title: Effects of Moderate-Volume, High-Load Lower-Body Resistance Training on Strength and Function in Persons with Parkinson's Disease: A Pilot Study Test-Retest Reliability and Minimal Detectable Change on Balance and Ambulation Tests, the 36-Item Short-Form Health Survey, and the Unified Parkinson Disease Rating Scale in People With Parkinsonism The effects of an exercise program on fall risk factors in people with Parkinson's disease: a randomized controlled trial. Leg-extension strength and chair-rise performance in elderly women with Parkinson's disease. Reliability of the PEDro scale for rating quality of randomized controlled trials. High intensity eccentric resistance training decreases bradykinesia and improves Quality Of Life in persons with Parkinson's disease: a preliminary study. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease.
abstract: Background . Resistance training research has demonstrated positive effects for persons with Parkinson 's disease ( PD ) , but the number of acute training variables that can be manipulated makes it difficult to determine the optimal resistance training program . Objective . The purpose of this investigation was to examine the effects of an 8-week resistance training intervention on strength and function in persons with PD . Methods . Eighteen men and women were r and omized to training or st and ard care for the 8-week intervention . The training group performed 3 sets of 5–8 repetitions of the leg press , leg curl , and calf press twice weekly . Tests included leg press strength relative to body mass , timed up- and -go , six-minute walk , and Activities-specific Balance Confidence question naire . Results . There was a significant group-by-time effect for maximum leg press strength relative to body mass , with the training group significantly increasing their maximum relative strength ( P < .05 ) . No other significant interactions were noted ( P > .05 ) . Conclusions . Moderate volume , high-load weight training is effective for increasing lower-body strength in persons with PD Background and Purpose : Distinguishing between a clinical ly significant change and change due to measurement error can be difficult . The purpose of this study was to determine test-retest reliability and minimal detectable change for the Berg Balance Scale ( BBS ) , forward and backward functional reach , the  Romberg Test and the Sharpened Romberg Test ( SRT ) with eyes open and closed , the Activities-specific Balance Confidence ( ABC ) Scale , the  Six-Minute Walk Test ( 6MWT ) , comfortable and fast gait speed , the  Timed “ Up & Go ” Test ( TUG ) , the Medical Outcomes Study 36-Item Short-Form Health Survey ( SF-36 ) , and the Unified Parkinson Disease Rating Scale ( UPDRS ) in people with parkinsonism . Subjects : Thirty-seven community-dwelling adults with parkinsonism ( mean age=71 years ) participated . The Hoehn and Yahr Scale median score of 2 was on the lower end of the scale ; however , the scores ranged from 1 to 4 . Methods : Subjects were tested twice by the same raters , with 1 week between tests . Test-retest reliability was calculated using intraclass correlation coefficients ( ICCs ) . Minimal detectable change was calculated using a 95 % confidence interval ( MDC95 ) . Results : The ICCs for test-retest reliability were above .90 for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and comfortable and fast gait speeds . The MDC95 values for those functional tests were : BBS=5/56 , ABC Scale=13 % , SRT with eyes closed=19 seconds , 6MWT=82 m , comfortable gait speed=0.18 m/s , and fast gait speed=0.25 m/s . The ICCs for test-retest reliability of SF-36 scores were above .80 , with the exception of the social functioning subscale . The MDC95 values for the SF-36 ranged between 19 % and 45 % . The MDC95 values for the UPDRS Activities of Daily Living section , Motor Examination section , and total scores were 4/52 , 11/108 , and 13/176 , respectively . Discussion and Conclusion : Minimal detectable change values are useful to therapists in rehabilitation and wellness programs in determining whether change during or after intervention is clinical ly significant . High test-retest reliability of scores for the BBS , ABC Scale , SRT with eyes closed , 6MWT , and gait speed make them trustworthy functional assessment s in people with parkinsonism . The SF-36 and UPDRS provide quality -of-life and disease severity rating values in the ongoing assessment of people with parkinsonism This r and omized controlled trial with blinded assessment aim ed to determine the effect of a 6-month minimally supervised exercise program on fall risk factors in people with Parkinson 's disease ( PD ) . Forty-eight participants with PD who had fallen or were at risk of falling were r and omized into exercise or control groups . The exercise group attended a monthly exercise class and exercised at home three times weekly . The intervention targeted leg muscle strength , balance , and freezing . The primary outcome measure was a PD falls risk score . The exercise group had no major adverse events and showed a greater improvement than the control group in the falls risk score , which was not statistically significant ( between group mean difference = -7 % , 95 % CI -20 to 5 , P = 0.26 ) . There were statistically significant improvements in the exercise group compared with the control group for two secondary outcomes : Freezing of Gait Question naire ( P = 0.03 ) and timed sit-to-st and ( P = 0.03 ) . There were statistically nonsignificant trends toward greater improvements in the exercise group for measures of muscle strength , walking , and fear of falling , but not for the measures of st and ing balance . Further investigation of the impact of exercise on falls in people with PD is warranted The lower extremity performance in elderly female patients with mild to moderate Parkinson 's disease ( PD ; n = 12 ) and controls ( n = 16 ) was compared . Isometric dynamometry and force-plate measurements were used . PD patients had lower ( p < .05 ) bilateral ( BL ) maximal isometric leg-extension force ( MF ) , BL isometric MF relative to body mass , and maximal rate of isometric force development than control participants . BL strength deficit was greater ( p < .05 ) in PD patients than in controls . A significantly longer chair-rise time and lower maximal rate of vertical-ground-reaction-force development while rising from a chair was found in PD patients than in controls . These findings suggest that elderly women with PD have lowered voluntary isometric force-generation capacity of the leg-extensor muscles . Reduced BL leg-extension strength might contribute to the difficulty of individuals with PD to rise from a chair BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . 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 question naire-39 [ PDQ-39 ] ) . Data was analyzed using separate 2 ( group ) x 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 OBJECTIVE To assess immediate and near-term effects of 2 exercise training programs for persons with idiopathic Parkinson 's disease ( IPD ) . DESIGN R and omized control trial . SETTING Public health facility and medical center . PARTICIPANTS Fifteen persons with IPD . INTERVENTION Combined group ( balance and resistance training ) and balance group ( balance training only ) underwent 10 weeks of high-intensity resistance training ( knee extensors and flexors , ankle plantarflexion ) and /or balance training under altered visual and somatosensory sensory conditions , 3 times a week on nonconsecutive days . Groups were assessed before , immediately after training , and 4 weeks later . MAIN OUTCOME MEASURES Balance was assessed by computerized dynamic posturography  , which determined the subject 's response to reduced or altered visual and somatosensory orientation cues ( Sensory Orientation Test [ SOT ] ) . Muscle strength was assessed by measuring the amount of weight a participant could lift , by using a st and ardized weight- and -pulley system , during a 4-repetition-maximum test of knee extension , knee flexion , and ankle plantarflexion . RESULTS Both types of training improved SOT performance . This effect was larger in the combined group . Both groups could balance longer before falling , and this effect persisted for at least 4 weeks . Muscle strength increased marginally in the balance group and substantially in the combined group , and this effect persisted for at least 4 weeks . CONCLUSION Muscle strength and balance can be improved in persons with IPD by high-intensity resistance training and balance training
target: However , most physical performance outcomes did not show clinical ly worthwhile improvement after progressive resistance exercise .
  CONCLUSION This review suggests that progressive resistance exercise can be effective and worthwhile in people with mild to moderate Parkinson 's disease , but carryover of benefit does not occur for all measures of physical performance .
  The current evidence suggests that progressive resistance training should be implemented in Parkinson 's disease rehabilitation , particularly when the aim is to improve walking capacity
background: QUESTION Does progressive resistance exercise improve strength and measures of physical performance in people with Parkinson 's disease ?