Pushing the limit to reach meaningful change: the impact of intensity-driven exercise on clinical outcomes for individuals with Parkinson’s disease. A single-subject design

Abstract

Purpose

Parkinson’s disease creates an inability to perform previous learned autonomic tasks, such as walking, which worsens with disease progression. Recommendations to incorporate exercise at moderate to high intensities for this population has been established but there is limited knowledge about its impact on clinical based outcomes. The purpose of this research is to investigate the effectiveness of a 6-week intensity-driven walking program on clinical-based outcomes in individuals with PD.

Materials/Methods

Five individuals with PD were recruited for this single-subject withdrawal design (A-B-A-B) study. 6-minute walk performance and other core neurological measures of gait were collected. Intervention phases incorporated a 30-minute individualized intensity-driven treadmill walking program practiced at 65% or more of ones maximum heart rate. Increased treadmill speed, incline, and resistance were manipulated to reach the target heart rate zone.

Results

6-minute walk test within condition visual analysis demonstrated a therapeutic change during intervention phases and a countertherapeutic change during withdraw periods for all 5 individuals. An abrupt therapeutic effect was demonstrated for all individuals between conditions with the percent of nonoverlapping data ranging from 70-90%. Band method analysis revealed a range of 9-19 sessions two standard deviations above baseline mean performances for all individuals.

Conclusion

To achieve sufficient walking performance, gait practiced at higher intensity levels may provide the optimal solution as an adjunct to standard care for individuals with PD who want to improve their walking.

IMPLICATIONS FOR REHABILITATION

• Parkinson’s disease creates an inability to perform previous learned autonomic tasks, such as walking, which worsens with disease progression.

• Exercise practiced at higher levels of intensity has been recommended to improve clinical based outcomes for the neurological population.

• Walking practice at higher intensity levels can provide a solution to improve gait endurance for individuals with Parkinson’s disease.

Keywords:

• Parkinson’s disease
• gait
• intensity
• treadmill
• heart rate

Disclosure

No potential conflict of interest was reported by the authors.

Additional information

Funding

The funder played no role in the design or reporting of this study.