Central and Peripheral Fatigue in Individuals With Parkinson's Disease - Evaluation and Training

Fatigue is one of the most common symptoms in individuals with Parkinson's Disease (PD). Past research indicated that more than half of the individuals with PD demonstrated fatigue symptom. The severity of fatigue was also correlated to the quality of life in individuals with PD. Finding the contributions of the central and the peripheral factors to fatigue and developing an effective training program for individuals with PD are very important.

Fatigue can be categorized into peripheral or central causes. The central fatigue and voluntary activation failure originate from the decrease in motivation or the reduction of the conduction within corticospinal tracts. Long term activation failure and central fatigue will cause disuse of muscle and result in peripheral weakness and peripheral fatigue. Quantifying the weighting of central versus peripheral factors contributing to the fatigue in people with PD is important.

Most of the conventional strength and endurance training programs were based on the researches of young groups. Almost no training program was design for enhancing the voluntary activation level and relief the central fatigue. Seeking an appropriate training program to enhance central activation is very important for individuals with PD who prone to fatigue.

Previous studies have shown that increasing afferent input by peripheral electrical stimulation (ES) at sensory threshold enhanced the plasticity of contralateral primary sensory cortex, the excitability of corticospinal tracts, and the functional performance in young adults. Combining afferent input with strength training was more effective than strength training along. ES, which is easy to quantify the dose of afferent input, is a feasible method to provide such training.

The purpose of this project is to investigate the effects of the combination of ES at sensory threshold and strength training on voluntary activation in the individuals with PD.

Study Overview

• Status: Completed
• Conditions: Parkinson Disease(PD)
• Intervention / Treatment: Device: Electronic muscle stimulator; Other: Muscle strength training

• Study Type: Interventional
• Enrollment (Actual): 66
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Taiwan
  • Taoyuan, Taiwan, 333
    • Chang Gung University

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 20 years to 80 years (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Health subjects:

Exclusion Criteria:

• Musculoskeletal injuries for knee.
• Osteoporosis.
• Diabetes.

PD subjects:

Inclusion Criteria:

• Clinical diagnosis of Parkinson disease.

Exclusion Criteria:

• Musculoskeletal injuries for knee.
• Osteoporosis.
• Diabetes.
• Any peripheral or central nervous system injury or disease patients.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

6

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
No Intervention: Stage 1: Health control; pilot study: Establishing the central and peripheral contributing factors to the voluntary muscle strength loss during a fatiguing exercise in young and PD groups.
No Intervention: Stage 1: PD subjects; pilot study: Establishing the central and peripheral contributing factors to the voluntary muscle strength loss during a fatiguing exercise in young and PD groups.
No Intervention: Stage 2: Health subjects; pilot study: Finding optimal sensory stimulation parameters for PD individuals.
No Intervention: Stage 2: PD subjects; pilot study: Finding optimal sensory stimulation parameters for PD individuals.
Experimental: Stage 3: PD subjects; Investigating the long-term effects of combined sensory stimulating strengthening program on the activation level and central fatigue in PD individuals.	Device: Electronic muscle stimulator; Participants will perform 8 weeks of electrical stimulation for Quadriceps muscle belly(30 minutes/time, 3 times/week).; Other: Muscle strength training; Participants will perform 8 weeks of isotonic contraction muscle strength training for lower extremities.
No Intervention: Stage 3: PD subjects (Control Subjects); Investigating the long-term effects of combined sensory stimulating strengthening program on the activation level and central fatigue in PD individuals.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Muscle twitch force	Measure of changes in muscle twitch force by interpolation twitch technique.	baseline, 8 weeks.
Muscle voluntary activity level	Measure of changes in muscle voluntary activity level by interpolation twitch technique.	Baseline,8 weeks
Muscle strength test for lower extremities.	Measure of changes in muscle strength test by clinical test.	Baseline, 8 weeks
The central activation and the excitability of motor cortex	Measure of changes in the central activation and the excitability of motor cortex by Transcranial magnetic stimulation.	Baseline,8 weeks

Collaborators and Investigators

• Sponsor: Chang Gung University

Study record dates

Study Major Dates

• Study Start (Actual): December 18, 2012
• Primary Completion (Actual): September 11, 2014
• Study Completion (Actual): May 10, 2015

Study Registration Dates

• First Submitted: October 18, 2013
• First Submitted That Met QC Criteria: October 24, 2013
• First Posted (Estimated): October 29, 2013

Study Record Updates

• Last Update Posted (Actual): March 28, 2024
• Last Update Submitted That Met QC Criteria: March 26, 2024
• Last Verified: March 1, 2024

More Information

Terms related to this study

• Keywords: Muscle strength, fatigue, electromyography (EMG), central fatigue, strength straining
• Additional Relevant MeSH Terms: Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Parkinsonian Disorders; Basal Ganglia Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases; Parkinson Disease
• Other Study ID Numbers: 100-3167A3