Complex Exercises Improve Cognition in People With Parkinson's Disease and Freezing of Gait.

BACKGROUND: Evidence has suggested that cognitive decline may be a risk factor for freezing of gait (FOG) in Parkinson's disease (PD). Complex and 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. OBJECTIVE: In this secondary analysis, we evaluated the effects of the adapted resistance training with instability (ARTI-complex and 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 explains the decrease in FOG previously published. METHODS: Participants were randomized to either the experimental group (ARTI, n = 17) or the active control group (TMR, n = 15). Both training groups exercised 3 times a week for 12 weeks (80-90 minute each session). FOG severity (FOG ratio from inertial sensors during a 360° turning-in-place task), frontal lobe function (Frontal Assessment Battery [FAB]), global cognition (Montreal Cognitive Assessment [MoCA]), and attention and psychomotor speed (Digit Symbol Substitution Test [DSST]) were evaluated before and after interventions. RESULTS: Only the ARTI group improved FAB, MoCA, and DSST scores at posttraining. In addition, ARTI was more effective than TMR in improving FAB scores at posttraining. The changes in FAB scores explained the changes in FOG ratio following ARTI (R2 = .43, P < .01). CONCLUSIONS: This pilot study suggests that ARTI, a complex and challenging training, improves cognition in people with FOG of PD. Improvements in frontal lobe function with ARTI help explain decreased FOG severity.

Factors Associated With Physical Activity and Sedentary Behavior in People With Parkinson Disease: A Systematic Review and Meta-Analysis.

OBJECTIVE: The goal of this review was to investigate factors associated with physical activity and sedentary behavior in people with Parkinson disease (PD). The magnitude of these associations were investigated in line with the International Classification of Functioning, Disability and Health components. METHODS: A systematic literature review was conducted until February 2023, searching 4 databases (PubMed, EMBASE, Web of Science, and Scopus) for original articles investigating associations with physical activity or sedentary behavior in people with PD. Two independent researchers performed data extraction, and the risk of bias in the included studies was assessed using the Quality in Prognosis Studies tool. Meta-analyses were conducted to determine the magnitude of the associations, and significant regression models from the included studies were described. RESULTS: Forty-two studies were included. Twenty-one factors associated with overall physical activity were identified. Higher levels of physical activity had small association with cognition and body mass index, and fair association with 17 factors related to self-efficacy, physical function, mobility, quality of life, age, PD symptoms, and more. Better manual dexterity and functional gait had moderate to good association with higher levels of physical activity. The regression model with the higher magnitude was composed mostly of contextual factors, except for the body max index. The magnitude of factors associated with physical activity intensity or sedentary behavior could not be identified. CONCLUSION: Functional gait and manual dexterity were the strongest factors related to physical activity in people with PD. Further investigation is needed to understand the factors associated with physical activity intensity and sedentary behavior. IMPACT: This study emphasizes the significance of considering contextual factors alongside body function and structure, activity and participation, and the health condition to enhance physical activity improvement during the rehabilitation process. By adopting such holistic approach, rehabilitation professionals can optimize the overall health and wellbeing of individuals with Parkinson disease.

Mesencephalic Locomotor Region and Presynaptic Inhibition during Anticipatory Postural Adjustments in People with Parkinson's Disease.

Individuals with Parkinson's disease (PD) and freezing of gait (FOG) have a loss of presynaptic inhibition (PSI) during anticipatory postural adjustments (APAs) for step initiation. The mesencephalic locomotor region (MLR) has connections to the reticulospinal tract that mediates inhibitory interneurons responsible for modulating PSI and APAs. Here, we hypothesized that MLR activity during step initiation would explain the loss of PSI during APAs for step initiation in FOG (freezers). Freezers (n = 34) were assessed in the ON-medication state. We assessed the beta of blood oxygenation level-dependent signal change of areas known to initiate and pace gait (e.g., MLR) during a functional magnetic resonance imaging protocol of an APA task. In addition, we assessed the PSI of the soleus muscle during APA for step initiation, and clinical (e.g., disease duration) and behavioral (e.g., FOG severity and APA amplitude for step initiation) variables. A linear multiple regression model showed that MLR activity (R2 = 0.32, p = 0.0006) and APA amplitude (R2 = 0.13, p = 0.0097) explained together 45% of the loss of PSI during step initiation in freezers. Decreased MLR activity during a simulated APA task is related to a higher loss of PSI during APA for step initiation. Deficits in central and spinal inhibitions during APA may be related to FOG pathophysiology.

Clinical and neuroimaging correlates in a pilot randomized trial of aerobic exercise for major depression.

BACKGROUND: Aerobic exercise (AE) combined with pharmacotherapy is known to reduce depressive symptoms; however, studies have not focused on long-term AE for volumetric changes of brain regions (amygdala, thalamus, and nucleus accumbens [NAcc]) linked to the control of affective responses and hopelessness in individuals with major depression (MD). In addition, AE with motor complexity (AEMC) would be more effective than AE in causing brain plasticity. We compared the effects of 24 weeks of AE and AEMC combined with pharmacotherapy on clinical and volumetric outcomes in individuals with MD. METHODS: Forty medicated individuals with MD were randomly assigned to nonexercising control (C), AE, and AEMC groups. The training groups exercised for 60 min, twice a week for 24 weeks. Clinical and volumetric outcomes were assessed before and after the 24 weeks. Effect size (ES) and confidence interval (CI) were calculated for within-group and between-groups changes. RESULTS: AE and AEMC reduced hopelessness (ES = -0.73 and ES = -0.62, respectively) and increased affective responses (ES = 1.24 and ES = 1.56, respectively). Only AE increased amygdala (ES = 0.27 left and ES = 0.34 right), thalamus (ES = 0.33 left and ES = 0.26 right) and left NAcc (ES = 0.54) volumes. AE was more effective than the C group in reducing hopelessness and causing brain plasticity. The changes in the right amygdala volume showed a strong trend in explaining 72 % of the changes in affective responses following AE (p = 0.06). LIMITATION: Lack of posttraining follow-up and small sample size. CONCLUSION: These preliminary data indicate that AE combined with pharmacotherapy can cause clinical improvement and brain plasticity in individuals with MD.

Perturbation-based balance training leads to improved reactive postural responses in individuals with Parkinson's disease and freezing of gait.

Perturbation-based balance training (PBT) exposes individuals to a series of sudden upright balance perturbations to improve their reactive postural responses. In this study, we aimed to evaluate the effect of a short PBT program on body balance recovery following a perturbation in individuals with freezing of gait due to Parkinson's disease. Volunteers (mean age = 64 years, SD = 10.6) were pseudorandomly assigned either to a PBT (n = 9) or to a resistance training (RT, n = 10) group. PBT was implemented through balance perturbations varying in the kind, direction, side and magnitude of support base displacements. Both groups exercised with progressive difficulty/load activities twice a week for 4 weeks. Specific gains and generalization to dual-tasking and faster-than-trained support base displacements were evaluated 24 h after the end of the training, and retention was evaluated after 30 days of no training. Results showed that, compared with RT, PBT led to more stable postural responses in the 30-day retention evaluation, as indicated by decreased CoP displacement, velocity and time to direction reversal and reduced numbers of near-falls. We found no transfer either to a dual task or to a higher perturbation velocity. In conclusion, a training program based on diverse unpredictable balance perturbations improved the stability of reactive postural responses to those perturbations suffered during the training, without generalization to more challenging tasks.

Cognitive and emotional factors influence specific domains of postural control in individuals with moderate-to-severe Parkinson's disease.

INTRODUCTION: Cognition and emotional state are domains that highly interfere with postural control in individuals with Parkinson's disease (PD). This study aims to find associations between executive function, anxiety, depression, and reactive and anticipatory postural control domains in individuals with moderate-to-severe Parkinson's disease. METHODS: In this study, 34 individuals with PD while on medication were thoroughly assessed for postural control in perturbed, quiet standing and stepping. We performed multiple linear stepwise regressions using postural variables as dependent and cognitive/emotional as independent variables. RESULTS: The results showed that cognitive flexibility explained 23 % of anticipatory postural adjustments (APA) duration, inhibitory control explained 42 % of instability on a malleable surface, anxiety explained 21 % of APA amplitude, and 38 % of reactive postural response amplitude. CONCLUSION: Our results highlight the impact of emotional and cognitive states on particular domains of postural control in individuals with PD while on medication. These results may have significant implications for future treatments, mainly considering the predictors for postural control domains, which were consistent with the assumption that impairments in affective and executive domains underlie posture. As we have shown that cognitive and emotional states influence postural control domains in individuals with PD, this should be taken into account in rehabilitation protocols.

Telerehabilitation during social distancing for people with Parkinson's disease: a retrospective study.

INTRODUCTION/AIM: Clinical worsening has been common in people with Parkinson's disease (PD) during the social distancing due to pandemic. It is unclear if telerehabilitation applied during social distancing preserves clinical aspects of people with PD who are frequent exercisers before the pandemic. Thus, we compared the effects of 10 months of supervised, home-based, real-time videoconferencing telerehabilitation (SRTT) and nonexercising control on clinical aspects in people with PD who are frequent exercisers before the pandemic. METHODS: Fifty-seven (SRTT group) and 29 (nonexercising control group) people with PD were retrospectively assessed (Clinical Trials Registry: RBR-54sttfk). Only the SRTT group performed a 60-min online training sessions, 2-3 days per week, for 10 months (April 2020 to January 2021) during social distancing. Quality of life (PD Questionnaire [PDQ-39]), walking (item 28 from the Unified Parkinson's Disease Rating Scale part III [UPDRS-III]), posture (item 29 from the UPDRS-III), and freezing of gait (New-FOG questionnaire [NFOGQ]) were retrospectively assessed before (February-March 2020) and during social distancing (February-March 2021). The assessments were performed in-person and remotely before and during social distancing, respectively. RESULTS: There were no between-group differences at baseline (p > 0.05). SRTT preserves PDQ-39 and walking scores but not posture and NFOGQ scores, while nonexercising control worsens scores in all variables. In addition, SRTT is more effective than nonexercising control in preserving PDQ-39 and walking scores. CONCLUSION: During social distancing, long-term SRTT preserves the subjective quality of life and walking, but not subjective posture and FOG in people with PD who are frequent exercisers before the pandemic.

Between-leg asymmetry in automatic postural responses to stance perturbations in people with Parkinson's disease.

BACKGROUND: People with Parkinson's disease (PwPD) showed impairments of balance control which can be aggravated by the presence of higher interlateral postural asymmetry caused by a distinct dopaminergic loss in the substantia nigra between cerebral hemispheres. RESEARCH QUESTION: We evaluate asymmetries between the more and the less affected leg in PwPD in responses to unanticipated stance perturbations. METHODS: Sixteen 16 PwPD participated in the experiment that consisted of recovering a stable upright stance, keeping the feet in place, in response to a perturbation caused by a sudden release of a load equivalent to 7 % of the participant's body mass. Anterior displacement and velocity of the center of pressure (CoP), the latency of gastrocnemius medialis muscle (GM) activation onset, rate of GM activation, and normalized magnitude of muscular activation were analyzed. RESULTS: Analysis revealed significantly rate (p = 0.04) and magnitude (p = 0.02) higher activation of GM in the less affected limb. No significant effects of the leg were found for GM activation latency or CoP-related variables. SIGNIFICANCE: There is a higher contribution of the less affected leg in automatic postural responses in PwPD.

Volume Load Rather Than Resting Interval Influences Muscle Hypertrophy During High-Intensity Resistance Training.

ABSTRACT: Longo, AR, Silva-Batista, C, Pedroso, K, de Salles Painelli, V, Lasevicius, T, Schoenfeld, BJ, Aihara, AY, de Almeida Peres, B, Tricoli, V, and Teixeira, EL. Volume load rather than resting interval influences muscle hypertrophy during high-intensity resistance training. J Strength Cond Res 36(6): 1554-1559, 2022-Interset rest interval has been proposed as an important variable for inducing muscle mass and strength increases during resistance training. However, its influence remains unclear, especially when protocols with differing intervals have equalized volume. We aimed to compare the effects of long (LI) vs. short rest interval (SI) on muscle strength (one repetition maximum [1RM]) and quadriceps cross-sectional area (QCSA), with or without equalized volume load (VL). Twenty-eight subjects trained twice a week for 10 weeks. Each subject's leg was allocated to 1 of 4 unilateral knee extension protocols: LI, SI, SI with VL -matched by LI (VLI-SI), and LI with VL-matched by SI (VSI-LI). A 3-minute rest interval was afforded in LI and VSI-LI protocols, while SI and VLI-SI employed a 1-minute interval. All subjects trained with a load corresponding to 80% 1RM. One repetition maximum and QCSA were measured before and after training. All protocols significantly increased 1RM values in post-training (p < 0.0001; LI: 27.6%, effect size [ES] = 0.90; VLI-SI: 31.1%, ES = 1.00; SI: 26.5%, ES = 1.11; and VSI-LI: 31.2%, ES = 1.28), with no significant differences between protocols. Quadriceps cross-sectional area increased significantly for all protocols in post-training (p < 0.0001). However, absolute changes in QCSA were significantly greater in LI and VLI-SI (13.1%, ES: 0.66 and 12.9%, ES: 0.63) than SI and VSI-LI (6.8%, ES: 0.38 and 6.6%, ES: 0.37) (both comparisons, p < 0.05). These data suggest that maintenance of high loads is more important for strength increases, while a greater VL plays a primary role for hypertrophy, regardless of interset rest interval.

Effects of Endurance Training on Motor Signs of Parkinson's Disease: A Systematic Review and Meta-Analysis.

BACKGROUND: Evidence has demonstrated that endurance training (ET) reduces the motor signs of Parkinson's disease (PD). However, there has not been a comprehensive meta-analysis of studies to date. OBJECTIVE: The aim of this study was to compare the effect of ET versus nonactive and active control conditions on motor signs as assessed by either the Unified Parkinson's Disease Rating Scale part III (UPDRS-III) or Movement Disorder Society-UPDRS-III (MDS-UPDRS-III). METHODS: A random-effect meta-analysis model using standardized mean differences (Hedges' g) determined treatment effects. Moderators (e.g., combined endurance and physical therapy training [CEPTT]) and meta-regressors (e.g., number of sessions) were used for sub-analyses. Methodological quality was assessed by the Physiotherapy Evidence Database. RESULTS: Twenty-seven randomized controlled trials (RCTs) met inclusion criteria (1152 participants). ET is effective in decreasing UPDRS-III scores when compared with nonactive and active control conditions (g = - 0.68 and g = - 0.33, respectively). This decrease was greater (within- and between-groups average of - 8.0 and - 6.8 point reduction on UPDRS-III scores, respectively) than the moderate range of clinically important changes to UPDRS-III scores (- 4.5 to - 6.7 points) suggested for PD. Although considerable heterogeneity was observed between RCTs (I2 = 74%), some moderators that increased the effect of ET on motor signs decreased the heterogeneity of the analyses, such as CEPTT (I2 = 21%), intensity based on treadmill speed (I2 = 0%), self-perceived exertion rate (I2 = 33%), and studies composed of individuals with PD and freezing of gait (I2 = 0%). Meta-regression did not produce significant relationships between ET dosage and UPDRS-III scores. CONCLUSIONS: ET is effective in decreasing UPDRS-III scores. Questions remain about the dose-response relationship between ET and reduction in motor signs.

Risk of falls using the Biodex Balance System in non-faller patients with Parkinson Disease.

PURPOSE: Biodex Balance System (BBS) is a low-cost platform used to assess balance in different populations. However, no study has used this tool to evaluate the risk of falls related to balance changes in non-faller individuals with Parkinson Disease (PD). OBJECTIVE: The aim of this study was to determine the changes in the balance in non-faller individuals with mild to moderate PD compared to healthy elders. METHODS: Forty-six PD patients at stages 2 and 3 were assessed in the 'on' state (fully medicated) as well as 31 age-matched healthy controls. They were submitted to the fall risk protocol of BBS and performed three 20-s trials and a 60-s rest interval between the trials. RESULTS: Non-faller PD patients had an increased instability when compared to the healthy controls in the anteroposterior (controls: 1.54 ± 1.00 vs. PD patients: 2.91 ± 0.93) and mediolateral directions (controls: 1.21 ± 0.57 vs. PD patients: 1.42 ± 0.46), resulting in a great overall instability in the PD patients (controls: 1.28 ± 0.61 vs. PD patients: 4.09 ± 1.22). A significant correlation between overall instability and UPDRS-III (motor symptoms) in individuals with PD was observed. CONCLUSION: BBS was able to identify the risk of falls in non-fallers, showing that PD patients have a greater risk of falls in unstable conditions than age-matched healthy elders, mainly due to the large sway in the anteroposterior direction. Furthermore, the severity of motor symptoms was related to overall instability which can increase the risk of falls in PD patients.

Muscle Failure Promotes Greater Muscle Hypertrophy in Low-Load but Not in High-Load Resistance Training.

ABSTRACT: Lasevicius, T, Schoenfeld, BJ, Silva-Batista, C, Barros, TdS, Aihara, AY, Brendon, H, Longo, AR, Tricoli, V, Peres, BdA, and Teixeira, EL. Muscle failure promotes greater muscle hypertrophy in low-load but not in high-load resistance training. J Strength Cond Res 36(2): 346-351, 2022-The purpose of this study was to investigate the effects of an 8-week resistance training program at low and high loads performed with and without achieving muscle failure on muscle strength and hypertrophy. Twenty-five untrained men participated in the 8-week study. Each lower limb was allocated to 1 of 4 unilateral knee extension protocols: repetitions to failure with low load (LL-RF; ∼34.4 repetitions); repetitions to failure with high load (HL-RF; ∼12.4 repetitions); repetitions not to failure with low load (LL-RNF; ∼19.6 repetitions); and repetitions not to failure with high load (HL-RNF; ∼6.7 repetitions). All conditions performed 3 sets with total training volume equated between conditions. The HL-RF and HL-RNF protocols used a load corresponding to 80% 1 repetition maximum (RM), while LL-RF and LL-RNF trained at 30% 1RM. Muscle strength (1RM) and quadriceps cross-sectional area (CSA) were assessed before and after intervention. Results showed that 1RM changes were significantly higher for HL-RF (33.8%, effect size [ES]: 1.24) and HL-RNF (33.4%, ES: 1.25) in the post-test when compared with the LL-RF and LL-RNF protocols (17.7%, ES: 0.82 and 15.8%, ES: 0.89, respectively). Quadriceps CSA increased significantly for HL-RF (8.1%, ES: 0.57), HL-RNF (7.7%, ES: 0.60), and LL-RF (7.8%, ES: 0.45), whereas no significant changes were observed in the LL-RNF (2.8%, ES: 0.15). We conclude that when training with low loads, training with a high level of effort seems to have greater importance than total training volume in the accretion of muscle mass, whereas for high load training, muscle failure does not promote any additional benefits. Consistent with previous research, muscle strength gains are superior when using heavier loads.

Perceptual and Neuromuscular Responses Adapt Similarly Between High-Load Resistance Training and Low-Load Resistance Training With Blood Flow Restriction.

ABSTRACT: Teixeira, EL, Painelli, VdS, Schoenfeld, BJ, Silva-Batista, C, Longo, AR, Aihara, AY, Cardoso, FN, Peres, BdA, and Tricoli, V. Perceptual and neuromuscular responses adapt similarly between high-load resistance training and low-load resistance training with blood flow restriction. J Strength Cond Res 36(9): 2410-2416, 2022-This study compared the effects of 8 weeks of low-load resistance training with blood flow restriction (LL-BFR) and high-load resistance training (HL-RT) on perceptual responses (rating of perceived exertion [RPE] and pain), quadriceps cross-sectional area (QCSA), and muscle strength (1 repetition maximum [RM]). Sixteen physically active men trained twice per week, for 8 weeks. One leg performed LL-BFR (3 sets of 15 repetitions, 20% 1RM), whereas the contralateral leg performed HL-RT (3 sets of 8 repetitions, 70% 1RM). Rating of perceived exertion and pain were evaluated immediately after the first and last training sessions, whereas QCSA and 1RM were assessed at baseline and after training. Rating of perceived exertion was significantly lower (6.8 ± 1.1 vs. 8.1 ± 0.8, p = 0.001) and pain significantly higher (7.1 ± 1.2 vs. 5.8 ± 1.8, p = 0.02) for LL-BFR than that for HL-RT before training. Significant reductions in RPE and pain were shown for both protocols after training (both p < 0.0001), although no between-protocol differences were shown in absolute changes ( p = 0.10 and p = 0.48, respectively). Both LL-BFR and HL-RT were similarly effective in increasing QCSA (7.0 ± 3.8% and 6.3 ± 4.1%, respectively; both p < 0.0001) and 1RM (6.9 ± 4.1% and 13.7 ± 5.9%, respectively; both P < 0.0001), although absolute changes for 1RM in HL-RT were greater than LL-BFR ( p = 0.001). In conclusion, LL-BFR produces lower RPE values and a higher pain perception than HL-RT. However, consistent application of these approaches result in chronic adaptations so that there are no differences in perceptual responses over the course of time. In addition, muscle strength is optimized with HL-RT despite similar increases in muscle hypertrophy between conditions.

Multidimensional Factors Can Explain the Clinical Worsening in People With Parkinson's Disease During the COVID-19 Pandemic: A Multicenter Cross-Sectional Trial.

Background: Self-reported clinical worsening by people with Parkinson's disease (PD) during social distancing may be aggravated in Brazil, where the e/tele-health system is precarious. Objectives: This study aims to investigate self-reported changes in motor and non-motor aspects during social distancing in people with PD living in Brazil and to investigate the factors that might explain these changes. Methods: In this multicenter cross-sectional trial, 478 people with a diagnosis of idiopathic PD (mean age = 67, SD = 9.5; 167 female) were recruited from 14 centers distributed throughout the five geographical regions of Brazil. The evaluators from each center applied a questionnaire by telephone, which included questions (previous and current period of social distancing) about the motor and non-motor experiences of daily living, quality of life, daily routine, and physical activity volume. Results: Self-reported clinical worsening in non-motor and motor aspects of daily life experiences (Movement Disorder Society-Unified PD Rating Scale-parts IB and II-emotional and mental health, and fear of falling) and in the quality of life was observed. Only 31% of the participants reported a guided home-based physical activity with distance supervision. Perceived changes in the quality of life, freezing of gait, decreased physical activity volume, daily routine, and fear of falling explained the self-reported clinical worsening (P < 0.05). Conclusions: Self-reported clinical worsening in people with PD living in Brazil during social distancing can also be aggravated by the precarious e/tele-health system, as perception of decreased physical activity volume and impoverishment in daily routine were some of the explanatory factors. Considering the multifaceted worsening, the implementation of a remote multi-professional support for these people is urgent.

Association of morningness-eveningness preference with physical activity during the COVID-19 pandemic social distancing: a cross-sectional survey in Brazil.

Social distancing (SDIST) to contain COVID-19 pandemic spread implies reduced sunlight exposure and social daily life, which delay the circadian system and increase eveningness preference. The regular practice of physical activity (PA) is a time cue that decreased during SDIST. However, it is unknown if decreased PA may be associated with increase of eveningness preference. This study aimed to investigate if PA changes might be associated with changes in the morningness-eveningness preference of individuals practicing SDIST in Brazil. For this, 322 adults (18-89 years-old) regularly living in Brazil between March and October 2020 answered an online survey including questions considering the before and during SDIST period on PA (min/week) and morningness-eveningness questionnaire score. Sociodemographic, SDIST, anthropometric, and health characteristics were also included in the online survey. Participants self-reported an increase of eveningness preference comparing Before-SDIST with During-SDIST scores (56 ± 12 vs. 52 ± 13, p < .0001). Self-reported PA decreased comparing Before-SDIST with During-SDIST (230 ± 170 vs. 149 ± 155 min/week, p < .0001). Decrease in the total volume of PA and hours spent outside per day, and higher body mass index were associated with the increase in eveningness preference (R2 = .077), although the decrease in the total volume of PA was the strongest association (R2 = .037). In summary, our results show that SDIST may cause a delay in the circadian system, which is associated with the decrease of PA, a reduction in the hours spent outside per day with sunlight exposure, and obesity.

Can remotely supervised exercise positively affect self-reported depressive symptoms and physical activity levels during social distancing?

The main objective of this cross-sectional study was to compare the self-reported depressive symptoms and physical activity (PA) levels among participants who performed self- nonexercising (NE), guided exercise (SGE), remotely supervised exercise (RSE), and face-to-face supervised exercise (FFE) during social distancing. Three hundred and forty-four individuals (≥18 years and 67% women) answered a self-reported online survey that included questions related to the physical exercise practice (e.g., supervised and remote) during social distancing and questions about perceptions of depressive symptoms (Montgomery-Åsberg Depression Rating Scale-Self Rated [MADRS-S] scores) and metabolic equivalent task minutes per week (METs min•wk-1) of moderate- and vigorous-intensity PA, and total PA scores (International Physical Activity Questionnaire-Short Form) before and during social distancing. The RSE group (n=45) showed higher METs of vigorous-intensity PA than the SGE (n=146) and NE (n=109) groups. The RSE and FFE (n=44) groups showed higher METs of the total PA scores than the SGE and NE groups. The NE group showed higher MADRS-S scores than the other groups. Lower MADRS-S scores depend on the exercise practice and higher METs of vigorous-intensity PA depend on the supervised exercise practice. Thus, telehealth interventions can be implemented during the pandemic to enhance vigorous PA.

Effects of resistance training on metabolic and cardiovascular responses to a maximal cardiopulmonary exercise test in Parkinson`s disease.

OBJECTIVE: To evaluate the effects of resistance training on metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson's disease. METHODS: Twenty-four patients with Parkinson's disease (modified Hoehn and Yahr stages 2 to 3) were randomly assigned to one of two groups: Control or Resistance Training. Patients in the Resistance Training Group completed an exercise program consisting of five resistance exercises (two to four sets of six to 12 repetitions maximum per set) twice a week. Patients in the Control Group maintained their usual lifestyle. Oxygen uptake, systolic blood pressure and heart rate were assessed at rest and during cycle ergometer-based maximal cardiopulmonary exercise testing at baseline and at 12 weeks. Assessments during exercise were conducted at absolute submaximal intensity (slope of the linear regression line between physiological variables and absolute workloads), at relative submaximal intensity (anaerobic threshold and respiratory compensation point) and at maximal intensity (maximal exercise). Muscle strength was also evaluated. RESULTS: Both groups had similar increase in peak oxygen uptake after 12 weeks of training. Heart rate and systolic blood pressure measured at absolute and relative submaximal intensities and at maximal exercise intensity did not change in any of the groups. Muscle strength increased in the Resistance Training but not in the Control Group after 12 weeks. CONCLUSION: Resistance training increases muscle strength but does not change metabolic and cardiovascular responses during maximal cardiopulmonary exercise testing in patients with Parkinson's disease without cardiovascular comorbidities.

Blood Flow Restriction Does Not Promote Additional Effects on Muscle Adaptations When Combined With High-Load Resistance Training Regardless of Blood Flow Restriction Protocol.

ABSTRACT: Teixeira, EL, Ugrinowitsch, C, de Salles Painelli, V, Silva-Batista, C, Aihara, AY, Cardoso, FN, Roschel, H, and Tricoli, V. Blood flow restriction does not promote additional effects on muscle adaptations when combined with high-load resistance training regardless of blood flow restriction protocol. J Strength Cond Res 35(5): 1194-1200, 2021-The aim of this study was to investigate, during high-load resistance training (HL-RT), the effect of blood flow restriction (BFR) applied during rest intervals (BFR-I) and muscle contractions (BFR-C) compared with HL-RT alone (no BFR), on maximum voluntary isometric contraction (MVIC), maximum dynamic strength (one repetition maximum [1RM]), quadriceps cross-sectional area (QCSA), blood lactate concentration ([La]), and root mean square of the surface electromyography (RMS-EMG) responses. Forty-nine healthy and untrained men (25 ± 6.2 years, 178.1 ± 5.3 cm and 78.8 ± 11.6 kg) trained twice per week, for 8 weeks. One leg of each subject performed HL-RT without BFR (HL-RT), whereas the contralateral leg was randomly allocated to 1 of 2 unilateral knee extension protocols: BFR-I or BFR-C (for all protocols, 3 × 8 repetitions, 70% 1RM). Maximum voluntary isometric contraction, 1RM, QCSA, and acute changes in [La] and RMS-EMG were assessed before and after training. The measurement of [La] and RMS-EMG was performed during the control sessions with the same relative load obtained after the 1RM test, before and after training. Similar increases in MVIC, 1RM, and QCSA were demonstrated among all conditions, with no significant difference between them. [La] increased for all protocols in pre-training and post-training, but it was higher for BFR-I compared with the remaining protocols. Increases in RMS-EMG occurred for all protocols in pre-training and post-training, with no significant difference between them. In conclusion, despite of a greater metabolic stress, BFR inclusion to HL-RT during rest intervals or muscle contraction did not promote any additive effect on muscle strength and hypertrophy.