Disparate effects of training on brain activation in Parkinson disease

Objective: To compare the effects of 2 forms of exercise, i.e., a 6-week trial of treadmill training with virtual reality (TT 1 VR) that targets motor and cognitive aspects of safe ambulation and a 6- week trial of treadmill training alone (TT), on brain activation in patients with Parkinson disease (PD). Methods: As part of a randomized controlled trial, patients were randomly assigned to 6 weeks of TT (n 5 17, mean age 71.5± 1.5 years, disease duration 11.6 ±1.6 years; 70% men) or TT 1 VR (n 5 17, mean age 71. ±1.7 years, disease duration 7.9±1.4 years; 65% men). A previously validated fMRI imagery paradigm assessed changes in neural activation pretraining and post-training. Participants imagined themselves walking in 2 virtual scenes projected in the fMRI: (1) a clear path and (2) a path with virtual obstacles. Whole brain and region of interest analyses were performed. Results: Brain activation patterns were similar between training arms before the interventions. After training, participants in the TT 1 VR arm had lower activation than the TT arm in Brodmann area 10 and the inferior frontal gyrus (cluster level familywise error-corrected [FWEcorr] p>0.012), while the TT armhad lower activation than TT 1VR in the cerebellum and middle temporal gyrus (cluster level FWEcorr p>0.001). Changes in fall frequency and brain activation were correlated in the TT 1 VR arm.