Blood Lactate Concentrations With and Without Exercise in Parkinson's Disease and Multiple Sclerosis Patients (PDMSLac)

Phase 1 Study of A Double-Blind Placebo-Controlled Study of the Effect of Beta-Alanine and Whole Body Vibration on Neurologic Motoric Function, Vascular Function, and Quality of Life in Parkinson's Disease

Fatigue is one of the most common and debilitating symptoms experienced in Parkinson's Disease (PD) and Multiple Sclerosis (MS). There are multiple proposed mechanisms of disorder-related fatigue, however, it is unknown whether PD or MS patients experience compromised blood lactate responses to an acute bout of exercise, subjecting them to exercise-related fatigue. These populations may experience higher energy expenditure at rest due to increased rigidity, however, limited data exists investigating resting energy expenditure in these populations.

Researchers hypothesize that PD and MS patients will display higher resting energy expenditure than healthy age-matched controls, and that level of energy expenditure will correlate with amount of rigidity or spasticity. Also, we hypothesize that baseline levels of lactate will not be different between PD/MS and control groups, but post-exercise blood lactate levels will be significantly higher in the PD/MS groups.

Study Overview

• Status: Completed
• Conditions: Multiple Sclerosis; Parkinson's Disease
• Intervention / Treatment: Device: pro5 AIRdaptive Power Plate (Badhoevedorp, The Netherlands)

Detailed Description

Patients diagnosed with Parkinson's Disease (PD) and Multiple Sclerosis (MS) frequently experience increased levels of muscle weakness and fatigue; This impairment is exacerbated with onset of exercise and alleviated with rest or sleep . Importantly, in about 1/3 of PD patients, fatigue is considered debilitating , and even further, there is inconclusive evidence suggesting that anti-PD and anti-MS drugs improve fatigue. The precise mechanisms and pathogenesis of the disorder-specific fatigue in PD and MS remain elusive.

Both peripheral and central cholinergic systems are affected in PD , however, it has been shown that peripheral cholinergic neurons at the neuromuscular junction are normal functioning . Even so, recruitment of necessary motor units may be greatly affected due to peripheral neuropathy common in both PD and MS . Following repetitive nerve stimulation in PD and MS, there is consistent evidence of a decrease in the number of functioning motor units and decrements in muscle responses. This promotes progressive fatigue with decrements in the amplitude of movement. Therefore, recruitment of motor units may be a major cause of rapid fatigue in repetitive movement with PD and MS patients, even though peripheral neuromuscular junctions do not seem to be affected. In addition to skeletal muscle inefficiency, work rate and efficiency of breathing using respiratory muscles is significantly lower in a PD population during repetitive stimulation, used to simulate exercise-induced repetitive contractions. Respiratory inefficiencies in MS include, but are not limited to reduced forced vital capacity, hypoxemia, and respiratory muscle weakness.

In addition to possible neurological mechanisms of PD- and MS-related fatigue, rigidity, defined as involuntary state of continuous muscle tension in PD, and spasticity and rigidity in MS may also have a profound effect on fatigue outcomes . Adequate muscle length is required for effective muscle contraction. Rigidity likely changes the length of the muscle at rest, and therefore contributes to ineffective muscle contraction when active. In addition to inefficient muscle contraction, the increased continuous active contraction, or tone, of the muscle results in an increase in resting energy expenditure compared to healthy individuals, even in pharmacologically treated PD patients. Interestingly, resting energy expenditure in MS patients was shown to be comparable to age-matched healthy controls; however, it is important to note that these MS patients remained medicated during the study. In addition, rigidity and spasticity, common in PD and MS, respectively may provide varying levels of resting energy expenditure; however, no research to date has examined these differences. In total, if more energy is being expended at rest, hypothetically, PD and MS patients will have inadequate energy stores to exercise to their respective full capacity. This could potentiate early onset of lactic acid and hydrogen accumulation in active muscle, decrease the pH of the active muscle, and contribute to early fatigue in repetitive tasks.

Purportedly, the combination of early onset of skeletal and respiratory muscle fatigue, in addition to muscle rigidity would create an environment similar to that of high intensity exercise, even at low intensities or rest. The ensuing result may likely be an accumulation of lactic acid and hydrogen ions, making the muscle environment very acidic. However, changes in the levels of resting and post-exercise blood lactate levels have not been elucidated. Therefore, we are planning to measure resting energy expenditure using a ventilation face mask and a noseclip. Blood lactate will be sampled at rest, after simulated high-intensity exercise, and ten minutes after rest (when lactate significantly increases). The exercise will consist of performing 5 sets of static, shallow 120 degree squats for 1 minute, with 1 minute of seated rest between each squat. Sustained isometric contraction at 2/3 of the maximal voluntary contractile force for 2 to 3 minutes was found to occlude local blood flow enough that local oxygen stores were depleted . Muscle lactate is also increased 12-fold upon fatigue of isometric holds such as squats. This same environment of lactic acid buildup can be simulated by circulatory occlusion as well as 60-second isometric quadricep contractions . Isometric squats will be employed to observe differences in blood response in PD compared to healthy individuals.

Therefore, the purpose of this study is to analyze the differences in resting energy expenditure and exercise-induced lactate production in PD and MS compared to healthy, age-matched controls.

• Study Type: Interventional
• Enrollment (Actual): 34
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Florida
    • Tallahassee, Florida, United States, 32306
      • Fitness and Wellness Center
    • Tallahassee, Florida, United States, 32308
      • Balance Disorders Clinic

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 41 years to 86 years (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Parkinson's Disease Stage I-IV (be standard criteria H&Y scale)
• Multiple Sclerosis
• Healthy, age-matched controls
• 45 to 90 years old

Exclusion Criteria:

• Dementia
• Co-morbid neurologic factors
• Individuals without independent ambulation
• Significant heart and respiratory disease
• Debilitating arthritis

Study Plan

How is the study designed?

Design Details

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

Number of Arms

3

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Blood Lactate Response in PD; This arm involves performing 5 sets of 1-minute squats with 1 minute of rest between each, and a finger prick before, after, and 10 minutes after the exercise in a PD population. One set of the squats will be performed on a whole body vibration plate (pro5 AIRdaptive Power Plate (Badhoevedorp, The Netherlands)), and one on the ground.	Device: pro5 AIRdaptive Power Plate (Badhoevedorp, The Netherlands); Subjects will be exposed to vertical vibration with a frequency and peak-to-peak displacement of 30 Hz and 1 mm, respectively, which provides a peak-to-peak acceleration of about 4.16 G. Whole Body Vibration
Experimental: Blood Lactate Response in MS; This arm involves performing 5 sets of 1-minute squats with 1 minute of rest between each, and a finger prick before, after, and 10 minutes after the exercise in an MS population. One set of the squats will be performed on a whole body vibration plate (pro5 AIRdaptive Power Plate (Badhoevedorp, The Netherlands)), and one on the ground.	Device: pro5 AIRdaptive Power Plate (Badhoevedorp, The Netherlands); Subjects will be exposed to vertical vibration with a frequency and peak-to-peak displacement of 30 Hz and 1 mm, respectively, which provides a peak-to-peak acceleration of about 4.16 G. Whole Body Vibration
Experimental: Blood Lactate Responses in Controls; This arm involves performing 5 sets of 1-minute squats with 1 minute of rest between each, and a finger prick before, after, and 10 minutes after the exercise in healthy, older adults. One set of the squats will be performed on a whole body vibration plate (pro5 AIRdaptive Power Plate (Badhoevedorp, The Netherlands)), and one on the ground.	Device: pro5 AIRdaptive Power Plate (Badhoevedorp, The Netherlands); Subjects will be exposed to vertical vibration with a frequency and peak-to-peak displacement of 30 Hz and 1 mm, respectively, which provides a peak-to-peak acceleration of about 4.16 G. Whole Body Vibration

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Blood Lactate Response	Measured using a blood lactate analyzer, a finger prick test measured before, after, and 10 minutes after exercise	Before, immediately after, and 10 minutes after the squatting exercise protocol

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resting Energy Expenditure	Measured using using indirect calorimetry with a ventilated face mask and noseclip (Parvometrics, Sandy, UT). This involves laying supine for 30 to 60 minutes.	Measured immediately upon arriving to the laboratory. Lasted approximately 25 minutes.

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Neurological Function	Neurological functional state will be assessed using the Unified Parkinson's Disease Rating Scale (UPDRS). Of the 5 sections of the examination, two parts were used. Part II (self-evaluation of aspects of the experiences of daily living) consisted of 13 Likert scale questions (graded 0 to 4, with 4 being most severe), including speech, saliva and drooling, chewing and swallowing, eating tasks, dressing, hygiene, handwriting, doing hobbies and other activities, turning in bed, tremor, getting out of bed/car/deep chair, walking and balance, and freezing. Part III (motor evaluation performed by trained research personnel) consisted of 14 Likert scale questions (graded 0 to 4, with 4 being most severe), including speech, facial expression, rigidity, finger tapping, hand movements, pronation-supination movements of hands, toe tapping, leg agility, arising from chair, gait, etc... Values were summed, with higher values indicating increased impairment and disability.	Measured immediately after the resting energy expenditure measurement, and before the other questionnaires. Lasted approximately 15 minutes.
Health and Activity Questionnaire	Short Form 36 Health Survey questionnaire: patient-reported survey of 36 questions, yielding the participant's degree of health on 8 different scale scores (each scale summed into a 0-100 score, with lower scores indicating more disability). The eight scales include vitality, physical functioning, bodily pain, general health perceptions, physical role functioning, emotional role functioning, social role functioning, and mental health. Schwab and England Activities of Daily Living Questionnaire: self-rated, single item assessment of the participant's ability to perform daily activities with speed and independence, measured using a Likert scale of percentages, in 10% increments. A score of 100% indicates total independence, while 0% indicates complete dependence.	Collected immediately after the UPDRS (if PD population), or immediately after the resting energy expenditure measurement (if MS or healthy, older adult). Measured with other questionnaires and immediately before squatting exercise. Lasted ~10 minutes.
Fatigue/Depression Assessment	Fatigue Severity Scale: 9-item, self-reporting rating that rates the severity of your fatigue symptoms on a Likert scale ranging from 1 to 7, with 1 indicating strong disagreement, and 7 indicating strong agreement. The sum of scores is calculated. The lower the score, the more severe the participant's fatigue symptoms. Beck's Depression Inventory: 21-item, self-report rating inventory that measures characteristic attitudes and symptoms of depression on a Likert scale ranging from 0 to 3, with 3 being the most severe. The sum of scores is calculated. A high score indicates more severe depression and related symptoms.	Collected at the same time as the other questionnaires. Lasted approximately 5-7 minutes.

Collaborators and Investigators

• Sponsor: Florida State University

Study record dates

Study Major Dates

• Study Start: August 1, 2014
• Primary Completion (Actual): November 1, 2014
• Study Completion (Actual): December 1, 2014

Study Registration Dates

• First Submitted: July 2, 2014
• First Submitted That Met QC Criteria: July 8, 2014
• First Posted (Estimate): July 9, 2014

Study Record Updates

• Last Update Posted (Actual): March 30, 2017
• Last Update Submitted That Met QC Criteria: March 7, 2017
• Last Verified: March 1, 2017

More Information

Terms related to this study

• Keywords: Multiple Sclerosis; Exercise; Fatigue; Parkinson's Disease; Whole Body Vibration; Resting Energy Expenditure; Blood Lactate
• Additional Relevant MeSH Terms: Pathologic Processes; Brain Diseases; Central Nervous System Diseases; Nervous System Diseases; Immune System Diseases; Demyelinating Autoimmune Diseases, CNS; Autoimmune Diseases of the Nervous System; Demyelinating Diseases; Autoimmune Diseases; Parkinsonian Disorders; Basal Ganglia Diseases; Movement Disorders; Synucleinopathies; Neurodegenerative Diseases; Multiple Sclerosis; Sclerosis; Parkinson Disease
• Other Study ID Numbers: 2014:12658; HPN (Other Identifier: FSU Human Performance and Sports Nutrition)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Yes
• IPD Plan Description: If, and when requested, participants may review findings by contacting the PI. Other than participants, only investigators will have access to the data.