mind and body, and 3) Working together as a team. Participants and partners felt that the support from the group, including the instructors and student volunteers, empowered and supported PwP to proactively self-manage their health, enjoy exercise in an inclusive group setting, and develop strong social connections with others in the local Parkinson’s community. Support for exercise from healthcare professionals was identified as both an enabler and barrier to participation. Critical reflections concerning its sustainability are offered, including implications for how exercise is considered as medicine for PwP, as well as some practical recommendations to galvanize community participation and provide inclusive and viable exercise opportunities for PwP

    An Evaluation of Phase IV Participants

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    Aims To evaluate the health and fitness of long-term Phase IV cardiac rehabilitation (CR) participants. Introduction Exercise training is considered a cornerstone intervention in Phase III and Phase IV CR. The benefits of exercise are only retained with adherence. Very little evaluative work has been conducted on those who remain involved in Phase IV to investigate their health and functional status in relation to key risk management criteria (i.e. BMI, waist circumference, blood pressure and functional status). Methods 34 Phase IV participants (male = 24; female = 10; mean age 72.74 ±5.71 years) with at least 6 months engagement in a once weekly CR circuit exercise class completed anthropometric (BMI and waist circumference), health measurements (resting blood pressure), and 6-minute shuttle walking distance (6MWD) for functional capacity. Comparison was made to a Phase III dataset (n= 669) obtained from the local CR team to evaluate health and functional status of long-term Phase IV participants. Results There was a 10% increase in those with a BMI > 25kg.m2 from Phase III to Phase IV (66% - 76% of the group). The mean BMI in the Phase IV cohort was 27.33 ±3.57kg.m2 and regional weight distribution measured by waist circumference was 99.72±11.92cm and 87.25 ±8.27cm in males and females respectively. Blood pressure remained in a normotensive range. 6MWD improved from a mean of 437.38 ±91.16m to 488.26 ±89.61m (11.62% improvement). Using the ACSM (2014) formula based on walking speed (m.min-1) in the 6MWD test, this represented a MET improvement from 3.08 to 3.32 METs for a sub-maximal walking effort. Conclusion A small improvement in sub-maximal functional capacity achieved in this Phase IV CR population, as measured by 6MWD. However, the MET equivalent value for this effort was only just in the moderate intensity range and below the 5-MET threshold normally associated with higher risk stratification. There is scope for education reinforcement related to healthy weight management to control for the risk associated with overweight / obesity, as measured by BMI and waist circumference in both the male and female Phase IV CR population
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