Three Months of Partnered Dance Aerobic Exercise May Reduce OFF-time and Enhance Quality of Life in Older Adults with Parkinson’s Disease Restricted; Files Only

Abstract

Background: Parkinson’s Disease (PD) is commonly treated with the dopamine precursor, levodopa. After some years on this medication, many individuals with PD experience medication-related motor fluctuations (MRMF) or OFF-time in which troubling motor and non-motor symptoms previously alleviated by levodopa return. OFF-time is one of the most disconcerting features of PD. Exercise, specifically dance, could be a beneficial adjunctive therapy to address OFF-time in individuals and enhance quality of life (QOL) and independence in people with PD.

Objective: To determine if a three-month program of partnered dance aerobic exercise (PDAE) and walking aerobic exercise (WALK) are effective in reducing OFF-time and enhancing QOL and independence, and if PDAE is superior to WALK at reducing OFF-time.

Methods: Participants were randomized into 30 hours of PDAE or WALK over 3 months. Psychosocial questionnaires, MDS-UPDRS, and 3-day OFF-state diaries were administered at baseline and after three months to measure reported OFF-time, QOL, independence, and disease severity. Within-group comparisons were analyzed using paired t-tests, and between-group comparisons were analyzed using independent t-tests and a linear mixed-effects model.

Results: After three months, PDAE reduced OFF-time and improved motor symptoms. Compared to WALK, PDAE reduced OFF-time, improved motor symptoms, and enhanced the experience of daily living.

Conclusion: PDAE is superior to WALK and is an effective adjunctive therapy to help improve OFF-time and QOL in individuals with PD after three months. Further studies are needed to determine the relationship between improving OFF-time and quality of life.

Table of Contents

 

Abstract........................................................................................................................................... 1

Introduction and Background.......................................................................................................... 2

Parkinson’s Disease..................................................................................................................... 2

Diagnostic criteria for PD........................................................................................................ 2

Common functional impairments in PD.................................................................................. 4

Common treatments for PD: levodopa.................................................................................... 7

Downsides of levodopa: OFF-time.......................................................................................... 7

Additional pharmacological approaches................................................................................ 10

Exercise, Dance, and PD: An alternative and engaging intervention strategy.......................... 11

Methods......................................................................................................................................... 13

Participants................................................................................................................................ 14

Interventions.............................................................................................................................. 16

Partnered Dance-Aerobic Exercise (PDAE).......................................................................... 17

Walking Aerobic Exercise (WALK)..................................................................................... 19

Evaluations................................................................................................................................ 19

Disease Severity and OFF-time............................................................................................. 19

Self-Administered Psychosocial Questionnaires – QOL and Independence Measures......... 20

Statistical Analysis.................................................................................................................... 23

Results........................................................................................................................................... 24

Baseline to post-training............................................................................................................ 27

PDAE versus WALK................................................................................................................. 28

Whole study correlations........................................................................................................... 29

Discussion..................................................................................................................................... 30

Improvement in MDS-UPDRS-III and IV................................................................................ 31

Improvement in PDQ-39........................................................................................................... 32

Possible mechanisms for improvement through PDAE............................................................ 34

Limitations and future directions............................................................................................... 36

Conclusion..................................................................................................................................... 37

References..................................................................................................................................... 38

Tables and Figures

Table 1: Movement Disorder Society Diagnosis Criteria for Parkinson’s Disease            1

Figure 1: Consort Diagram of Participants                                                                       14

Table 2: Participant’s Demographic and Clinical Characteristics at Baseline                  15

Figure 2: Hypothesized Beneficial Outcomes of Partnered Dance Aerobic

Exercise                                                                                                                             18

Table 3: WALK versus PDAE Baseline, Post-training, and Δ in QOL/Independence Outcome Measures             24

Table 4: WALK versus PDAE Baseline, Post-training and Δ in OFF-time Outcome Measures                 27

Table 5: Pearson Correlations between the percent change of the percentage of

waking hours spent in the OFF-state and percent change in QOL and independence measures for both groups                30

About this Honors Thesis

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School	Emory College
Department	Neuroscience and Behavioral Biology
Degree	B.S.
Submission	Honors Thesis
Language	English
Research Field	Health Sciences, Alternative Medicine Biology, Neuroscience Health Sciences, Aging
Keyword	Aerobic Exercise Adapted Argentine Tango Independence Levodopa Quality of Life Dance Parkinson's Disease OFF-time
Committee Chair / Thesis Advisor	Madeleine Hackney, Emory University
Committee Members	J. Alex Grizzell, Emory University J. Lucas Mckay, Emory University

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