THE EFFECTIVENESS OF PROGRESSIVE RESISTANCE TRAINING IN MANAGING PROGRESSIVE SUPRANUCLEAR PALSY: A CASE STUDY

Abstract

SETTING The Centre for STRONG Medicine is an outpatient multidisciplinary geriatric service at Concord Hospital, Sydney. An 82-year-old male with a primary diagnosis of Progressive Supranuclear Palsy (PSP) with cardiac and metabolic comorbidities was referred in March 2023. PSP is a rare neurological disorder that affects gait, balance, vision, and cognition. The participant mobilised with a rollator and had previously sustained vertebral and wrist fractures secondary to falls. MANAGEMENT Management was to use progressive resistance training (PRT) to combat mobility decline, prevent falls and provide education to encourage independent exercise. Initial assessment determined current health status using Falls Self Efficacy Scale (FSE-I) and Fried Frailty Phenotype (FFP) questionnaires, and measured function and strength using maximal gait speed, five times sit-to-stand (5xSTS) and one repetition maximum (1RM), respectively. FSE-I determined a high fear of falling and FFP determined frail classification. Outcomes informed the PRT exercise prescription targeting the major muscle groups for 2-3 sets of 7-9 repetitions at 70-85% 1RM progressed gradually and preformed twice weekly in a supervised group. Education regarding breathing, exercise tempo, rest, progression, and risk mitigation were provided. All outcomes were reassessed after 12-weeks of training. RESULTS Attendance was 100% (23 sessions) with improvement in all outcomes. Functional improvements included 0.25metres/second increase in maximal gait speed, 2.5 second reduction in 5xSTS, and safe mobilisation without a rollator. Strength improvements included 101% increase in 1RM leg press, 100% increase in 1RM triceps extension and 72% increase in 1RM seated row. Frailty status improved to pre-frail and fear of falling reduced. Self-reported improvements included increased steadiness and confidence exercising unsupervised. DISCUSSION Although PSP is progressive, PRT resulted in meaningful benefits in strength and function that improved daily task performance and confidence. Further research is needed to investigate the effects of PRT on PSP management in a larger cohort.