The Effect of a Multimodal Exercise Intervention on Interlimb Coordination in Individuals with Parkinson’s Disease

Abstract

Background Interlimb coordination, between arms, legs, and arm – leg pairs, is affected by Parkinson’s Disease. The impaired coordination is not the result of slower gait speed, a common characteristic of Parkinson’s gait, but a result of the reduction of scaling and amplitude of movement. Interlimb coordination assists in the regulation of angular momentum about the body’s center of mass, by providing cancellation of the momentum generated, especially in the transverse and sagittal planes. Inclusion of coordinative exercises in interventions to improve balance and gait for individuals with PD has been emphasized in the literature, but not often reported as an objective outcome. The primary aim of this study was to investigate the effect of a 24 session performance-based gait training program on interlimb coordination for individual with Parkinson’s Disease. Methods Individuals with mild to moderate PD were recruited to participate in a 24 session multimodal exercise training program. Each session focused on full body movements at a moderate intensity for 60 minutes twice a week. Participants were fitted with six inertial measurement units and completed a 10 minute walk test overground before and after the intervention. The primary and secondary outcomes were interlimb coordination, as measured by the point estimate of relative phase and the phase coordination index, speed, distance, and cadence. Coordination was calculated between arm, leg, and contralateral arm – leg pairs, accounting for the more affected (MA) and less affected (LA) sides. Results 13 participants (7 males) completed the 24 session program. Leg coordination did not change between pre-(170.7517.20) and post-(169.2420.83) assessments. Coordination between arms improved from 161.528.72 to 168.089.63, Phase Coordination Index (PCI) (10.37  4.86% to 7.13  5.01%). The more affected arm – leg pair was closer to in-phase (25.3±12.2° vs 19.1±9.3°), while the less affected pair maintained the phase relationship (19.2±12.6° vs 20.1±11.8°). Distance (89.3277.20m), speed (0.140.12m/s), and cadence (6.2 steps/min) increased. Speed was correlated to MA coordination at the pre- (r = -0.4731) and post- (r = -0.6455) assessment. LA correlated to speed only at the pre assessment (r = -0.5133). Discussion Coordination between the leg – leg pair was not different between pre- and post-assessment, however, coordination improved between arms. Coordination between the more affected arm – leg pair improved, but was not altered for the less affected pair. Speed and cadence were not correlated to coordination between arms or between legs at either assessment, but were related to the coordination between the more affected arm – leg pair. Conclusion This pilot study provides preliminary evidence that interlimb coordination between arms and arm – leg pairs is improved after a multimodal, moderate intensity, exercise training program.