Parkinson’s disease (PD) is related to a progressive degeneration of the dopaminergic neurons in the substancia nigra at the basal ganglia. The major symptoms and signs of PD are resting tremor, bradykinesia, and muscle rigidity that impact the walking pattern. Changes in the walking pattern due to uneven surfaces are called adaptive locomotion, which is required in everyday life, such as stepping over obstacles.
Some studies revealed that specific physical activity programs can improve the gait pattern over even surfaces in PD patients. However, little is known about the impact of a multimode physical activity program on the adaptive locomotion of these patients. Thus, the purpose of this study was to analyze the effects of a multimode physical activity program focusing on aerobic capacity, flexibility, strength, coordination and balance on gait parameters during obstacle avoidance in PD patients.
Six patients with idiopathic PD (62.2 ± 6.4 years old; mild to moderate stages of the disease-stages 1-2 in the Hoehn and Yahr scale) completed the program (6-month period, 72 sessions, 3 times a week, and 60 min per session). Data on gait kinematics were collected before and after the program. During the assessments, the patients walked on an 8-m pathway at their preferred velocity and stepped over each one of the two obstacles that were in the middle of the pathway. Obstacle heights were tailored according to the patient’s body scale: low obstacle corresponded to ankle height and high obstacle to half of knee height. Participants performed 5 trials for each obstacle height that were presented in blocks. The blocks of trials were randomized among the patients.
A digital camcorder recorded the trajectories of passive markers attached to the right fifth metatarsal and the left first metatarsal joints at the right sagittal plane. The images were analyzed by the Dvideow 6.3 software and a specific algorithm was written (Matlab 7.0) to calculate the following dependent variables: leading and trailing foot placements before the obstacle, leading and trailing toe clearances, and leading foot placement after obstacle crossing.
The Shapiro-Wilks test revealed that there was not normal data distribution. Therefore, the pre- and postintervention results were statistically compared by the Wilcoxon nonparametric test. The significance level was kept at 5% (p < .05). The comparisons showed a significant decrease on the trailing foot placement before the obstacle (Z = -2.138; p < .034); an increase on the leading foot placement after the obstacle crossing (Z = -5.955; p < .001), and on the leading and trailing toe clearances (Z = -2.282; p < .023 and Z = -2.400; p < .017; respectively). These results suggest that the multimode physical activity program positively affects the adaptive locomotion of Parkinson’s disease patients by allowing them to increase the amplitude of motion trajectory. Such changes in the walking pattern can provide safer locomotion. Acknowledgments: FAPESP, PIBIC, CNPq, FINEP, FNS-MS.
