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Randomized Controlled Trial
. 2021 Jun:87:13-19.
doi: 10.1016/j.parkreldis.2021.04.005. Epub 2021 Apr 20.

High intensity aerobic exercise improves bimanual coordination of grasping forces in Parkinson's disease

A Elizabeth Jansen  1 , Mandy Miller Koop  1 , Anson B Rosenfeldt  1 , Jay L Alberts  2
Affiliations
Randomized Controlled Trial

High intensity aerobic exercise improves bimanual coordination of grasping forces in Parkinson's disease

A Elizabeth Jansen et al. Parkinsonism Relat Disord. 2021 Jun.

Abstract

Introduction: Parkinson's disease (PD) disrupts the control and coordination of grasping forces, likely due to a disruption in basal ganglia circuitry and diminished activity within the supplementary motor area (SMA). High intensity aerobic exercise has been shown to enhance connectivity between basal ganglia nuclei and cortical areas, including the SMA. The aim of this project was to determine the effects of high intensity lower extremity exercise on motor control patterns underlying a manual dexterity task.

Methods: PD participants completed eight weeks of high intensity aerobic exercise under forced or voluntary exercise (FE or VE) modalities. Grasping forces for each limb were quantified during a functional bimanual dexterity task. Data were collected while OFF antiparkinsonian medication at baseline, end of treatment (EOT), and eight weeks after exercise cessation (EOT+8).

Results: Eight weeks of high intensity exercise improved MDS-UPDRS Motor III clinical ratings by more than 4 points (~15%) for the FE and VE groups. Time to complete the task decreased nearly 30% across both groups as well. The control and coordination of grasping forces, simultaneity of force initiation, and rate of grip and load force exhibited significant improvements following exercise. In general, improvements in biomechanical outcomes were sustained following exercise cessation.

Conclusion: High intensity aerobic exercise, achieved via a forced or voluntary mode, improved PD symptoms and bimanual dexterity. Sustained improvement of upper extremity motor control following exercise cessation indicates high intensity exercise enhances CNS functioning and suggests exercise may be a candidate for altering PD progression.

Trial registration: ClinicalTrials.gov NCT01636297.

Keywords: Exercise; Grip force; Load force; Parkinson's disease.

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Conflict of interest statement

Declarations of Interest: Dr. Alberts has authored intellectual property related to the motor control algorithm for the forced exercise cycle. The remaining authors declare no conflicts of interest.

Figures

Figure 1:
Figure 1:
(a-inset) Bimanual dexterity hardware and experimental setup. The upper and lower objects were identical 6 degree-of-freedom force/torque transducers. The two objects were connected via an electromagnet which exerted a 10N resistive force. Participants stabilized the lower transducer (stabilizing limb) while pulling on the upper transducer to overcome the electromagnetic resistance (manipulating limb). Panels 1b (forced exercise participant) and 1d (voluntary exercise participant) depict grip (solid red and blue lines) and load (dashed red and blue lines) forces produced by the stabilizing and manipulating limb prior to exercise initiation. Panels 1c and 1e depict grasping forces for the same two participants following eight weeks of FE (1c) or VE (1e) exercise. Lift-off refers to when the two objects were separated. Total task time is depicted by the shaded area.
Figure 2:
Figure 2:
Biomechanical metrics of grasping forces across all clinical visits for the voluntary exercise (VE-blue), forced exercise (FE-red) and the combined VE and FE (black) cohorts. Grip and Load delays calculate the time difference between the initiation of forces on the upper and lower transducers. Maximum rate of grip force production is measured by the lower transducer (stabilizing limb) and upper transducer (manipulating limb) and quantifies intralimb coordination. The delays decreased in the combined cohort and the rates of force production increased in the FE, but not the VE cohort, after 8 weeks of high intensity exercise. *=p<0.05.
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