Selective effects of exercise on reactive and proactive inhibition in Parkinson's disease.

Objective: Patients with Parkinson's disease (PD) have an obvious motor inhibition disorder, which is closely related to their motor symptoms. Although previous studies have shown that exercise can improve their inhibition deficits, the effect of exercise on different types of inhibition (proactive and reactive inhibition) has not been addressed. Methods: We used a behavioral paradigm combined with a series of questionnaires to explore the effect of long-term exercise on different types of motor inhibition in 59 patients with PD aged 55-75 years. According to the intensity and frequency of exercise, the participants were divided into regular-exercise and no-exercise groups. To obtain the average reference value for inhibition ability at the same age, we also recruited 30 healthy elderly people as controls. Results: The main defect in the motor inhibition of PD is reactive inhibition, while proactive inhibition has no obvious differences compared with healthy controls. Additionally, compared with the non-exercise group, PD in the exercise group showed significantly better reaction speeds and reactive control ability, fewer motor symptoms and negative emotions. Conclusions: Taken together, the motor inhibition defects of patients with PD affect only reactive inhibition. In addition, PD with exercise reported fewer negative emotions than that of the non-exercise group, indicating that exercise can relieve negative emotions and improve behavioral symptoms and quality of life in PD to a certain extent. We demonstrate for the first time that exercise has and can improve reactive inhibition in PD patients and has no effect on proactive inhibition.

The Feasibility and Positive Effects of Wuqinxi Exercise on the Cognitive and Motor Functions of Patients with Parkinson's Disease: A Pilot Study.

INTRODUCTION: Parkinson's disease (PD) is a chronic degenerative disease of the central nervous system common in middle-aged and elderly people, which has a serious impact on patients' cognitive and motor functions. Exercise can improve the nonmotor symptoms of PD patients, but the optimal type of exercise for the cognitive function of patients is unclear. Therefore, the purpose of this study is the impact of 12 weeks of Wuqinxi exercise on the cognitive and motor function in PD patients. METHODS: Thirty PD patients participated in the study and were randomly assigned to two groups: Wuqinxi group (n = 15) or stretching group (n = 15). All the participants performed a 12-week exercise program twice a week, 90 min/session. The assessments were conducted before and after exercise intervention, included cognitive function (frontal assessment battery (FAB); Stroop test I and II), motor functions (Unified Parkinson's Disease Rating Scale Part III (UPDRS-III); timed up and go (TUG)). RESULTS: We found the FAB and Stroop I scores were significantly higher in the Wuqinxi group than in the stretching group. Participants in the Wuqinxi group significantly improved their UPDRS-III (17.73 ± 9.88) and TUG (10.50 ± 1.79) score after 12 weeks of training intervention. CONCLUSION: The results show that the use of Wuqinxi for rehabilitation therapy for cognition is feasible, widely accepted, and effective in patients with Parkinson's disease. This study provides preliminary evidence for further large-scale and controlled studies.

Intermittent theta burst stimulation facilitates functional connectivity from the dorsal premotor cortex to primary motor cortex.

BACKGROUND: Motor information in the brain is transmitted from the dorsal premotor cortex (PMd) to the primary motor cortex (M1), where it is further processed and relayed to the spinal cord to eventually generate muscle movement. However, how information from the PMd affects M1 processing and the final output is unclear. Here, we applied intermittent theta burst stimulation (iTBS) to the PMd to alter cortical excitability not only at the application site but also at the PMd projection site of M1. We aimed to determine how PMd iTBS-altered information changed M1 processing and the corticospinal output. METHODS: In total, 16 young, healthy participants underwent PMd iTBS with 600 pulses (iTBS600) or sham-iTBS600. Corticospinal excitability, short-interval intracortical inhibition (SICI), and intracortical facilitation (ICF) were measured using transcranial magnetic stimulation before and up to 60 min after stimulation. RESULTS: Corticospinal excitability in M1 was significantly greater 15 min after PMd iTBS600 than that after sham-iTBS600 (p = 0.012). Compared with that after sham-iTBS600, at 0 (p = 0.014) and 15 (p = 0.037) min after iTBS600, SICI in M1 was significantly decreased, whereas 15 min after iTBS600, ICF in M1 was significantly increased (p = 0.033). CONCLUSION: Our results suggested that projections from the PMd to M1 facilitated M1 corticospinal output and that this facilitation may be attributable in part to decreased intracortical inhibition and increased intracortical facilitation in M1. Such a facilitatory network may inform future understanding of the allocation of resources to achieve optimal motion output.

Modulation of hand motor skill performance induced by motor practice combined with matched or mismatched hand posture motor imagery.

Motor imagery (MI), the mental rehearsal of a movement without muscle activation, combined with motor practice (MP) improves the performance of athletes and promotes rehabilitation of motor function among patients with brain injury. The actual hand posture influences the mental simulation of hand movements such that the ability of MI to affect corticospinal excitability is enhanced when the actual hand posture is consistent with the imagined movement of the hand. However, how MP combined with matched or mismatched hand posture MI modulates hand motor skill performance and the underlying neural mechanisms remain unclear. Thus, we first investigated whether MI hand posture that was compatible or incompatible with the actual MP influenced motor performance and corticospinal excitability induced by MI combined with MP. Twenty-eight healthy young adults repeatedly imagined either (1) closing their right hand into a fist with the thumb on top of the fingers and then opening the hand before actually performing that exact motor action or (2) performing the same motor skill but first imagining the right thumb touching the little finger before opening the hand . Changes in the peak acceleration of the hand grasp were measured to assess motor performance. The amplitudes of motor-evoked potentials (MEPs) in a target muscle were obtained using transcranial magnetic stimulation to assess corticospinal activation, a measure of primary cortex stimulation, before, immediately after, and 20 min after the performance. When the results of two-way repeated-measures analyses of variance assessing the effects of the protocols and time on the various measurements were found to be significant, post hoc paired t tests with Bonferroni corrections for multiple comparisons were applied. The results showed that both peak grasp acceleration and corticospinal excitability significantly increased immediately and 20 min after task completion (p < 0.05 for all) only when the MI hand posture matched with that of the actual MP. We then determined whether this increased corticospinal activity was associated with decreased short-interval intracortical inhibition, as measured using paired-pulse transcranial magnetic stimulation. Similar to our previous results, we found that short-interval intracortical inhibition was significantly decreased immediately and 20 min after task completion (p < 0.05 for both) only when MI matched MP. We concluded that the increased motor performance and corticospinal excitability induced by MI and MP depended on the match between the hand posture in the MI and MP, and that this increased corticospinal excitability was associated with disinhibition of the primary motor cortex activity.

Effect of acupuncture at ST36 on motor cortical excitation and inhibition.

BACKGROUND: Acupuncture at Zusanli (ST36) is often used to facilitate motor recovery after stroke. However, the effect of acupuncture at ST36 on motor cortical excitation and inhibition remains unclear. This study aimed to explore the effect of acupuncture at ST36 on motor cortical excitation and inhibition. METHODS: Twenty healthy volunteers were recruited to receive acupuncture treatment. We selected the acupoint ST36 and its respective sham point as the experimental acupoint. Transcranial magnetic stimulation (TMS) was used to measure motor-evoked potentials (MEP) at 7 time points-before acupuncture (Pre), acupuncture (T0), 4 and 8 min after acupuncture (T4; T8), needle removal (T12), 4 and 8 min after needle removal (T16; T20). Simultaneously, paired TMS (pTMS) was employed to measure short- and long-interval intracortical inhibition (SICI [short latency intracortical inhibition]; LICI [long latency intracortical inhibition]), respectively, at three time points-before acupuncture (Pre), acupuncture (T0), needle removal (T12). After removing the acupuncture needle, all subjects were asked to quantify their Deqi sensation using a Gas table. RESULTS: The average Deqi sensation score of all subjects during acupuncture at ST36 was higher than that observed at the sham point. With acupuncture at ST36, the MEP amplitude was higher at three time points (T0, T4, T8) than at Pre, although the MEP amplitude tended toward Pre after needle removal. The MEP amplitude was also higher at the same time points (T0, T4, T8) than at the sham point. Furthermore, the Deqi sensation score was correlated with MEP amplitude. With acupuncture at ST36, SICI and LICI at T0 were higher than those at Pre, and SICI and LICI at T0 were higher than those at the sham point. CONCLUSION: Acupuncture at ST36 increased motor cortical excitation and had an effect on the remaining needle phase. Deqi sensation was correlated with MEP amplitude. Acupuncture at ST36 also decreased motor cortical inhibition.

Motor learning enhanced by combined motor imagery and noninvasive brain stimulation is associated with reduced short-interval intracortical inhibition.

BACKGROUND: Motor imagery (MI) improves motor skill learning, which is further enhanced when MI is paired with primary motor cortex transcranial brain stimulation or with electrical stimulation of the peripheral median nerve. Applying both stimulation types (here with 25 ms intervals) is called paired associative stimulation (PAS25). The final primary motor cortex output is determined by combined excitatory and intracortical inhibitory circuits, and reducing the latter is associated with enhanced synaptic transmission and efficacy. Indeed, short-interval intracortical inhibition (SICI) inhibits motor evoked potentials (MEPs), and motor learning has been associated with decreased SICI and increased cortical excitability. Here, we investigated whether cortical excitability and SICI are altered by PAS25 applied after MI-induced modulation of motor learning. METHODS: Peak acceleration of a hand-grasping movement and MEPs and SICI were measured before and after MI alone, PAS25 alone, and MI followed by PAS25 in 16 healthy participants to evaluate changes in motor learning, corticospinal excitability, and intracortical inhibition. RESULTS: After PAS25 alone, MEP amplitude increased while peak acceleration was unchanged. However, PAS25 applied following MI not only significantly enhanced both peak acceleration (p = 0.011) and MEP amplitude (p = 0.004) but also decreased SICI (p = 0.011). Moreover, we found that this decrease in SICI was significantly correlated with both the peak acceleration (r = 0.49, p = 0.029) and the MEP amplitude (r = 0.56, p = 0.013). CONCLUSIONS: These results indicate that brain function altered by PAS25 of the motor cortex enhances MI-induced motor learning and corticospinal excitability and decreases SICI, suggesting that SICI underlies, at least in part, PAS25 modulation of motor learning.

Motor skill learning induces brain network plasticity: A diffusion-tensor imaging study.

Motor skills and the acquisition of brain plasticity are important topics in current research. The development of non-invasive white matter imaging technology, such as diffusion-tensor imaging and the introduction of graph theory make it possible to study the effects of learning skills on the connection patterns of brain networks. However, few studies have characterized the brain network topological features of motor skill learning, especially open skill. Given the need to interact with environmental changes in real time, we hypothesized that the brain network of high-level open-skilled athletes had higher transmission efficiency and stronger interaction in attention, visual and sensorimotor networks. We selected 21 high-level basketball players and 25 ordinary individuals as control subjects, collected their DTI data, built a network of brain structures, and used graph theory to analyze and compare the network properties of the two groups at global and regional levels. In addition, we conducted a correlation analysis on the training years of high-level athletes and brain network nodal parameters on the regional level to assess the relationship between brain network topological characteristics and skills learning. We found that on the global-level, the brain network of high-level basketball players had a shorter path length, small-worldness, and higher global efficiency. On the regional level, the brain nodes of the high-level athletes had nodal parameters that were significantly higher than those of control groups, and were mainly distributed in the visual network, the default mode network, and the attention network. The changes in brain node parameters were significantly related to the number of training years.

Visual and Action-control Expressway Associated with Efficient Information Transmission in Elite Athletes.

Effective information transmission for open skill performance requires fine-scale coordination of distributed networks of brain regions linked by white matter tracts. However, how patterns of connectivity in these anatomical pathways may improve global efficiency remains unclear. In this study, we hypothesized that the feeder edges in visual and motor systems have the potential to become "expressways" that increase the efficiency of information communication across brain networks of open skill experts. Thirty elite athletes and thirty novice subjects were recruited to participate in visual tracking and motor imagery tasks. We collected structural imaging data from these subjects, and then resolved structural neural networks using deterministic tractography to identify streamlines connecting cortical and subcortical brain regions of each participant. We observed that superior skill performance in elite athletes was associated with increased information transmission efficiency in feeder edges distributed between orbitofrontal and basal ganglia modules, as well as among temporal, occipital, and limbic system modules. These findings suggest that there is an expressway linking visual and action-control system of skill experts that enables more efficient interactions of peripheral and central information in support of effective performance of an open skill.

Differences between motor execution and motor imagery of grasping movements in the motor cortical excitatory circuit.

BACKGROUND: Both motor imagery (MI) and motor execution (ME) can facilitate motor cortical excitability. Although cortical excitability is modulated by intracortical inhibitory and excitatory circuits in the human primary motor cortex, it is not clear which intracortical circuits determine the differences in corticospinal excitability between ME and MI. METHODS: We recruited 10 young healthy subjects aged 18-28 years (mean age: 22.1 ± 3.14 years; five women and five men) for this study. The experiment consisted of two sets of tasks involving grasp actions of the right hand: imagining and executing them. Corticospinal excitability and short-interval intracortical inhibition (SICI) were measured before the interventional protocol using transcranial magnetic stimulation (baseline), as well as at 0, 20, and 40 min (T0, T20, and T40) thereafter. RESULTS: Facilitation of corticospinal excitability was significantly greater after ME than after MI in the right abductor pollicis brevis (APB) at T0 and T20 (p < 0.01 for T0, and p < 0.05 for T20), but not in the first dorsal interosseous (FDI) muscle. On the other hand, no significant differences in SICI between ME and MI were found in the APB and FDI muscles. The facilitation of corticospinal excitability at T20 after MI correlated with the Movement Imagery Questionnaire (MIQ) scores for kinesthetic items (Rho = -0.646, p = 0.044) but did not correlate with the MIQ scores for visual items (Rho = -0.265, p = 0.458). DISCUSSION: The present results revealed significant differences between ME and MI on intracortical excitatory circuits of the human motor cortex, suggesting that cortical excitability differences between ME and MI may be attributed to the activation differences of the excitatory circuits in the primary motor cortex.

Expertise-Level-Dependent Functionally Plastic Changes During Motor Imagery in Basketball Players.

Motor imagery is the mental process of rehearsing or simulating a given action without overt movements. The aim of the present study is to examine plastic changes in relevant brain areas during motor imagery with increasing expertise level. Subjects (novices, intermediate and elite players) performed motor imagery of basketball throws under two experimental conditions (with-ball and without-ball). We found that all basketball players exhibited better temporal congruence (between motor imagery and motor execution) and higher vividness of motor imagery than novices. The vividness of motor imagery was higher for the with-ball than for the without-ball conditions in all three subject groups. The results from functional magnetic resonance imaging (fMRI) showed three different patterns of cortical activation. Activation in the left middle frontal gyrus increased and that in the left supplementary motor area decreased with increasing levels of motor expertise. Importantly, brain activation in the left postcentral gyrus was the highest in the intermediate players compared to both novices and elite players. For the elite group, these three areas showed higher activation in the without-ball condition than the with-ball condition, while the opposite trend was found in intermediate players. Our findings suggest that the level of motor expertise may be related to high-order brain functions that are linked to different activation patterns in different brain areas.

Maintenance of balance between motor cortical excitation and inhibition after long-term training.

Motor learning with professional experience leads to cortical reorganization with plasticity. Long-term training facilitates motor cortical excitability. It is not clear how beneficial cortical plasticity is maintained during long-term training. We studied this question in 15 elite badminton athletes and 15 novices. We hypothesize that motor cortical excitation increases after long-term training and this is accompanied by increased motor cortical inhibition. Motor cortical excitation was measured with motor-evoked potential (MEP) input-output curve using transcranial magnetic stimulation (TMS). Motor cortical inhibition was measured with short-interval intracortical inhibition (SICI) and long-interval intracortical inhibition (LICI) by a paired-pulse TMS paradigm. We found MEP was increased at high TMS intensity and the MEP input-output curve was steeper in athletes compared to novices. Both SICI and LICI were also increased in athletes. In addition, both SICI and LICI were correlated with the slope of MEP input-output curve in athletes but not in novices. The slope of MEP input-output curve, SICI and LICI were also correlated with the training time in athletes. We conclude that both cortical excitation and cortical inhibition are increased, and that the balance between cortical excitation and inhibition is maintained during long-term training.

Traditional Chinese Exercise for Cardiovascular Diseases: Systematic Review and Meta-Analysis of Randomized Controlled Trials.

BACKGROUND: Traditional Chinese exercise (TCE) has widespread use for the prevention and treatment of cardiovascular disease; however, there appears to be no consensus about the benefits of TCE for patients with cardiovascular disease. The objective of this systematic review was to determine the effects of TCE for patients with cardiovascular disease. METHODS AND RESULTS: Relevant studies were searched by PubMed, Embase, Web of Science, the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature, and the China National Knowledge Infrastructure. We covered only published articles with randomized controlled trials. The outcome measures included physiological outcomes, biochemical outcomes, physical function, quality of life, and depression. A total of 35 articles with 2249 cardiovascular disease patients satisfied the inclusion criteria. The pooling revealed that TCE could decrease systolic blood pressure by 9.12 mm Hg (95% CI -16.38 to -1.86, P=0.01) and diastolic blood pressure by 5.12 mm Hg (95% CI -7.71 to -2.52, P<0.001). Patients performing TCE also found benefits compared with those in the control group in terms of triglyceride (standardized mean difference -0.33, 95% CI -0.56 to -0.09, P=0.006), 6-minute walk test (mean difference 59.58 m, 95% CI -153.13 to 269.93, P=0.03), Minnesota Living With Heart Failure Questionnaire results (mean difference -17.08, 95% CI -23.74 to -10.41, P<0.001), 36-Item Short Form physical function scale (mean difference 0.82, 95% CI 0.32-1.33, P=0.001), and Profile of Mood States depression scale (mean difference -3.02, 95% CI -3.50 to -2.53, P<0.001). CONCLUSIONS: This study demonstrated that TCE can effectively improve physiological outcomes, biochemical outcomes, physical function, quality of life, and depression among patients with cardiovascular disease. More high-quality randomized controlled trials on this topic are warranted.

Morphological and Functional Differences between Athletes and Novices in Cortical Neuronal Networks.

The cortical structural and functional differences in athletes and novices were investigated with a cross-sectional paradigm. We measured the gray matter volumes and resting-state functional connectivity in 21 basketball players and 21 novices with magnetic resonance imaging (MRI) techniques. It was found that gray matter volume in the left anterior insula (AI), inferior frontal gyrus (IFG), inferior parietal lobule (IPL) and right anterior cingulate cortex (ACC), precuneus is greater in basketball players than that in novices. These five brain regions were selected as the seed regions for testing the resting-state functional connectivity in the second experiment. We found higher functional connectivity in default mode network, salience network and executive control network in basketball players compared to novices. We conclude that the morphology and functional connectivity in cortical neuronal networks in athletes and novices are different.

Cognitive motor intervention for gait and balance in Parkinson's disease: systematic review and meta-analysis.

OBJECTIVE: We performed a systematic review and meta-analysis to assess the effect of cognitive motor intervention (CMI) on gait and balance in Parkinson's disease. DATA SOURCES: PubMed, Embase, Cochrane Library, CINAHL, Web of Science, PEDro, and China Biology Medicine disc. METHODS: We included randomized controlled trials (RCTs) and non RCTs. Two reviewers independently evaluated articles for eligibility and quality and serially abstracted data. A standardized mean difference ± standard error and 95% confidence interval (CI) was calculated for each study using Hedge's g to quantify the treatment effect. RESULTS: Nine trials with 181 subjects, four randomized controlled trials, and five single group intervention studies were included. The pooling revealed that cognitive motor intervention can improve gait speed (Hedge's g = 0.643 ± 0.191; 95% CI: 0.269 to 1.017, P = 0.001), stride time (Hedge's g = -0.536 ± 0.167; 95% CI: -0.862 to -0.209, P = 0.001), Berg Balance Scale (Hedge's g = 0.783 ± 0.289; 95% CI: 0.218 to 1.349, P = 0.007), Unipedal Stance Test (Hedge's g = 0.440 ± 0.189; 95% CI: 0.07 to 0.81, P =0.02). CONCLUSIONS: The systematic review demonstrates that cognitive motor intervention is effective for gait and balance in Parkinson's disease. However, the paper is limited by the quality of the included trials.