Effects of the agility boot camp with cognitive challenge (ABC-C) exercise program for Parkinson's disease

Abstract

Few exercise interventions practice both gait and balance tasks with cognitive tasks to improve functional mobility in people with PD. We aimed to investigate whether the Agility Boot Camp with Cognitive Challenge (ABC-C), that simultaneously targets both mobility and cognitive function, improves dynamic balance and dual-task gait in individuals with Parkinson's disease (PD). We used a cross-over, single-blind, randomized controlled trial to determine efficacy of the exercise intervention. Eighty-six people with idiopathic PD were randomized into either an exercise (ABC-C)-first or an active, placebo, education-first intervention and then crossed over to the other intervention. Both interventions were carried out in small groups led by a certified exercise trainer (90-min sessions, 3 times a week, for 6 weeks). Outcome measures were assessed Off levodopa at baseline and after the first and second interventions. A linear mixed-effects model tested the treatment effects on the Mini-BESTest for balance, dual-task cost on gait speed, SCOPA-COG, the UPDRS Parts II and III and the PDQ-39. Although no significant treatment effects were observed for the Mini-BESTest, SCOPA-COG or MDS-UPDRS Part III, the ABC-C intervention significantly improved the following outcomes: anticipatory postural adjustment sub-score of the Mini-BESTest (p = 0.004), dual-task cost on gait speed (p = 0.001), MDS-UPDRS Part II score (p = 0.01), PIGD sub-score of MDS-UPDRS Part III (p = 0.02), and the activities of daily living domain of the PDQ-39 (p = 0.003). Participants with more severe motor impairment or more severe cognitive dysfunction improved their total Mini-BESTest scores after exercise. The ABC-C exercise intervention can improve specific balance deficits, cognitive-gait interference, and perceived functional independence and quality of life, especially in participants with more severe PD, but a longer period of intervention may be required to improve global cognitive and motor function.

Fig. 1. CONSORT diagram.

236 people with Parkinson’s disease were assessed for eligibility. Of these, 143 did not meet inclusion criteria, and 60 declined to participate in the study, leaving 93 subjects consented and randomized into the two intervention groups and 86 subjects’ data analyzed after dropouts. During the first intervention, 3 subjects dropped out during Exercise intervention and 4 dropped out during Education intervention. During the second intervention, 4 subjects dropped out during the Exercise intervention. One subject fell during the exercise class resulting in a hip fracture. There were also 3 minor adverse events that did not result in drop-outs: 2 fell during the exercise class and 1 fell getting out of a car.

Fig. 2. Mean and SE of outcomes at the 3 time-points in each group.

The bar graphs are mean and SE of the delta after Exercise (red) and after Education (blue). a Mini-BESTest total score, b Mini-BEST APA subscore, c MDS-UPDRS Part II score, d PIGD subscore, e PDQ-39, ADL subscore, and f Dual-task cost (% change from single task) on gait speed.

Fig. 3. Results by disease and cognitive severity.

Mean and SE of the delta after Exercise (red) and after Education (blue) when splitting subjects based on motor severity (MDS-UPDRS Part III) or cognitive severity (SCOPA-COG) for a Mini-BESTest total, b MDS-UPDRS II and c PDQ-39.