Influences of Cognitive and Aerobic Training in PD Patients

Parkinson’s disease (PD) patients often experience deficits in motor learning, which can affect their functional autonomy. Although evidence raises that exercise training in PD patients could improve implicit motor learning (iML), the influence of which type of training can empower it remains to be explored.PURPOSE: To determine the effectiveness of cognitive feedback treadmill training (CFTT), traditional treadmill training (TTT), and cycling training (CT) on sequence-specific iML in PD patients.METHODS: Forty-two PD patients (17F) were recruited into CFTT, TTT, CT, and Control (C). Before (T0) and after (T4) a training period (3 times/week for 4 weeks; C patients maintained their usual lifestyle), participants carried out a Serial Reaction Time Task to assess the iML and an incremental test to exhaustion to measure the maximal oxygen consumption (V̇O2max) and both ventilatory thresholds (gas-exchange threshold, GET; respiratory compensation point, RCP). The exercise intensity increased over time based on gait speed for TTT, gait speed and gait parameters for CFTT, and patients’ ventilatory thresholds for CT. During each training, TTT and CT patients had to be focused exclusively on exercise intensity; instead, CFTT patients followed cognitive feedback targets (i.e., step length and cadence) administered as cognitive training. Changes in iML were assessed by two-way RM-ANOVA with Groups (CFTT, TTT, CT, and C) and Time (T0 vs. T4) as factors. V̇O2max, GET, and RCP were compared across groups and time with two-way RM-ANOVA. Predictors of iML were assessed by applying a step-forward multiple linear regression mode, using V̇O2 measured through sessions expressed in percentage of RCP (%RCP) and individual characteristics.RESULTS: iML improved for CFTT and CT compared with baseline (p < 0.05). The combination of %RCP and physical status of patients can predict overall and individual iML (r2 > 0.42).CONCLUSION: Exercise protocol structured as cognitive feedback training or intensive aerobic training can lead to substantial gains in sequence-specific iML in PD patients, suggesting that cognitive and exercise intensity are potential keys to be considered in rehabilitation programs to enhance motor learning and promote well-being among PD individuals.