Arm and hand exercises may ease tremor, improve grip in Parkinson’s
Benefits seen both alone and with virtual reality training in small trial
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- An eight-week program of arm and hand exercises was found to ease tremor and improve grip strength in people with Parkinson's.
- Adding virtual reality training using Nintendo Wii games also boosted hand dexterity among participants in the small clinical trial.
- The researchers concluded that this type of exercise program, with or without VR training, may provide benefits for those living with Parkinson's.
Eight weeks of exercises designed to strengthen the arms and hands while muscles lengthen reduced tremor and improved grip strength and hand function in people with Parkinson’s disease, the results of a small randomized clinical trial show.
The benefits were seen whether the exercises were done alone or combined with virtual reality (VR) training using video games, according to the researchers. Nearly half of the study participants were first given VR training for less than 30 minutes using Nintendo Wii games.
Trial data showed that only the group that also used VR games showed a significant improvement in fine hand movements — the small, precise motions needed for tasks such as handling buttons or picking up small objects. Still, the researchers noted that outcomes between the two groups did not differ significantly, so the results do not definitely indicate that adding virtual reality was better than doing the exercises without such training.
“Exercises alone or added to Nintendo Wii games can mitigate tremors and improve strength and gross manual dexterity in Parkinson’s disease,” the researchers wrote. “Adding virtual reality further benefits fine manual dexterity, suggesting a valuable role for gamified rehabilitation.”
The study, “Effects of eccentric upper limbs exercises, added with virtual reality, on tremor and upper limbs function in people with Parkinson’s disease: A randomized clinical trial,” was published in the Journal of Hand Therapy.Â
Parkinson’s is characterized by progressive motor symptoms, including tremor. People with Parkinson’s can also develop muscle weakness and reduced hand dexterity, making everyday tasks more difficult.
So-called eccentric exercise is a type of training that involves producing force as a muscle lengthens, for example, slowly lowering a weight. Such exercises can promote muscle strengthening and neural adaptations and have previously been investigated as a means of reducing tremor in people with Parkinson’s.
Virtual reality provides another rehabilitation approach that combines physical movement with cognitive demands, such as attention, planning, and visuospatial processing. VR games allow users to control virtual activities through physical movements, potentially providing repeated, task-oriented training and visual feedback. Previous studies have suggested VR may help motor coordination and dexterity.
Testing exercise with and without virtual reality training
Now, researchers in Brazil tested whether combining VR games, specifically those on the Nintendo Wii, with eccentric upper-limb exercises would provide additional benefits to lessen tremor and improve muscle strength and hand dexterity in people with Parkinson’s.
The trial, which involved 25 people with Parkinson’s, was conducted at a single center in the country. All participants were taking dopamine-replacing medications, which increase or mimic the effects of dopamine, the chemical messenger in the brain that helps control movement and is progressively lost in Parkinson’s.
A total of 14 patients were randomly assigned to receive eccentric upper-limb exercise alone, while 11 received the same exercises plus Nintendo Wii training. The groups did not differ significantly in demographic or clinical characteristics, though the Wii group had a somewhat higher proportion of women (55% vs. 43%). The mean age of those in the exercise-only group was 63.5, while that of the participants in the VR group was 59.8.
Both groups completed eccentric exercises twice weekly for eight weeks or about two months, for a total of 16 sessions. The exercises targeted muscles involved in elbow bending and wrist movement, with resistance progressively adjusted for each participant. Each eccentric exercise session lasted about 35 minutes.
The Wii group received an additional 20 minutes of virtual reality training using tennis and boxing games from Wii Sports and cycling and canoeing from Wii Sports Resort. The games required combinations of arm movements alongside attention, planning, concentration, and visuospatial skills.
Adding Wii game training may help improve dexterity
All participants were evaluated before training, immediately afterward, and one month later. Tremor was assessed with the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) and a smartphone application. Grip strength and both gross and fine hand dexterity were also tested.
On the MDS-UPDRS, three tremor types — resting, postural, and kinetic — were lessened in both groups, and the benefits remained evident one month after training. Kinetic tremor occurs during voluntary movement, while postural tremor appears when a person holds a position against gravity.
Smartphone measurements offered a more mixed picture, according to the researchers. Kinetic tremor amplitude decreased significantly in both groups after training and remained lower at follow-up. Tremor amplitude is the size or distance of the involuntary shaking in the hand or arm.
Meanwhile, postural tremor amplitude improved significantly only in the solely eccentric exercise group, while no significant improvement in resting tremor amplitude was detected with the app. There were no significant between-group differences in these tremor measures, the team noted.
Grip strength, however, increased significantly in both groups after treatment, and the gains were maintained one month later. Both groups also improved on gross manual dexterity tests. Adding Wii training did not produce a significant between-group advantage for these outcomes, the researchers noted.
Only the Wii group showed an improvement in fine dexterity tests; however, the difference between the Wii and exercise-only groups was not statistically significant.
The present study concludes that eccentric exercises alone or added with commercial Nintendo Wii games can mitigate tremors and improve muscle strength and gross manual dexterity in people with [Parkinson’s disease].
The researchers hypothesized that the Wii games may have helped fine dexterity because their tasks require movements similar to those used in everyday activities and dexterity testing, such as gripping and rapid hand and forearm adjustments.
Overall, according to the team, the findings support eccentric upper-limb exercise as a potential approach to reducing tremor and improving strength and hand function in Parkinson’s. The researchers said the data also suggest that adding game-based VR may provide an additional fine-dexterity benefit that warrants confirmation in larger trials.
“The present study concludes that eccentric exercises alone or added with commercial Nintendo Wii games can mitigate tremors and improve muscle strength and gross manual dexterity in people with [Parkinson’s disease],” the team concluded. The researchers noted that “the addition of VR to the eccentric exercise program can promote improvements in fine manual dexterity, suggesting that task characteristics of virtual games can complement traditional hand therapy approaches.”
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