Effects of treadmill training on gait of elders with Parkinson's disease: a literature review

ABSTRACT Parkinson's disease is the second most common neurodegenerative disorder in old age. Aging process for elders with Parkinson's disease can induce gait disturbances with more functional disabilities than for elders without the disease. Treadmill training as a therapy has resulted in notable effects on the gait of patients with Parkinson's disease and may be a resource for geriatric neurological rehabilitation. This review aimed to study the effects on gait after treadmill training in elderly patients with Parkinson's disease. The search was performed in the databases PubMed®, LILACS, PEDro and EMBASE, with the following keywords: “Parkinson's disease”, “elderly”, “treadmill training” and “gait evaluation”. The quality of the studies included was assessed by PEDro Scale. Eleven studies met the inclusion and exclusion criteria. Eight studies were randomized, and only one did a follow-up. One can observe in this review that treadmill training with or without weight support (at least 20 minutes, two to three times a week, with progressive increase of loads, for minimum of 6 weeks) in elderly patients with the Parkinson's disease was effective to improve gait. In addition, both were considered safe (since some studies described the use of belts, even in unsupported training) and can be associated with therapies complementary to gait, such as repetitive transcranial magnetic stimulation, visual cues or anodal transcranial direct current stimulation. Treadmill training in elderly patients with Parkinson's disease is an intervention that improves gait outcomes, but further studies are required for better proofs.

摘要 帕金森病（Parkinson's disease）是老年人群中第二高发的神经退行性疾病。相较于健康老年人，帕金森病患者的衰老进程更易诱发步态障碍，且伴随更为显著的功能残疾。跑步机训练（treadmill training）作为一种治疗手段，已被证实对帕金森病患者的步态改善具有显著效果，或可成为老年神经康复的有效资源。本综述旨在探讨跑步机训练对老年帕金森病患者步态的影响。本研究检索了PubMed®、LILACS、PEDro及EMBASE数据库，检索关键词为“帕金森病”、“老年人”、“跑步机训练”与“步态评估（gait evaluation）”。采用PEDro量表（PEDro Scale）对纳入研究的方法学质量进行评估。最终共有11项研究符合纳入与排除标准，其中8项为随机对照研究，仅1项设置了随访环节。本综述结果显示，针对老年帕金森病患者实施无论是否联合体重支持的跑步机训练（每次训练至少20分钟、每周2~3次、负荷逐步递增且疗程至少6周），均可有效改善其步态功能。此外，该训练方式安全性良好（部分研究提及即使在无体重支持的训练中也可使用安全带辅助），且可与步态康复的辅助疗法联合应用，如重复性经颅磁刺激（repetitive transcranial magnetic stimulation）、视觉提示或阳极经颅直流电刺激（anodal transcranial direct current stimulation）。综上，跑步机训练可作为改善老年帕金森病患者步态结局的有效干预手段，但仍需开展更多高质量研究以提供更充分的循证证据。