Cognitively Challenging Agility Boot Camp Program for Freezing of Gait in Parkinson Disease

Abstract

Introduction. It is well documented that freezing of gait (FoG) episodes occur in situations that are mentally challenging, such as dual tasks, consistent with less automatic control of gait in people with Parkinson disease (PD) and FoG. However, most physical rehabilitation does not include such challenges. The purpose was to determine (1) feasibility of a cognitively challenging Agility Boot Camp-Cognitive (ABC-C) program and (2) effects of this intervention on FoG, dual-task cost, balance, executive function, and functional connectivity. Methods. A total of 46 people with PD and FoG enrolled in this randomized crossover trial. Each participant had 6 weeks of ABC-C and Education interventions. Outcome measures were the following: FoG, perceived and objective measures; dual-task cost on gait; balance; executive function; and right supplementary motor area (SMA)-pedunculopontine nucleus (PPN) functional connectivity. Effect sizes were calculated. Results. ABC-C had high compliance (90%), with a 24% dropout rate. Improvements after exercise, revealed by moderate and large effect sizes, were observed for subject perception of FoG after exercise, dual-task cost on gait speed, balance, cognition (Scales for Outcomes in Parkinson's disease-Cognition), and SMA-PPN connectivity. Conclusions. The ABC-C for people with PD and FoG is a feasible exercise program that has potential to improve FoG, balance, dual-task cost, executive function, and brain connectivity. The study provided effect sizes to help design future studies with more participants and longer duration to fully determine the potential to improve FoG.

Keywords: Parkinson disease; brain imaging; exercise.

Conflict of interest statement

Conflict of Interest Statement: Dr. Horak has an equity interest in APDM, a company that may have a commercial interest in the results of this study. This potential conflict of interest has been reviewed and managed by the Research & Development Committee at the VA Portland Health Care System and Oregon Health & Science University. They have put in place a plan to help ensure that this research study is not affected by the financial interest.

Figures

Appendix 3 Figure:

Association between FoG Ratio at baseline and delta for the Education (A) and ABC-C (B) interventions.

Figure 1:

Study design

Figure 2:

Consort diagram

Figure 3:

Mean (and SEM) over the three time-point in the 2 groups (exercise first and education first) and bar graphs (Mean±SEM) of the delta for: A) NFOG-Q, B) FoG Ratio, C) Dual-task cost on gait speed, and D) SMA-PPN Connectivity.