Exergaming in the treatment of gait, balance, and quality of life in Parkinson's disease: Overview of systematic reviews.

INTRODUCTION: Postural instability and gait impairments are common in people with PD, both of which have a negative effect on their quality of life. Systematic reviews have demonstrated benefits of using exergaming in enhancing these outcomes. However, there is no consensus over whether exergaming therapy is better than conventional physical therapy for enhancing gait, balance, and quality of life. OBJECTIVES: The aim of this overview is to systematically synthesize and evaluate the available evidence found in published systematic reviews and meta-analyses, on the effects of exergaming therapy on balance, gait, and quality of life, compared to conventional physical therapy or no intervention. METHODS: This overview was reported in accordance with the statement of Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). A comprehensive search was carried out in nine databases. Two reviewers independently extracted data using a standardized forms and the search strategy included terms related to intervention, population, and study type. The methodological quality of the included systematic reviews/meta-analysis (SRs/Mas) was evaluated using the "A Measurement Tool to Assess Systematic Reviews 2" (AMSTAR-2). The "Grading of Recommendations Assessment, Development and Evaluation" (GRADE) was used to assess the quality of the evidence. The risk of bias assessment was performed using the "Risk Of Bias In Systematic Reviews" (ROBIS). PROSPERO registration number: CRD42021238131. RESULTS: 112 SRs/MAs were found and nine of them were selected. Six reviews were rated as very low methodological quality and three reviews as low methodological quality. Five reviews were classified with low risk of bias and four reviews with high risk of bias. Most of the SR/MAs demonstrated significant effects on balance favoring exergaming therapy over conventional therapy, however those studies had been rated as very low quality of evidence. Inconclusive results were found for the quality of life and gait outcomes. CONCLUSION: Exergaming therapy shows promise for the rehabilitation of PD. However, this overview was unable to conclude with certainty that exergaming therapy is superior to conventional physical therapy in improving gait, balance, or quality of life in people with PD. The effectiveness of exergaming therapy in the treatment of people with PD still need to be verified by high-quality studies.

Effects of a Resistance Training Protocol on Physical Performance, Body Composition, Bone Metabolism, and Systemic Homeostasis in Patients Diagnosed with Parkinson's Disease: A Pilot Study.

Parkinson's disease (PD) is a neurodegenerative disorder characterized by motor impairments and it is correlated with loss of bone mineral density. This study aimed to analyze the effects of resistance training on bone metabolism, systemic homeostasis, body composition, and physical performance in people with PD. Thirteen subjects (age 64.83 ± 5.70) with PD diagnosis were recruited. Participants performed neuromuscular tests, body composition assessment, and blood sample analysis at baseline, and after an 11 weeks-training period. Each training session lasted 90 min, three times a week. The participants had significant improvements in the timed up and go (p < 0.01), sit to stand (p < 0.01), dominant peg-board (p < 0.05), dominant foot-reaction time (p < 0.01), and functional reach tests (p < 0.05). They showed better pressure foot distributions in the left forefoot (p < 0.05) and hindfoot (p < 0.05) and increased cervical right lateral bending angle (p < 0.05). The protocol affects bone metabolism markers osteocalcin (p < 0.05), calcium (p < 0.01), PTH (p < 0.01), the C-terminal telopeptide (CTX) (p < 0.01), and vitamin D (p < 0.05). Eleven weeks of resistance training improved manual dexterity, static and dynamic balance, reaction time, cervical ROM, and reduced bone loss in people with PD.

Vitamin D and Parkinson's Disease.

Vitamin D is a fat-soluble secosteroid, traditionally considered a key regulator of bone metabolism, calcium and phosphorous homeostasis. Its action is made possible through the binding to the vitamin D receptor (VDR), after which it directly and indirectly modulates the expression of thousands of genes. Vitamin D is important for brain development, mature brain activity and associated with many neurological diseases, including Parkinson's disease (PD). High frequency of vitamin D deficiency in patients with Parkinson's disease compared to control population was noted nearly twenty years ago. This finding is of interest given vitamin D's neuroprotective effect, exerted by the action of neurotrophic factors, regulation of nerve growth or through protection against cytotoxicity. Vitamin D deficiency seems to be related to disease severity and disease progression, evaluated by Unified Parkinson's Disease Rating Scale (UPDRS) and Hoehn and Yahr (H&Y) scale, but not with age of PD onset and duration of disease. Additionally, fall risk has been associated with lower vitamin D levels in PD. However, while the association between vitamin D and motor-symptoms seems to be possible, results of studies investigating the association with non-motor symptoms are conflicting. In addition, very little evidence exists regarding the possibility to use vitamin D supplementation to reduce clinical manifestations and disability in patients with PD. However, considering the positive balance between potential benefits against its limited risks, vitamin D supplementation for PD patients will probably be considered in the near future, if further confirmed in clinical studies.

Virtual functional mobility test: A potential novel tool for assessing mobility of individuals with Parkinson's disease in a multitask condition.

There are few instruments available for evaluating functional mobility during multitasking in people with Parkinson's Disease (PD). Virtual Reality is a potentially tool capable of aiding in the evaluation of functional mobility. The purpose of this study is to verify the potential of the Virtual Functional Mobility Test (VFMT) as a clinical tool to assess functional mobility of people with PD during multitasking condition. 25 people with PD and 25 people without PD, matched for age and sex, were recruited. Participants were evaluated through the Trail Making Test, Timed "UP and GO" test, Timed "UP and GO" test in dual task condition and through the VFMT, composed of 1) a simple task, and 2) a complex task. The VFMT and clinical tests were sensitive to differentiate the groups, except the trail making test part B (p = 0.332) and complex task (p = 0.052). Strong correlations were observed between parts A and B of the trail making test (r = 0.75) and complex task (r = 0.72); Moderate correlations between Timed Up and Go test and Timed Up and Go test in dual task condition with simple task (r = 0.47) and complex task (r = 0.55), respectively, were found. The complex task and simple task showed excellent and moderate reliability intra-rater, respectively. It was concluded that the novel VFMT is feasible, sensible, reliable and has potential as an instrument for the evaluation of functional mobility during multitasking in people with PD.

STATIC BALANCE MEASUREMENTS IN STABLE AND UNSTABLE CONDITIONS DO NOT DISCRIMINATE GROUPS OF YOUNG ADULTS ASSESSED BY THE FUNCTIONAL MOVEMENT SCREEN™ (FMS™).

BACKGROUND: The Functional Movement Screen™ (FMS™) has been the focus of recent research related to movement profiling and injury prediction. However, there is a paucity of studies examining the associations between physical performance tasks such as balance and the FMS™ screening system. PURPOSE: The purpose of this study was to compare measures of static balance in stable and unstable conditions between different groups divided by FMS™ scores. A secondary purpose was to discern if balance indices discriminate the groups divided by FMS™ scores. STUDY DESIGN: Cross-sectional study. METHODS: Fifty-seven physically active subjects (25 men and 32 women; mean age of 22.9 ± 3.1 yrs) participated. The outcome was unilateral stance balance indices, composed by: Anteroposterior Index; Medial-lateral Index, and Overall Balance Index in stable and unstable conditions, as provided by the Biodex balance platform. Subjects were dichotomized into two groups, according to a FMS™ cut-off score of 14: FMS1 (score > 14) and FMS2 (score ≤ 14). The independent Students t-test was used to verify differences in balance indices between FMS1 and FMS2 groups. A discriminant analysis was applied in order to identify which of the balance indices would adequately discriminate the FMS™ groups. RESULTS: Comparisons between FMS1 and FMS2 groups in the stable and unstable conditions demonstrated a higher unstable Anteroposterior index for FMS2 (p=0.017). No significant differences were found for other comparisons (p>0.05). The indices did not discriminate the FMS™ groups (p > 0.05). CONCLUSIONS: The balance indices adopted in this study were not useful as a parameter for identification and discrimination of healthy subjects assessed by the FMS™. LEVEL OF EVIDENCE: 2c.

Motor learning, retention and transfer after virtual-reality-based training in Parkinson's disease--effect of motor and cognitive demands of games: a longitudinal, controlled clinical study.

OBJECTIVES: To evaluate the learning, retention and transfer of performance improvements after Nintendo Wii Fit™ training in patients with Parkinson's disease and healthy elderly people. DESIGN: Longitudinal, controlled clinical study. PARTICIPANTS: Sixteen patients with early-stage Parkinson's disease and 11 healthy elderly people. INTERVENTIONS: Warm-up exercises and Wii Fit training that involved training motor (shifts centre of gravity and step alternation) and cognitive skills. A follow-up evaluative Wii Fit session was held 60 days after the end of training. Participants performed a functional reach test before and after training as a measure of learning transfer. MAIN OUTCOME MEASURES: Learning and retention were determined based on the scores of 10 Wii Fit games over eight sessions. Transfer of learning was assessed after training using the functional reach test. RESULTS: Patients with Parkinson's disease showed no deficit in learning or retention on seven of the 10 games, despite showing poorer performance on five games compared with the healthy elderly group. Patients with Parkinson's disease showed marked learning deficits on three other games, independent of poorer initial performance. This deficit appears to be associated with cognitive demands of the games which require decision-making, response inhibition, divided attention and working memory. Finally, patients with Parkinson's disease were able to transfer motor ability trained on the games to a similar untrained task. CONCLUSIONS: The ability of patients with Parkinson's disease to learn, retain and transfer performance improvements after training on the Nintendo Wii Fit depends largely on the demands, particularly cognitive demands, of the games involved, reiterating the importance of game selection for rehabilitation purposes.