Abstract
Introduction. The effectiveness of the currently utilized therapies for FoG is limited. Several studies demonstrated a beneficial impact of Nordic walking (NW) on several gait parameters in Parkinson's disease, but only one paper reported reduction of freezing. Research Question. In the present study, the question is whether NW is an effective therapeutic intervention in FoG. Methods Twenty PD subjects trained NW for 12 weeks, with a frequency of twice per week. Each session lasted about 60 minutes. Twenty patients in the control group did not use any form of physiotherapy (no-intervention group). Freezing of Gait Questionnaire (FOGQ), the Timed Up and Go (TUG) test, and the Provocative Test for Freezing and Motor Blocks (PTFMB) were performed at baseline, immediately after the end of NW program, and three months later. Results The results of FOGQ, TUG, and total PTFMB revealed significant improvement after completing the exercise program, and this effect persisted at follow-up. The results of the PTFMB subtests showed a different effect of NW on particular subtypes of FoG. Start hesitation, sudden transient blocks that interrupt gait, and blocks on turning improved considerably, while motor blocks, when walking through narrow space and on reaching the target, did not respond to NW training. Significance. The results show, for the first time, that FoG during turning and step initiation, two most common forms of this gait disorder, has been significantly reduced by NW training. Different responses of particular subtypes of FoG to NW probably reflect their different pathophysiologies. Conclusions The present study showed that NW training had a beneficial effect on FOG in PD and that the achieved improvement is long-lasting. Future research should clarify whether the observed improvement limited to FoG triggered by only some circumstances reflects different pathomechanisms of FoG subtypes.
Highlights
Freezing of gait (FoG) is a disabling phenomenon usually observed in the more advanced stages of Parkinson’s disease (PD) [1,2,3]
Results e Nordic walking (NW) group consisted of 8 females and 12 males, with a mean age of 72.1 ± 7.5 and a mean disease duration of 5.2 ± 1.1 years. e mean age of 11 females and 9 males in the control group was 67.6 ± 6.6 years, and the mean disease duration was 6.0 ± 1.2 years. e difference in age between the groups was on the verge of statistical significance (p 0.051). e duration of disease was significantly longer in the control group (p 0.04); it was included in further analysis as a cofactor; this difference on average equaled only 0.8 year
Freezing of Gait Questionnaire. e changes in FOGQ results after the NW training period in both groups were analysed by generalized linear models (GLMs) that achieved statistical significance of p < 0.0001
Summary
Freezing of gait (FoG) is a disabling phenomenon usually observed in the more advanced stages of Parkinson’s disease (PD) [1,2,3]. According to the proposed definition, FoG is a “brief, episodic absence or marked reduction of forward progression of feet despite the intention to walk” [4]. FoG leads to impaired mobility, significantly increases the risk of falling over, and interferes with daily activities [5, 6]. It has a significantly negative impact on the quality of life of PD patients [7, 8]. Limited effectiveness of the currently utilized therapies for FoG most probably reflects the complexity of pathomechanism of this phenomenon. Optimization of pharmacotherapy (especially the adjustment of dopaminergic treatment), external cueing, deep brain stimulation, and different forms of physiotherapy are among the proposed treatment options [11]
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