Re: 파킨슨 증상 서동증, 떨림 등 원심성 근수축저항운동이 효과적

[문형철]

High intensity eccentric resistance training decreases bradykinesia and improves quality of life in persons with Parkinson's disease: A preliminary study

Author links open overlay panelLeland E. Dibble a, Tessa F. Hale b, Robin L. Marcus a, J. Parry Gerber c, Paul C. LaStayo a

Abstract

Persons with Parkinson disease (PD) often demonstrate bradykinesia during mobility tasks. Bradykinesia combined with other PD-related movement deficits may contribute to self-reported reductions in quality of life. At this time, no studies have examined the effects of resistance exercise as an intervention to reduce bradykinesia and improve self-reported quality of life. Therefore, we examined changes in muscle force production, clinical measures of bradykinesia, and quality of life following 12 weeks of a high intensity eccentric resistance exercise program in persons with mild to moderate PD. Twenty individuals with idiopathic PD were matched into an experimental or an active control group. All participants were tested prior to and following a 12-week intervention period. The experimental group performed high intensity quadriceps contractions on an eccentric ergometer 3 days a week for 12 weeks. The active control group participated in an evidence based exercise program of PD. The outcome variables were quadriceps muscle force, clinical bradykinesia measures (gait speed, timed up and go) and disease specific quality of life (Parkinson's disease questionairre-39 [PDQ-39]). Data was analyzed using separate 2 (group) × 2 (time period) ANOVAs. Results demonstrated significant time by group interaction effects for gait speed, timed up and go, and the composite PDQ-39 score (p < 0.05). Muscle force, bradykinesia, and QOL were improved to a greater degree in those that performed high intensity eccentric resistance training compared to an active control group. Additional research is needed to determine if this type of training has long-term impact and if it results in an alteration of the natural history of mobility and QOL decline in persons with PD.

초록

파킨슨병 (PD) 환자는

이동 작업 중에 서동증을 보이는 경우가 많습니다.

서동증은 다른 PD 관련 운동 결손과 함께

자가 보고된 삶의 질 저하를 초래할 수 있습니다.

현재로서는 서동증을 줄이고

자가 보고된 삶의 질을 개선하기 위한 개입으로서

저항 운동의 효과를 조사한 연구는 없습니다.

따라서

저희는 경증에서 중등도 PD 환자를 대상으로

12주 동안 고강도 편심 저항 운동 프로그램을 실시한 후

근력 생성의 변화, 서동증의 임상적 측정치 및 삶의 질을 조사했습니다.

특발성 파킨슨병 환자 20명을 실험군 또는 활성 대조군으로 분류했습니다. 모든 참가자는 12주간의 중재 기간 전과 후에 검사를 받았습니다. 실험 그룹은 12주 동안 일주일에 3일씩 편심 에르고미터에서 고강도 대퇴사두근 수축을 수행했습니다. 활성 대조군은 PD의 증거 기반 운동 프로그램에 참여했습니다. 결과 변수는 대퇴사두근 근력, 임상적 서동 운동 측정(보행 속도, 시간 초과 및 이동), 질환별 삶의 질(파킨슨병 질문지-39[PDQ-39])이었습니다. 데이터는 별도의 2(그룹) × 2(기간) 분산 분석( ANOVA)을 사용하여 분석했습니다. 그 결과 보행 속도, 시간 초과 및 이동, 종합 PDQ-39 점수에 대해 그룹별 상호작용 효과가 유의미한 것으로 나타났습니다(p <0.05).

고강도 편심 저항 훈련을 수행한 그룹은

활동적인 대조군에 비해 근력, 서동 운동 및 QOL이 더 많이 개선되었습니다.

이러한

유형의 훈련이 장기적인 영향을 미치는지,

그리고 이러한 훈련이 파킨슨병 환자의 자연스러운 이동성 및 QOL 저하를 변화시키는지

확인하기 위해서는 추가 연구가 필요합니다.

Background and introduction

Idiopathic Parkinson's disease (PD) is one of the most common degenerative neurologic disorders with an estimated preval‎ence of 128–187 per 100,000 persons and an annual incidence of 20 per 100,000 persons [1], [2]. The cardinal motor deficits of the disease (rigidity, akinesia, bradykinesia, tremor, and loss of postural control) contribute to an on-going deterioration of independence in activities of daily living and quality of life (QOL). Given the progressive nature of PD, and the relatively 

Participant selection criteria

Persons with Hoehn and Yahr stages 1–3 PD receiving care for PD through the Movement Disorders Clinics at local hospitals and physician offices were recruited to participate. Utilizing the within group effect size for muscle strength changes in previous research [10], an a priori power analysis suggested that a sample size of 7 participants in each group would result in statistical power greater than 0.80 at an alpha level of 0.05. A target sample size of twenty participants was recruited to

Results

Twenty individuals with PD were enrolled in the trial (10 eccentric group participants, 10 controls). One participant from the standard care group did not complete the trial because of unrelated health issues; therefore the results reflect 19 participants. There were no significant differences between the groups on any of the demographic variables or outcome measures at the pre-intervention tests (Table 1).

Discussion

In this preliminary study, our overall hypothesis was that PD-related bradykinesia was in part reversible, and that high intensity loading of the quadriceps associated with our experimental group would result in amplified benefit in terms of increased movement speed and QOL relative to our active control group. Our results demonstrated that a 12-week program of high intensity eccentric resistance training can produce improved muscle force production, reduced bradykinesia, and improved QOL in