Chinese Exercise Modalities in Parkinson's Disease
Chinese Exercise Modalities in Parkinson's Disease
This study will compare the effects of two Chinese and one Western exercise modalities on the
 signs and symptoms of Parkinson's disease.
The long-term goal of this project is to study the effects of different exercise modalities
 on Parkinson's disease (PD). PD is a disorder whose primary disability stems from motor
 dysfunction including balance. Recent studies have shown that the risk of falling in the
 elderly can be reduced through the practice of the Chinese complementary and alternative
 medicine (CAM) such as T'ai Chi Chuan (TCC). This finding may be highly significant to PD.
 Although a recent report from Emory suggests PD patients can do well with aerobic (walk-run)
 exercise training (AET), it is still unclear whether the potential anti-Parkinsonian effect
 of such modalities is secondary to improved physical fitness (CRF), motor control or both.
 CAM interventions such as TCC may offer a unique opportunity to examine these fundamental
 questions.

 In PD we hypothesize that exercise training will reduce primary and secondary disability and
 that some of these changes represent adaptive reprogramming of central motor pathways. We
 will conduct a controlled double-blind, 16-week dose-response study of exercise based on
 caloric expenditure and thus on the cardiorespiratory fitness effects of exercise (CRF). The
 treatments will be Qi Gong (minimal caloric expenditure), TCC (low expenditure), and
 walk-cycle AET (moderate expenditure).

 We will examine exercise-induced change in motor control using quantitative measures of motor
 disability, including dynamic gait stability measures. We will also examine exercise effects
 on central and peripheral indices of Parkinsonian motor disability.

 A caloric "dose-response" effect of exercise would suggest CRF is a major determinant of the
 anti-Parkinsonian effects of exercise. If the Chinese modalities are as effective or superior
 to AET however, this would suggest that other mechanisms such as change in central motor
 programming may be playing a role (e.g. relaxation effects, reinforcement of central motor
 programs?). A better understanding of exercise-induced neural plasticity and motor control
 would offer a significant, and heretofore unexploited rehabilitative potential in PD.
Inclusion Criteria:

 -  Ambulatory patients with Parkinson's Disease, defined as a clinical state in which at
 least two of these four cardinal features are present- 1) slowness of movement, 2)
 tremor at rest, 3) muscular rigidity, 4) gait disturbance or posture imbalance.

 -  Ambulatory patients with Parkinson's Disease not exercising regularly more than 2x per
 week. Willing to be randomly assigned to 1 of the 3 exercise modalities: Tai Chi, Qi
 Gong and Aerobic exercise.

 NOTE THAT PARTICIPATION IN THE STUDY REQUIRES BI-WEEKLY PARTICIPATION IN A 16-WEEK
 SUPERVISED EXERCISE PROGRAM PLUS RELATED EVALUATIONS AT EMORY. ACCORDINGLY, RECRUITMENT IS
 LIMITED TO LOCAL PATIENTS.