Aerobic walking using continuous heart rate training.

Aerobic walking using interval heart rate training

Participants who were randomized to continuous training in the first 2 years of the study.

Continuous Training-Years 1 & 2

Participants who were randomized to interval training in the first 2 years of the study.

Interval Training -Years 1 & 2

Participants who were assigned to continuous training in the third year of the study without randomization. Due to potentially increased risk of knee pain without additional fitness benefits, we dropped the interval group for the third year.

Continuous-Year 3

Total

Sex: Female, Male

Region of Enrollment

Education

Disease duration (years)

Modified Hoehn and Yahr Scale (higher values are worse) 1.0: Unilateral involvement only 1.5: Unilateral and axial involvement 2.0: Bilateral involvement without impairment of balance 2.5: Mild bilateral disease with recovery on pull test 3.0: Mild to moderate bilateral disease; some postural instability; physically independent 4.0: Severe disability; still able to walk or stand unassisted 5.0: Wheelchair bound or bedridden unless aided

modified Hoehn-Yahr Scale

Unified Parkinson's Disease Rating Scale (UPDRS) is an ordinal scale with all items scored from 0=normal function to 4=very severely disabled. Section III: UPDRS motor section is based on physical examination evaluates the components of parkinsonism (tremor, rigidity, bradykinesia, gait/posture). There are 27 items resulting in a maximum score of 108 (range 0-108). Higher scores are worse.

UPDRS- Section III score

Total antiparkinsonian treatment daily dose expressed in levodopa equivalents per Tomlinson et al (PMID:21069833)

Levodopa equivalent/day

VO2max

Score ranges from 0-30. Higher scores are better.

Montreal Cognitive Assessment

VO2max after the training - VO2max at baseline (Adjusted for levodopa-equivalent, year, training mode, setting).
Please see publication PMID: 24991037 for details.

The participants who completed 6 months of aerobic training

Completers

Change in Aerobic Fitness

Time complete the 7 m Walk test after 6 months aerobic training - Time complete the 7 m Walk test at baseline

The participants who completed 6 months of aerobic training. Because all treatment arms were designed to deliver a similar average aerobic intensity, we planned to pool a priori all completers from the Continuous and Interval Training Arms for analysis.

Change in 7 Meter Walk Time

=Score after 6 months training - baseline score Unified Parkinson's Disease Rating Scale (UPDRS) is an ordinal scale with all items scored from 0=normal function to 4=very severely disabled. It has 3 sections: I) Mental, Behavior, and Mood: Comprises four questions on intellectual impairment, thought disorder, depression, and apathy (scores range 0-16). II) The Activities of Daily Living (ADL) subscale is based on interview and comprises 13 items (scores range 0-52). III) UPDRS motor section is based on physical examination evaluates the components of parkinsonism (tremor, rigidity, bradykinesia, gait/posture). There are 27 items resulting in a maximum score of 108. Higher scores are worse.

Change in the UPDRS Section I Score

Change in UPDRS Section II Score

=Score after 6 months of training - baseline score. The Fatigue Severity Scale (FSS) is a self-administered unidimensional generic 9-item fatigue rating scale. These are rated on a seven-grade Likert scale of which only the respective ends are defined (''completely disagree''=1 to ''completely agree''=7). The total FSS score represents the mean score of each of the nine items, yielding a score range between 1 and 7, higher scores indicating a higher level of fatigue.

Change in Fatigue Severity Scale Score

=Score after 6 months training - score at baseline. The Geriatric Depression Scale (GDS)-short form is a 15 item yes/no questionnaire. The range is 0-15 and scores >5 suggest depression. Higher scores are worse.

Change in Geriatric Depression Scale Score

= PDQUALIF score after 6 months training - baseline score The PDQUALIF is a 32 item questionnaire resulting in 7 factors. . Subjects rate themselves between 1 (most favorable) and 5 (least favorable) on a Likert scale. Factor scores are standardized to100 and lower scores are better. The outcome measure is the average of these 7 factor scores.

Change in Parkinson's Disease Quality of Life Scale (PDQUALIF) Score

Change in the UPDRS Section III Score

=Score after 6 months training - baseline score The total UPDRS score is calculated by adding Section I, Section II, and Section III scores (below). Higher scores are worse. The score ranges 0-176.
Unified Parkinson's Disease Rating Scale (UPDRS) is an ordinal scale with all items scored from 0=normal function to 4=very severely disabled. It has 3 sections: I) Mental, Behavior, and Mood: Comprises four questions on intellectual impairment, thought disorder, depression, and apathy (scores range 0-16). II) The Activities of Daily Living (ADL) subscale is based on interview and comprises 13 items (scores range 0-52). III) UPDRS motor section is based on physical examination evaluates the components of parkinsonism (tremor, rigidity, bradykinesia, gait/posture). There are 27 items resulting in a maximum score of 108.

Change in the Total UPDRS Score

=Score after 6 months training - baseline score. MOCA=Montreal Cognitive Training Assessment Scores range 0-30, higher is better.

Change in the MOCA Score

performance on the Eriksen's flanker task (see PMID: 24991037). Participants were asked to identify the orientation of a central arrow cue ('<' or '>'), which was flanked on both sides by two arrow cues that either pointed in the same direction (congruent: <<<<<) or a different direction (incongruent: >><>>). Using reaction times (RT) during congruent and incongruent trials, the PIS was calculated as =((RT_incongruent - RT_congruent) / RT_congruent) * 100. Higher PIS is worse.

Change in Percent Increase Score (PIS) on Eriksen's Flanker Task

=amount after 6 months training - amount at baseline Total antiparkinsonian treatment daily dose expressed in levodopa equivalents per Tomlinson et al (PMID:21069833). Higher scores are worse.

Change in LEDD (Levodopa Equivalent Daily Dose)

The duration of exercise sessions (3x/week) was advanced from 15 to 45 minutes over the first 6 weeks. Participants were asked to wear electronic heart rate and walking speed monitors (Polar RS400, Kempele, Finland) and fill out diaries for each session. The goal for continuous training was to remain within 70-80% of HRmax throughout the session.

Continuous Training - Years 1 & 2

The duration of exercise sessions (3x/week) was advanced from 15 to 45 minutes over the first 6 weeks. Participants were asked to wear electronic heart rate and walking speed monitors (Polar RS400, Kempele, Finland) and fill out diaries for each session. Interval trainees alternated every 3 minutes between slower (60-70% of HRmax) and faster (80-90% of HRmax) walking.

Interval Training - Years 1 & 2

Participant were assigned to continuous training without randomization.

Continuous Training - Year 3

Years 1 & 2

Year 3

Ergun Y. Uc, MD

This group consists of 21 subjects who were randomized to continuous training in the first two years of the study and 17 subjects who were assigned to continuous training without randomization in the third year of the study. Thus, total group size is 38.

Continuous Training

This group consists of 22 subjects who were randomized to interval training in the first two years of the study. No subjects were assigned to the interval training in the third year of the study.

Interval Training

Parkinson Disease

The maximal heart rate (HRmax) in the exercise prescription was based on age[Goldberg, Elliot, and Kuehl1988] and reduced by 20% in participants who used beta-blockers.[Wonisch et al. 2003] The duration of exercise sessions (3x/week) was advanced from 15 to 45 minutes over the first 6 weeks. The goal for continuous training was to remain within 70-80% of HRmax throughout the session.

Continuous training

Interval trainees alternated every 3 minutes between slower (60-70% of HRmax) and faster (80-90% of HRmax) walking [Wisloff et al. 2007].

antiparkinson/insult

Effects of Aerobic Exercise in Parkinson's Disease

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