Treadmill Walking Linked to Greater Gait Stability, Less Cognitive Control in Parkinson’s, Study Says

Treadmill walking, but not over-ground walking, can improve gait stability in patients with Parkinson’s disease, a study has found.

The research, “Treadmill walking reduces pre-frontal activation in patients with Parkinson’s disease” was published in Gait & Posture.

It is widely known that Parkinson’s patients have difficulties preforming learned motor skills automatically, a phenomenon referred to as decreased motor automaticity. Automaticity is the ability to perform movements without having to pay attention to the details of the movement, particularly for actions that require low levels of precision or for movements that are frequently made, such as walking.

Evidence indicates that the gait changes observed in Parkinson’s patients are associated with impaired rhythmicity and increased activation of the prefrontal cortex — a brain area responsible for higher thought processes, such as decision making, planning and reasoning. It’s believed that prefrontal activation occurs to compensate patients’ reduced automaticity.

Researchers from the Tel Aviv Sourasky Medical Center, in Israel, decided to investigate whether treadmill walking, when the pace is determined and fixed, reduced prefrontal activation in Parkinson’s patients (which improves  automatic motor skills) in comparison to over-ground walking.

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Twenty Parkinson’s patients (10 men and 10 women; mean age 69.8 years) were asked to walk at a self-selected walking speed over-ground (in a 32-yard corridor) and then on a treadmill. Each walking condition was tested five times.

On the treadmill, patients had to walk for 30 seconds after they reached the steady state for their self-selected comfortable walking speed.

Using a non-invasive imaging technique called functional near-infrared spectroscopy (fNIRS), researchers assessed the participants’ prefrontal activation by measuring the changes in hemoglobin (the molecule in red blood cells that carries oxygen) concentrations within that brain region.

Gait and prefrontal activation were assessed during the two walking conditions in the “on” medication state (when medication does not wear off and motor symptoms are controlled). All participants completed the over-ground trials in approximately 30 seconds each.

Compared to over-ground walking, prefrontal activation was significantly decreased during treadmill walking, as measured by a lower hemoglobin concentration in that brain region.

Gait stability was greater on the treadmill, in comparison to the over-ground walking condition.

“From a clinical perspective, our findings add further support to the idea that training on the treadmill may be useful to improve gait stability while also freeing cognitive resources to allow for more targeted and challenging training such as dual task training,” researchers said. Dual-tasking involves performing a primary motor task, such as standing, and a secondary task, like talking, simultaneously. It is the primary means of assessing the automaticity of a given motor task.

Further research is warranted to assess the mechanisms behind prefrontal activation and how disease severity or medication regimens may influence the body’s response to an external pacemaker, such as treadmill exercising.