Transcranial direct current stimulation enhanced benefit from aerobic exercise and improved gait in Parkinson’s patients immediately after the session. There were gains in gait variability, reaction time and executive gait control.
The result was observed in a study conducted by researchers at the Institute of Biological Sciences of the University of Paulista (Unesp), on the campus of Rio Claro, with 20 volunteers. The article was published in the scientific journal Neurorehabilitation and nervous system repair.
Participants attended two 30-minute sessions of aerobic exercise (moderate-intensity cycling) combined with different conditions of transcranial active stimulation (tDCS) or placebo, one week at a time.
Before and immediately after each session, cognitive functions and brain activity while walking were assessed. Spatiotemporal parameters were also included in the analysis to monitor stride quantity and length and to measure walking speed. In the randomized, double-blind, crossover study, there was a placebo control.
“Compared to pre-assessment, participants had reduced step time variability, reduced individual and optional reaction time, and increased activity in the brain region stimulated during walking after aerobic exercise combined with active tDCS,” the researchers wrote in the article, which was the support From FAPESP.
a business consultant, Rodrigo Vittorio It shows that to allow comparison without bias, volunteers received active interventions and, on separate days, a type of placebo, that is, simulated stimulation for only ten seconds, while the time in the studied patients was 20 minutes. Half of the sample took the active placebo sequence, and the other half took the active placebo.
Transcranial stimulation is performed by means of two small rectangular electrodes, which are placed in specific places in the skull. The device, both portable and battery, is attached to electrodes attached to the scalp, forming an electrical circuit that runs through the brain. The current is very low, 2 milliamperes (mA), but enough to stimulate the neurons, making them ready to function if the organism requires movement.
“Even with a limited sample size, we saw that transcranial stimulation increased the activity of the prefrontal cortex, an area of the brain that Parkinson’s patients use to control walking more than healthy people. We saw improvements, including cognitive function,” says Vittorio, who is currently working on Research Fellow in the School of Science and Health at Northumbria University (in the UK).
In an interview with FAPESP . agencyOne of the goals of the work, he says, is to understand the effects of brain stimulation technology after previous studies by groups he was already a part of had demonstrated that aerobic exercise helps with the motor activity of Parkinson’s patients.
“Transcranial stimulation, in addition to being safe, is promising in terms of enhancing the effects of interventions and treatments. It is already prescribed, for example, in cases of depression,” Vittorio says.
Data from the World Health Organization (WHO) indicated that about 1% of the world’s population over 65 years of age developed Parkinson’s disease in 2019. In Brazil, due to the lack of mandatory notification of cases, it is estimated that 250,000 people are infected.
Parkinson’s disease leads to a chronic and progressive deterioration of the central nervous system, caused by a decrease in the production of dopamine, a substance that transmits messages between nerve cells (neurotransmitters).
Dopamine helps to perform voluntary body movements automatically, that is, it is not necessary to think about the movement that the muscles should make. In the absence of it, the individual loses control of the motor. Medications prescribed to treat the disease generally work to replace dopamine.
Parkinson’s patients experience specific degenerations in the areas of the brain involved in this automatic movement control. To make up for this deficiency, they use attention resources. In the research, stimulation-related aerobic exercise increased this compensatory capacity in volunteers.
Among the main symptoms of the disease are slow movement, stiffness in the joints of the wrist, elbow, shoulder, thigh, and ankle, trembling when resting in the hands, and reaching imbalance. Therefore, improving walking for these patients could make a difference to their quality of life, and prevent falls, for example.
Recently, another group of researchers from Unesp, on the Bauru campus, concluded that the synergistic stride length of patients with Parkinson’s disease while crossing obstacles is 53% lower than that of healthy people of the same age and weight.
This synergy refers to the ability of the locomotor system to adapt movement—a combination of factors such as speed and foot position—when it is necessary to cross an obstacle, such as climbing a pavement guide (Read more on agencia.fapesp.br/36083/).
Article Aerobic exercise combined with transcranial direct current stimulation on the prefrontal cortex in Parkinson’s disease: effects on cortical activity, gait, and cognition. Available in: https://journals.sagepub.com/doi/abs/10.1177/15459683211019344?journalCode=nnrb.
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