Telerehabilitation during social distancing for people with Parkinson's disease: a retrospective study.

INTRODUCTION/AIM: Clinical worsening has been common in people with Parkinson's disease (PD) during the social distancing due to pandemic. It is unclear if telerehabilitation applied during social distancing preserves clinical aspects of people with PD who are frequent exercisers before the pandemic. Thus, we compared the effects of 10 months of supervised, home-based, real-time videoconferencing telerehabilitation (SRTT) and nonexercising control on clinical aspects in people with PD who are frequent exercisers before the pandemic. METHODS: Fifty-seven (SRTT group) and 29 (nonexercising control group) people with PD were retrospectively assessed (Clinical Trials Registry: RBR-54sttfk). Only the SRTT group performed a 60-min online training sessions, 2-3 days per week, for 10 months (April 2020 to January 2021) during social distancing. Quality of life (PD Questionnaire [PDQ-39]), walking (item 28 from the Unified Parkinson's Disease Rating Scale part III [UPDRS-III]), posture (item 29 from the UPDRS-III), and freezing of gait (New-FOG questionnaire [NFOGQ]) were retrospectively assessed before (February-March 2020) and during social distancing (February-March 2021). The assessments were performed in-person and remotely before and during social distancing, respectively. RESULTS: There were no between-group differences at baseline (p > 0.05). SRTT preserves PDQ-39 and walking scores but not posture and NFOGQ scores, while nonexercising control worsens scores in all variables. In addition, SRTT is more effective than nonexercising control in preserving PDQ-39 and walking scores. CONCLUSION: During social distancing, long-term SRTT preserves the subjective quality of life and walking, but not subjective posture and FOG in people with PD who are frequent exercisers before the pandemic.

Perception of COVID-19 Pandemic by Brazilian People With Parkinson's Disease and Multiple Sclerosis.

COVID-19 in Brazil is threatening, and it has forced the government to adopt partial lockdown as a strategy to stop the spread of the virus in the first wave of pandemic (March 2020). These preventive measures during the COVID-19 pandemic may affect the motor and non-motor symptoms in people with Parkinson's disease (PD) and Multiple sclerosis (MS). Thus, the purpose of this study was to investigate the perception during the first wave of COVID-19 pandemic lockdown on motor and non-motor symptoms, and also measure physical activity level, quality of life, and sleep quality in Brazilian people with PD and MS. One hundred and fifty-three participants (PD-97 and MS-56) answered an online survey to identify the perception of motor and non-motor symptoms, and characterize the physical activity level, and quality of life and sleep in these neurological Brazillian population. During the beginning of pandemic lockdown in Brazil, our results indicated that 69% of people with PD and 55% of people with MS reported worse on motor aspects and lower amount of physical activity performed. Also, 75.2% (PD) and 92.9% (MS) of our cohort were considered inactive or sedentary. Based on the perception and behavior of the population studied, people with PD and MS should be encouraged to perform more physical activity in order to reduce the effects of isolation in motor and non-motor aspects of the diseases. Teleinterventions, such as home-based exercise, should be included in the new routine of people with PD and MS to reduce the impacts of lockdown and to maintain quality of life at a good level.

Acute Cardiovascular Responses to Self-selected Intensity Exercise in Parkinson's Disease.

Parkinson's disease patients frequently present cardiovascular dysfunction. Exercise with a self-selected intensity has emerged as a new strategy for exercise prescription aiming to increase exercise adherence. Thus, the current study evaluated the acute cardiovascular responses after a session of aerobic exercise at a traditional intensity and at a self-selected intensity in Parkinson's disease patients. Twenty patients (≥ 50 years old, Hoehn & Yahr 1-3 stages) performed 3 experimental sessions in random order: Traditional session (cycle ergometer, 25 min, 50 rpm, 60-80% maximum heart rate); Self-selected intensity: (cycle ergometer, 25 min, 50 rpm with self-selected intensity); and Control session (resting for 25 min). Before and after 30 min of intervention, brachial and central blood pressure (auscultatory method and pulse wave analysis, respectively), cardiac autonomic modulation (heart rate variability), and arterial stiffness (pulse wave analysis) were evaluated. Brachial and central systolic and diastolic blood pressure, heart rate, and the augmentation index increased after the control session, whereas no changes were observed after the exercise sessions (P<0.01). Pulse wave velocity and cardiac autonomic modulation parameters did not change after the three interventions. In conclusion, a single session of traditional intensity or self-selected intensity exercises similarly blunted the increase in brachial and central blood pressure and the augmentation index compared to a non-exercise control session in Parkinson's disease patients.

Influence of motor impairment on exercise capacity and quality of life in patients with Parkinson disease.

This study evaluated the impact of motor impairment (MI) on exercise capacity and quality of life in patients with Parkinson disease (PD). One hundred ninety-two patients (≥50 years old) were divided according to the Hoehn and Yahr stages in: mild (stage I), mild to moderate (stage II), moderate (stage III), and advanced MI (stage IV). Exercise capacity (6-min walk test [6MWT]) and quality of life (Parkinson's Disease Questionnaire [PDQ-39]) were obtained. In this context, 6MWT was progressively worse with increasing the severity of MI (P<0.01). Patients with advanced MI achieved 39% of predicted 6MWT of healthy subject, while subjects with mild MI achieved 83% of healthy subject (P<0.01). In addition, patients with advanced MI presented higher (i.e., worse) PDQ-39 scores in summary index, cognition, mobility and activities of daily live domains compared to other groups (P<0.01). Patients with moderate MI also presented worse scores in PDQ-39 summary index, mobility and activities of daily live domains in comparison with mild MI patients (P<0.01). Higher MI was correlated with worse exercise capacity (6MWT: r=-0.46, P<0.01), with worse PDQ-39 summary index and the mobility and activities of daily live domains scores (r=0.38, r=0.46, and r=0.43, P<0.01). In conclusion, MI is related to lower exercise capacity and quality of life (i.e., PDQ-39 summary index and mobility and activities of daily live domains) in patients with PD.

Cardiovascular, perceived exertion and affective responses during aerobic exercise performed with imposed and a self-selected intensity in patients with Parkinson's disease.

BACKGROUND: Exercise with self-selected intensity (SSI) has emerged as a new strategy for exercise prescription aiming to increase exercise adherence in Parkinson's disease (PD). OBJECTIVE: We compared the cardiovascular, perceived exertion and affective responses during traditional aerobic exercise and with SSI in PD. METHODS: Twenty patients with PD performed two aerobic exercise sessions in random order with an interval of at least 72 h between them: Traditional session (cycle ergometer, 25 min, 50 rpm) with imposed intensity (II) (60-80% maximum heart rate [HR]) and SSI: (cycle ergometer, 25 min, 50 rpm) with SSI. The HR (Polar V800 monitor), systolic blood pressure (auscultatory method), rating of perceived exertion (Borg scale 6-20) and affective responses (feeling scale) were assessed during the exercise at 8th and 18th minute. The Generalized Estimating Equation Model was used for comparison between both sessions (P < 0.05). RESULTS: The exercise intensity was not significantly different between both exercise sessions (8th minute: II -76.3±1.0 vs. SSI -76.5±1.3 % of maximal HR; 18th minute: II -78.9±0.9 vs. SSI -79.1±1.3 % of maximal HR, p = 0.93). Blood pressure, perceived exertion and affective responses were also not significantly different between both sessions (P > 0.05). CONCLUSIONS: Cardiovascular and psychophysiological responses were not different during aerobic exercise performed with II and with SSI in patients with PD.

Parkinson's disease does not alter automatic visual-motor coupling in postural control.

This study examined the coupling between visual information and body sway in patients with Parkinson's disease (PD) compared with healthy controls. Postural control performance was compared between 14 patients with PD (age: 69.6 ±â€¯8.8 years - stages 1-3 of the Hoehn and Yahr scale) and 14 healthy control participants (age: 68.6 ±â€¯3.0 years). Participants stood upright in a moving room that remained motionless or continuously oscillated in the anterior-posterior direction. Ten trials were performed in the following conditions: no movement of the room (1 trial) and with the room moving at frequencies of 0.1, 0.17, and 0.5 Hz (3 trials each frequency). Body sway and moving room displacement were recorded. The results indicated that patients with PD displayed larger body sway magnitude in the stationary room condition. Body sway of patients with PD was induced by visual manipulation in all three visual stimulus frequencies, but body sway of patients with PD was less coherent compared to that of the control participants. However, no difference was observed in the visual-body sway coupling structure. These results indicate that patients with PD can unconsciously couple body sway to visual information in order to control postural sway in a similar manner to healthy participants with intact visual-motor coupling for posture control. However, this coupling is marked by greater variability, indicating that people with PD have a motor system with greater inherent noise leading to a more varied behavior.

Accumulation properties of inorganic mercury and organic mercury in the red-crowned crane Grus japonensis in east Hokkaido, Japan.

The red-crowned (Japanese) crane Grus japonensis is native to east Hokkaido, Japan, in contrast to the East Asia mainland. Previously, we reported that red-crowned cranes in Hokkaido were highly contaminated with mercury in the 1990s and that the contamination rapidly decreased to a moderate level in the 2000s. In the present study, we determined levels of organic mercury (O-Hg) in the liver and kidney of cranes in east Hokkaido in comparison with levels of total mercury (T-Hg). T-Hg levels in the kidneys were higher than those in the livers in adults but not in subadults and juveniles; however, the reverse was the case for O-Hg even for adults. The ratio of O-Hg to T-Hg in both the liver and kidney decreased as T-Hg increased in the three developmental stages. While the ratios of O-Hg to T-Hg in the liver and kidney of adults were significantly lower than those of juveniles, the ratios were similar for adults and juveniles in a lower range of T-Hg. The ratio of selenium (Se) to T-Hg decreased as T-Hg increased in both the liver and kidney, irrespective of stages. Mercury burdens in feathers were about 59% and 67% of the total body burdens for juveniles and adults, respectively. Furthermore, ratios of carbon and nitrogen stable isotopes to T-Hg varied greatly, with no relation to mercury level in the liver. The results suggest slow accumulation of inorganic mercury in the kidney of red-crowned cranes in east Hokkaido, Japan.

Changes of mercury contamination in red-crowned cranes, Grus japonensis, in East Hokkaido, Japan.

Red-crowned cranes (Grus japonensis) are native to eastern Hokkaido (island population), in contrast to the mainland, which migrates between the Amur River basin and eastern China-Korea peninsula. During the 1990s we found that Red-crowned cranes in Hokkaido were highly contaminated with mercury: however, the source was unknown. We investigated the time trend of mercury contamination in Red-crowned cranes. Total mercury levels in the livers and kidneys from cranes dead in the 2000s were lower than those dead in the 1990s. Feather is a major pathway of mercury excretion for many bird species and is used as an indicator of blood mercury level during feather growth. As internal organs from the specimens collected before 1988 were not available, we analyzed the flight feather shavings from stuffed Red-crowned cranes dead in 1959-1987 and found that the mercury level of feathers from cranes dead in the 1960s and 1970s was not more than those from the cranes dead in the 2000s. These results suggest that mercury contamination in Red-crowned cranes in Hokkaido decreased temporally during the 1990s-2000s. This indicates the possible occurrence of some mercury pollution in Red-crowned cranes' habitat in this region in the 1990s or before.