Inbal Maidan, Keren Rosenberg-Katz, Yael Jacob, Nir Giladi, Jeffrey M Hausdorff, Anat Mirelman
Overview
Comparing the effects of two forms of exercise, namely treadmill training combined with virtual reality (TT + VR) aimed at motor and cognitive aspects of safe ambulation and treadmill training alone (TT), on brain activation in patients with Parkinson disease (PD).
Methods:
As part of a randomized controlled trial, patients were randomly assigned to 6 weeks of TT (n = 17, mean age 71.5 ± 1.5 years, disease duration 11.6 ± 1.6 years; 70% men) or TT + VR (n = 17, mean age 71.2 ± 1.7 years, disease duration 7.9 ± 1.4 years; 65% men). A validated fMRI imaging paradigm measured changes in neural activation pre- and post-training. Two virtual scenes were projected in the fMRI: (1) a path with no obstacles and (2) a path with virtual obstacles. The whole brain and the region of interest were analyzed.
Results:
Brain activation patterns were similar between training arms before the interventions. Participants in the TT + VR arm had lower activation after training than the TT group arm in Brodmann area 10 and the inferior frontal gyrus (cluster level familywise error–corrected [FWEcorr] p < 0.012), while the TT arm had lower activation than TT + VR in the cerebellum and middle temporal gyrus (cluster level FWEcorr p < 0.001). In the TT + VR arm, changes in fall frequency and brain activation were correlated.
Conclusions:
Exercise modifies brain activation patterns in patients with Parkinson’s disease in a mode-specific way. As a result of motor-cognitive training, the reliance on frontal regions was reduced, possibly reflecting a greater degree of brain efficiency.
The V-TIME academic research project has led to many of these papers, and is implemented commercially by GaitBetter.