The Adapted Resistance Training with Instability Randomized Controlled Trial for Gait Automaticity

Bianca Vieira-Yano, Douglas N. Martini, Fay B. Horak, Andrea de Lima-Pardini, Filipe Almeida, Vagner P. Santana, Daniel Lima, Alana X. Batista, Raquel Marquesini, Jumes Lira, Egberto R. Barbosa, Daniel M. Corcos, Carlos Ugrinowitsch, Carla Silva-Batista*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Deficits in the cerebellar locomotor region (CLR) have been associated with loss of gait automaticity in individuals with freezing of gait in Parkinson's disease (freezers); however, exercise interventions that restore gait automaticity in freezers are lacking. We evaluated the effects of the adapted resistance training with instability ([ARTI] complex exercises) compared with traditional motor rehabilitation (without complex exercises) on gait automaticity and attentional set-shifting. We also verified associations between gait automaticity change and CLR activation change previously published. Methods: Freezers were randomized either to the experimental group (ARTI, n = 17) or to the active control group (traditional motor rehabilitation, n = 15). Both training groups performed exercises 3 times a week for 12 weeks. Gait automaticity (dual-task and dual-task cost [DTC] on gait speed and stride length), single-task gait speed and stride length, attentional set-shifting (time between Trail Making Test parts B and A), and CLR activation during a functional magnetic resonance imaging protocol of simulated step initiation task were evaluated before and after interventions. Results: Both training groups improved gait parameters in single task (P < 0.05), but ARTI was more effective than traditional motor rehabilitation in improving DTC on gait speed, DTC on stride length, dual-task stride length, and CLR activation (P < 0.05). Changes in CLR activation were associated with changes in DTC on stride length (r = 0.68, P = 0.002) following ARTI. Only ARTI improved attentional set-shifting at posttraining (P < 0.05). Conclusions: ARTI restores gait automaticity and improves attentional set-shifting in freezers attributed to the usage of exercises with high motor complexity.

Original languageEnglish (US)
Pages (from-to)152-163
Number of pages12
JournalMovement Disorders
Volume36
Issue number1
DOIs
StatePublished - Jan 2021

Keywords

  • Freezers; dual-task cost; cerebellar locomotor region; attentional control; motor complexity

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology

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