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Master's Dissertation
DOI
https://doi.org/10.11606/D.100.2024.tde-15042024-192316
Document
Author
Full name
Mário Vergari Filho
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
São Paulo, 2024
Supervisor
Committee
Batista, Carla da Silva (President)
Fécchio, Rafael Yokoyama
Kanegusuku, Hélcio
 
Title in Portuguese
Efeitos do treinamento resistido com instabilidade adaptado sobre a função cognitiva de indivíduos com congelamento da marcha na doença de Parkinson: uma análise secundária de um estudo controlado e randomizado
Keywords in Portuguese
Cognição global
Congelamento da marcha
Doença de Parkinson
Função frontal
Inibição cognitiva
Abstract in Portuguese
O declínio cognitivo pode ser um fator de risco para o congelamento da marcha (CM) na doença de Parkinson (DP). Exercícios de complexidade motora têm sido sugeridos como potenciais estratégias de reabilitação para diminuir a gravidade da CM e melhorar a cognição; no entanto, não se sabe se a melhora na cognição explicaria a diminuição da gravidade do CM após o exercício. Avaliamos os efeitos do treinamento resistido adaptado com instabilidade (exercícios de complexidade motora de TRIA) comparado com a reabilitação motora tradicional (RMT sem exercícios complexos) sobre a função cognitiva em pessoas com CM de DP. Verificamos também se a melhora cognitiva prediz a melhora do CM previamente publicada. Os participantes foram randomizados para o grupo experimental (TRIA, n=17) ou para o grupo controle ativo (RMT, n=15). Ambos os grupos possuíam escores entre 3 e 4 na escala de Hoehn e Yahr. Ambos os grupos realizaram exercícios 3 vezes por semana durante 12 semanas (80-90 min cada sessão). A função frontal (Frontal Assessment Battery - FAB), cognição global (Montreal Cognitive Assessment - MoCA), atenção e velocidade de processamento (Digit Symbol Substitution Test - DSST) foram avaliadas antes e após as intervenções. Ambos os grupos foram similares na condição pre-treinamento (p>0,05). Apenas o grupo TRIA melhorou os escores FAB, MoCA e DSST do pré para o pós-treinamento (p<0,05). Não houve diferenças entre TRIA e RMT para nenhum dos desfechos no pós-treinamento (p>0,05). As mudanças nos escores da FAB explicaram as mudanças na razão do Congelamento da Marcha (giro de 360 graus Freezing of Gait ratio) após a TRIA (R2=0,47; p=0,002). O TRIA, um treinamento motor desafiador e complexo, melhora a cognição em pessoas com CM na DP. A disfunção frontal está ligada à fisiopatologia do CM. A melhora da função frontal explica a diminuição da gravidade da CM após treinamento motor desafiador e complexo.
 
Title in English
Effects of resistance training with adapted instability on the cognitive function of individuals with freezing of gait in Parkinson's disease: a secondary analysis of a randomized controlled trial
Keywords in English
Cognitive inhibition
Freezing of gait
Frontal executive function
Global cognition
Parkinson's disease
Abstract in English
Cognitive decline may be a risk factor for freezing of gait (FOG) in Parkinsons disease (PD). Challenging exercises have been suggested as potential rehabilitation strategies to decrease FOG severity and improve cognition; however, it is unknown whether improvement in cognition would explain decreased FOG severity following exercise. We evaluated the effects of the adapted resistance training with instability (ARTI-challenging exercises) compared with traditional motor rehabilitation (TMR-without challenging exercises) on cognitive function in people with FOG of PD. We also verified whether cognitive improvement predicts the FOG improvement previously published. Participants were randomized either to the experimental group (ARTI, n=17) or to the active control group (TMR, n=15). Both groups had a score of 3 and 4 on the Hoehn and Yahr scales. Both groups exercised 3 times a week for 12 weeks (80-90 min each session). Frontal executive function (Frontal Assessment Battery-FAB), global cognition (Montreal Cognitive Assessment-MoCA), attention and psychomotor speed (Digit Symbol Substitution Test-DSST) were evaluated before and after interventions. Both groups were similar at pre-training (p>0.05). Only the ARTI group improved FAB, MoCA, and DSST scores from pre- to posttraining (p<0.05). There were no differences between ARTI and TMR for any of the outcomes at posttraining (p>0.05). The changes in FAB scores explained the changes in FOG ratio (360-degree turning in place) following ARTI (R2=0.47; p=0.002). ARTI, a challenging and complex motor training, improves cognition in people with FOG of PD. Frontal executive dysfunction is linked to FOG pathophysiology. Frontal executive improvement explains decreased FOG severity after challenging and complex motor training.
 
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Publishing Date
2024-07-22
 
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