Improvements in Bilateral Differences in Lean Mass and Strength in Persons with Parkinson’s Disease Presenting Unilateral Motor Symptoms

In persons with Parkinson’s disease (PD), individuals present altered motor symptoms such as rigidity, tremors and bradykinesia. These motor symptoms typically present in the early stages of PD unilaterally. Resistance training with instability (RTI) and cadence walking (CW) are effective in improving markers of fragility and motor function. The benefit of combining RTI and CW and its effects on lean mass and strength hav not been studied. PURPOSE: to examine the effects of RTI, CW and RTI+CW on lean mass in affected and unaffected sides and strength in persons with PD. METHODS: individuals diagnosed with mild to moderate PD (N=18 ( 6 female, 12 males); MHY stage=1.53 + 0.50; age = 63.67 + 7.23 y; BMI = 27.38 + 3.88 kg/m2) were randomized into RTI, CW or RTI+CW exercise groups for 8-weeks. RTI and CW were performed 3 days/week and RTI+CW was performed 4 days/week (2 days RTI and 2 days CW). RTI included full-body machine and free-weight exercises with volume (reps and sets) and instability progressions. CW included volume (time) and intensity (speed) progressions for 8-weeks. DXA scans and strength assessments were performed at pre- and post-assessments. RESULTS: A significant difference was present between affected and unaffected sides of lean mass in the upper and lower body of PD participants, with the unaffected side averaging more lean mass for all groups. The average lean mass at pre-assessments in the unaffected arm was 2.92 + 1.05 kg versus the affected arm at 2.80 + 0.99 kg, p=0.043. The difference in the unaffected and affected arms’ lean mass decreased and was no longer significant at post-assessments (unaffected 2.9 + 1.01 kg and affected 2.88 + 1.00 kg, p=0.165), indicating a significant time effect. There was not a significant difference in lean mass for the affected and unaffected legs. A significant group x time effect was observed for RTI and RTI+CW in comparison to CW alone for lean mass differences in affected and unaffected arms at post-assessments (p=0.048 and p=0.44). A significant difference was noted between RTI and RTI+CW in comparison to CW alone in chest press improvements at post-assessments (RTI 30.00 + 16.43 lbs, CW 7.50 + 11.29 lbs, p=0.033 and RTI+CW 18.33 + 7.53 lbs, p=0.47). Interestingly, no group differences in leg press were noted. CONCLUSION: Bilateral differences exist in lean mass DXA results in the affected and unaffected arms of persons with PD who present motor symptoms unilaterally. The bilateral differences in lean mass are improved in RTI and RTI+CW but not in CW alone

Improvements in the 8-Dimensions of the Parkinson’s Disease Quality of Life Questionnaire after 8-weeks of Resistance Training with Instability and/or Cadence Walking in Persons with Mild to Moderate Parkinson’s Disease

Physical activity helps slow the progression of Parkinson’s disease (PD). Resistance training with iPhysical activity helps slow the progression of Parkinson’s disease (PD). Resistance training with instability (RTI) and cadence walking (CW) add an additional skill (compared to resistance training and walking alone) to improve neuromuscular connections and blood flow to the brain during exercise. A cross-training exercise regimen, combining both resistance training and walking (RTI+CW), has not been studied to determine its effect on the progression of Parkinson’s disease. PURPOSE: to examine the changes in the 8-dimensions of the Parkinson’s Disease Questionnaire (PDQ39) (mobility, activities of daily living (ADL), emotional well-being, stigma, social support, cognition, communication and bodily discomfort) after 8-weeks of RTI, CW and RTI+CW in individuals with mild to moderate PD. METHODS: individuals diagnosed with mild to moderate PD (N=18 ( 6 female, 12 males); MHY stage=1.53 + 0.50; age = 63.67 + 7.23 y; BMI = 27.38 + 3.88 kg/m2) were randomized into RTI, CW or RTI+CW exercise groups for 8-weeks. RTI and CW were performed 3 days/week and RTI+CW was performed 4 days/week (2 days RTI and 2 days CW). RTI included full-body machine and free-weight exercises with volume (reps and sets) and instability progressions. CW included volume (time) and intensity (speed) progressions for 8-weeks. The PDQ39 questionnaire was given at pre- and post-assessments. RESULTS: improvements in the PDQ39 questionnaire were seen across all groups in all 8 dimensions of mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication and bodily discomfort. A significant time effect was observed for dimensions of mobility (17.33 + 7.30 and 15.94 + 7.6, p=0.043), stigma (7.12 + 3.50 and 6.12 + 2.75, p=0.02) and bodily discomfort (7.34 + 1.97 and 6.05 + 2.46, p=0.005). A significant group x time effect was observed for mobility and bodily discomfort. A Tukey’s post hoc analysis revealed significant differences between RTI+CW and CW for mobility (RTI+CW 16.00 + 6.54 and 13.83 + 5.42 and CW 18.00 + 6.48 and 17.33 + 10.39, p=0.04) and RTI and CW for bodily Physical activity helps slow the progression of Parkinson’s disease (PD). Resistance training with instability (RTI) and cadence walking (CW) add an additional skill (compared to resistance training and walking alone) to improve neuromuscular connections and blood flow to the brain during exercise. A cross-training exercise regimen, combining both resistance training and walking (RTI+CW), has not been studied to determine its effect on the progression of Parkinson’s disease. PURPOSE: to examine the changes in the 8-dimensions of the Parkinson’s Disease Questionnaire (PDQ39) (mobility, activities of daily living (ADL), emotional well-being, stigma, social support, cognition, communication and bodily discomfort) after 8-weeks of RTI, CW and RTI+CW in individuals with mild to moderate PD. METHODS: individuals diagnosed with mild to moderate PD (N=18 ( 6 female, 12 males); MHY stage=1.53 + 0.50; age = 63.67 + 7.23 y; BMI = 27.38 + 3.88 kg/m2) were randomized into RTI, CW or RTI+CW exercise groups for 8-weeks. RTI and CW were performed 3 days/week and RTI+CW was performed 4 days/week (2 days RTI and 2 days CW). RTI included full-body machine and free-weight exercises with volume (reps and sets) and instability progressions. CW included volume (time) and intensity (speed) progressions for 8-weeks. The PDQ39 questionnaire was given at pre- and post-assessments. RESULTS: improvements in the PDQ39 questionnaire were seen across all groups in all 8 dimensions of mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication and bodily discomfort. A significant time effect was observed for dimensions of mobility (17.33 + 7.30 and 15.94 + 7.6, p=0.043), stigma (7.12 + 3.50 and 6.12 + 2.75, p=0.02) and bodily discomfort (7.34 + 1.97 and 6.05 + 2.46, p=0.005). A significant group x time effect was observed for mobility and bodily discomfort. A Tukey’s post hoc analysis revealed significant differences between RTI+CW and CW for mobility (RTI+CW 16.00 + 6.54 and 13.83 + 5.42 and CW 18.00 + 6.48 and 17.33 + 10.39, p=0.04) and RTI and CW for bodily discomfort (RTI 7.33 + 1.97 and 5.67 + 2.16; CW 7.33 + 1.63 and 6.50 + 1.97). CONCLUSION: All exercise groups improved in scores for all 8-dimensions of the PDQ39 questionnaire. Significant time effects were observed for mobility, stigma and bodily discomfort. RTI+CW improved mobility more than CW alone. RTI improved bodily discomfort more than CW alone. (RTI 7.33 + 1.97 and 5.67 + 2.16; CW 7.33 + 1.63 and 6.50 + 1.97). CONCLUSION: All exercise groups improved in scores for all 8-dimensions of the PDQ39 questionnaire. Significant time effects were observed for mobility, stigma and bodily discomfort. RTI+CW improved mobility more than CW alone. RTI improved bodily discomfort more than CW alone.nstability (RTI) and cadence walking (CW) add an additional skill (compared to resistance training and walking alone) to improve neuromuscular connections and blood flow to the brain during exercise. A cross-training exercise regimen, combining both resistance training and walking (RTI+CW), has not been studied to determine its effect on the progression of Parkinson’s disease. PURPOSE: to examine the changes in the 8-dimensions of the Parkinson’s Disease Questionnaire (PDQ39) (mobility, activities of daily living (ADL), emotional well-being, stigma, social support, cognition, communication and bodily discomfort) after 8-weeks of RTI, CW and RTI+CW in individuals with mild to moderate PD. METHODS: individuals diagnosed with mild to moderate PD (N=18 ( 6 female, 12 males); MHY stage=1.53 + 0.50; age = 63.67 + 7.23 y; BMI = 27.38 + 3.88 kg/m2) were randomized into RTI, CW or RTI+CW exercise groups for 8-weeks. RTI and CW were performed 3 days/week and RTI+CW was performed 4 days/week (2 days RTI and 2 days CW). RTI included full-body machine and free-weight exercises with volume (reps and sets) and instability progressions. CW included volume (time) and intensity (speed) progressions for 8-weeks. The PDQ39 questionnaire was given at pre- and post-assessments. RESULTS: improvements in the PDQ39 questionnaire were seen across all groups in all 8 dimensions of mobility, activities of daily living, emotional well-being, stigma, social support, cognition, communication and bodily discomfort. A significant time effect was observed for dimensions of mobility (17.33 + 7.30 and 15.94 + 7.6, p=0.043), stigma (7.12 + 3.50 and 6.12 + 2.75, p=0.02) and bodily discomfort (7.34 + 1.97 and 6.05 + 2.46, p=0.005). A significant group x time effect was observed for mobility and bodily discomfort. A Tukey’s post hoc analysis revealed significant differences between RTI+CW and CW for mobility (RTI+CW 16.00 + 6.54 and 13.83 + 5.42 and CW 18.00 + 6.48 and 17.33 + 10.39, p=0.04) and RTI and CW for bodily discomfort (RTI 7.33 + 1.97 and 5.67 + 2.16; CW 7.33 + 1.63 and 6.50 + 1.97). CONCLUSION: All exercise groups improved in scores for all 8-dimensions of the PDQ39 questionnaire. Significant time effects were observed for mobility, stigma and bodily discomfort. RTI+CW improved mobility more than CW alone. RTI improved bodily discomfort more than CW alone

Improvements in Markers of Fragility after 8-weeks of Resistance Training with Instability and/or Cadence Walking in Persons with Mild to Moderate Parkinson’s Disease

In persons with Parkinson’s disease (PD), resistance training with instability (RTI) and cadence walking (CW) are effective in improving markers of fragility and motor function. The benefit of combining RTI and CW to markers of fragility and motor function in individuals with PD has not been studied. PURPOSE: to examine the effects of RTI, CW and RTI+CW on markers of fragility (6-minute walk (6MW), timed-up-and-go (TUG), walking speed, stride-to-stride variability and handgrip strength) in individuals with PD. METHODS: individuals diagnosed with mild to moderate PD (N=18 ( 6 female, 12 males); MHY stage=1.53 + 0.50; age = 63.67 + 7.23 y; BMI = 27.38 + 3.88 kg/m2) were randomized into RTI, CW or RTI+CW exercise groups for 8-weeks. RTI and CW were performed 3 days/week and RTI+CW was performed 4 days/week (2 days RTI and 2 days CW). RTI included full-body machine and free-weight exercises with volume (reps and sets) and instability progressions. CW included volume (time) and intensity (speed) progressions for 8-weeks. RESULTS: stride to stride variability improved significantly more in RTI+CW versus CW and RTI alone (2.54 + 1.18 inches, 0.19 + 0.28 inches, p=0.006 and -1.38 + 0.98 inches, p=0.008, respectively). Arm swing in the affected versus the unaffected arm significantly improved in the RTI+CW and RTI groups compared to the CW group (3.198 + 1.29 inches, 5.20 + 2.16, p=0.043 and 0.46 + 0.22 inches, p=0.003, respectively). There were significant pre- and post-improvements in distance of the 6-minute walk (1642 + 370 feet, 1801 + 350 feet, p=0.002), stride velocity (1.04 + 0.14 m/s, 0.99 + 0.15 m/s, p=0.002), steps per minute (116.91 + 15.12 spm, 125.38 + 15.73 spm, p=0.011), stride-to-stride variability (2.16 + 1.68 inches, 1.48 + 1.33 inches, p=0.003), arm swing difference between affected and unaffected sides (9.97 + 6.65 inches, 5.70 + 4.24 inches, P=0.005), Berg Balance scale (51.00 + 3.58, 53.39 + 3.18, PCONCLUSION: all exercise groups significantly improved markers of fragility including endurance, stride velocity and variability, hand grip, arm swing difference and balance after 8-weeks of RTI, CW or RTI+CW. Additionally, RTI+CW may be more effective than CW alone in preventing falls in persons with PD due to the significant improvements in stride-to-stride variability. RTI group’s stride-to-stride-variability worsened over the course of 8-weeks. RTI+CW and RTI may be more effective than CW alone in improving arm swing of the PD affected side during walking in individuals with PD

Improvements in Markers of Fragility and Motor Function after 8-weeks of Resistance Training with Instability and/or Cadence Walking in Persons with Mild to Moderate Parkinson’s Disease

In persons with Parkinson’s disease (PD), resistance training with instability (RTI) and cadence walking (CW) are effective in improving markers of fragility and motor function. A combination of RTI and CW and its potential added effects on fragility and motor function has not been studied. PURPOSE: to examine the effects of RTI, CW and RTI+CW on markers of fragility (grip strength, walking speed and variability, upper and lower body strength and endurance) and motor function in individuals with PD. METHODS: individuals diagnosed with mild to moderate PD (N=10 (1 female, 9 males); Hoehn and Yahr (MHY) stage=1.5 + 0.4; age=66 + 12 y; BMI = 28.10 + 2.5 kg/m2) were randomized into RTI, CW or RTI+CW exercise groups for 8-weeks. RTI and CW were performed 3 days/week and RTI+CW was performed 4 days/week (2 days RTI and 2 days CW). RTI included full-body machine and free-weight exercises with volume (reps and sets) and instability progressions. CW included volume (time) and intensity progressions. RESULTS: stride to stride variability improved significantly more in RTI+CW versus CW alone (3.28 + 1.94 in and 0.79 + 0.28 in, P=0.007). The RTI group increased stride length significantly more than the RTI+CW group (6.04 + 0.96 in, 5.96 + 0.75 in, P=0.032). The RTI group increased upper body strength significantly more than CW (26.25 + 19.74 lbs, 5.00 + 8.66 lbs, P=0.046). There were significant pre- and post-improvements in distance of the 6-minute walk (1691 + 456 ft, 1913 + 374 ft, P=0.012), stride velocity (1.04 + 0.14 m/s, 0.97 + 0.12 m/s, P=0.11), steps per minute (116.91 + 15.12 spm, 125.38 + 15.73 spm, P=0.009), stride-to-stride variability (4.21 + 2.68 in, 1.97 + 1.51 in, P=0.028), arm swing of the affected side (7.44 + 4.92 in, 14.40 + 5.52 in, P=0.003), Berg Balance scale (51.90 + 2.85, 54.20 + 2.70, P=0.005), leg press (250 + 68.80, 304 + 78.20, P=0.001), chest press (78.50 + 23.10 lbs, 96.50 + 26.67 lbs, P=0.006) and hand grip of the affected side (34.00 + 11.36 kg, 37.60 + 10.48 kg, P=0.010). CONCLUSION: after 8-weeks of RTI, CW or RTI+CW, all exercise groups significantly improved endurance, stride velocity and variability, upper and lower body strength, arm swing in affected side and balance. RTI+CW may be more effective than CW alone in preventing falls in persons with PD due to the significant improvement in stride-to-stride variability

Improvements in Disease Rating Scale after 8-weeks of Resistance Training with Instability and/or Cadence Walking in Persons with Mild to Moderate Parkinson’s Disease

Physical activity helps slow the progression of Parkinson’s disease (PD). Resistance training with instability (RTI) and cadence walking (CW) add an additional skill (compared to resistance training and walking alone) to improve neuromuscular connections and blood flow to the brain during exercise. A cross-training exercise regimen, combining both resistance training and walking, has not been studied to determine its effect on the progression of Parkinson’s disease. PURPOSE: to examine the changes in Parkinson’s disease progression determined by the Unified Parkinson’s Disease Rating Scale (UPDRS) after 8-weeks of RTI, CW and RTI+CW in individuals with mild to moderate PD. METHODS: individuals diagnosed with mild to moderate PD (N=10 (1 female,9 males); Hoehn and Yahr (MHY) stage=1.5 + 0.4; age = 66 + 12 y; BMI = 28.10 + 2.5 kg/m2) were randomized into RTI, CW or RTI+CW exercise groups for 8-weeks. RTI and CW were performed 3 days/week and RTI+CW was performed 4 days/week (2 days RTI and 2 days CW). RTI included full-body machine and free-weight exercises with volume (reps and sets) and instability progressions. CW included volume (time) and intensity progressions for 8-weeks. RESULTS: there was a significant difference in the objective motor examination (ME) improvement on the UPDRS between RTI and CW (0.14 + 0.36 and 0.36 + 0.42, P=0.034). No group differences were found in the subjective self-reported activities of daily living (ADL) section on the UPDRS. Significant time interactions were found for the pre- and post-ratings of ADL (0.80 + 0.41, 0.88 + 0.55, PCONCLUSION: RTI improves ME scores significantly more than CW after 8-weeks in persons with mild to moderate PD. RTI, CW and a combination of the two improves subjective ratings (ADL) and objective ratings (ME and MHY) after 8-weeks

A population study of clinical trial accrual for women and minorities in neuro-oncology following the NIH Revitalization Act.

BackgroundThe NIH Revitalization Act, implemented 29 years ago, set to improve the representation of women and minorities in clinical trials. In this study, we investigate progress made in all phase therapeutic clinical trials for neuroepithelial CNS tumors stratified by demographic-specific age-adjusted disease incidence and mortality. Additionally, we identify workforce characteristics associated with clinical trials meeting established accrual benchmarks.MethodsRegistry study of published clinical trials for World Health Organization defined neuroepithelial CNS tumors between January 2000 and December 2019. Study participants were obtained from PubMed and ClinicalTrials.gov. Population-based data originated from the CBTRUS for incidence analyses. SEER-18 Incidence-Based Mortality data was used for mortality analysis. Descriptive statistics, Fisher exact, and χ 2 tests were used for data analysis.ResultsAmong 662 published clinical trials representing 49 907 participants, 62.5% of participants were men and 37.5% women (P < .0001) representing a mortality specific over-accrual for men (P = .001). Whites, Asians, Blacks, and Hispanics represented 91.7%, 1.5%, 2.6%, and 1.7% of trial participants. Compared with mortality, Blacks (47% of expected mortality, P = .008), Hispanics (17% of expected mortality, P < .001) and Asians (33% of expected mortality, P < .001) were underrepresented compared with Whites (114% of expected mortality, P < .001). Clinical trials meeting accrual benchmarks for race included minority authorship.ConclusionsFollowing the Revitalization Act, minorities and women remain underrepresented in therapeutic clinical trials for neuroepithelial tumors, relative to disease incidence and mortality. Study accrual has improved with time. This study provides a framework for clinical trial accrual efforts and offers guidance regarding workforce considerations associated with enrollment of underserved patients