Objective: To determine the neurophysiological and behavioral effects of exercise-based priming and virtual reality in individuals with PD.

Background: Individuals with Parkinson’s disease (PD) are known to experience postural instability. The primary motor cortex is important for modulating postural control, and its excitability is known to vary with the demands of the postural task. Transcranial magnetic stimulation (TMS)-based studies have shown that corticomotor excitability (CME) is reduced during movement and intracortical inhibition is reduced in PD. Endurance exercise has emerged as a primer to task-specific practice in rehabilitation. Here, we explored the role of exercise priming and VR for inducing neuroplasticity in individuals with PD.

Method: Four individuals with PD (age: 57 ± 5, 2 males, H&Y stage: 1.75 ± 0.5) underwent moderate-high intensity endurance exercise on a recumbent stepper (30 minutes total, 5 minutes warm up and cool down). Immediately after exercise, participants played VR-based games targeted towards static and dynamic balance for 30 minutes. The intervention was performed for 9 sessions over 3 weeks. Outcomes involved TMS based measures and the mini-Balance evaluations systems test assessed at baseline and post intervention. Single and paired pulse TMS were used for measuring recruitment curve slopes (80 % active motor threshold (AMT) – 140% AMT), short interval intracortical inhibition and cortical silent period duration for the tibialis anterior representation.

Results: Preliminary findings showed a trend towards increased corticomotor excitability and cortical inhibition following aerobic exercise and VR. There was a trend towards increase in balance, however this change did not meet the clinical threshold.

Conclusion: Our preliminary findings suggest that exercise-priming and VR may increase the excitability of the descending corticospinal tracts from the M1 and increase intracortical inhibition, by modulating the activity of the GABAergic circuits within the M1. It appears that exercise priming and VR can improve the milieu within the M1 for task-practice, but further work is required to confirm these findings. Outcomes from this research will be clinically important for developing exercise as a priming adjunct for balance rehabilitation in PD.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exercise-based-priming-and-virtual-reality-for-optimizing-neuroplasticity-and-balance-in-parkinsons-disease/