Parkinson’s disease is historically recognized as a neuromotor disorder. However, non-motor symptoms (NMS) can occur well before the onset of motor symptoms, including sleep disorder, cognitive decline, anxiety, depression, autonomic difficulties, sensory symptoms, olfactory disturbances and fatigue. Typically, NMS at late stage dominate the clinical manifestation and are major determinants of quality of life in patients with PD. NMS usually show minimal response to standard of care and currently available treatment options for NMS are often inadequate.

We have recently conducted a preliminary efficacy trial sponsored by NIH (NICHD 1R21HD094003). In this project, we examined the efficacy of a Qigong exercise in major NMS of PD and some motor symptoms. In this project, we enrolled a total of 52 participants with PD. They were randomly assigned to a Qigong exercise group (n=27) or sham Qigong control group (n=25).

Both groups participated in a baseline and end-intervention evaluation sessions and 12-week intervention that including one weekly training/group exercise session and daily practice at home. There were 18 dropouts, and 34 participants (17 in each group) completed the intervention and evaluation sessions.

The increase in mean values of PD sleep scale (PDSS-2) in the Qigong group was significantly (p<0.05) different from the increase of mean value in the Sham Qigong group (Table below). The changes in fatigue (PFS) (p=0.10), Depression (GDS) (p=0.06), Anxiety (GA) (p=0.17), and PD Non-Motor Symptoms Questionnaire (NMSQ) score (p=0.19) showed trends towards significant between-group differences.

The New Freezing of Gait Questionnaire (NFOGQ) scores significantly decreased (-4.3 ± 3.5) in Qigong group, which is significantly different (p<0.01) from a non-significant increase (0.8 ± 3.6) in the sham Qigong group in participants who showed the sign of freezing of gait (Figure below). We are planning a future large-scale trial.

Summary: In this project, we use a novel gait-training device and its partner AI-based control program developed in our laboratory for working with chronic non-ambulatory stroke survivors.

Individuals are randomly assigned to our robotic gait training program or traditional cycling program to compare cardiovascular, pulmonary and sensorimotor functions between groups. Our previous pilot study with the device produced promising results and we hope to see improvements in cardiovascular, pulmonary and sensorimotor functions in those who partake in the gait training program.

Additionally, we will compare outcomes between the gait-training and cycling group to see how our gait-training program compares to a traditional cycling program commonly used for chronic non-ambulatory stroke survivors. The long-term goal is to make the gait training program available to in-home or community settings.

Above: Table 3 shows the pre-training, post-training and change in values from pre- and post- for each of the cardiovascular risk factors. A P-value less than or equal to 0.05 indicates the change is statistically significant. rHR = resting heart rate. SBP = systolic blood pressure. DBP = diastolic  blood pressure. LDL = low-density lipoprotein cholesterol. PHQ-9 = patient health questionnaire-9 (depression measure).

Summary: Our previous pilot projects using gaiting training with non-ambulatory individuals with spinal cord injury have shown improvements in lower extremity muscle strength, anxiety and depression, and measures related to cardiovascular disease risk. Specifically, our 8-week gait training program improved glycemic control (HbA1c level), lipid profile (LDL-C and HDL-C levels), and inflammatory marker (IL-6) as shown in table 3 (below).

Our goal is to expand on our pilot with proper research design to examine the influence of spinal neuroplastic changes after gait training on cardiac adaptation. This project may extend our traditional view on the benefit of gait training on the cardiovascular system.

Above: Table 3 shows the pre-training, post-training and change in values from pre- and post- for each of the glycemic control, lipid profile, and inflammatory marker measures. A P-value less than or equal to 0.05 indicates the change is statistically significant.

Fibromyalgia (FM) is a chronic syndrome with widespread chronic pain, chronic fatigue and sleep disturbances. The cause of FM is still unknown. Various interventions have been recommended, but there is a lack of holistic approach to simultaneously manage multiple symptoms.

Qigong is a mind-body self-management approach that has shown beneficial results in various health conditions. This study was to examine the efficacy of a 10-week daily Qigong, a mind-body intervention program, on fibromyalgia symptoms.

A total of 59 participants with fibromyalgia were randomly assigned to a Qigong exercise group z(n=29) or a sham Qigong control group (n=30). There were 13 dropouts. Forty-six participants (n=24, n=22, respectively) completed the study. The Qigong group practiced mild body movements synchronized with deep diaphragmatic breathing and meditation. The sham-Qigong group practiced only mild body movements. Both groups practiced the interventions two times per day at home, plus one weekly group practice session with a Qigong instructor.

Clinical assessments include the Short-Form McGill Pain Questionnaire, Pittsburg Sleep Quality scale, Revised Fibromyalgia Impact Questionnaire, and visual analog scale for fatigue. The experimental group improved before and after the intervention in pain by -35.3% (p < 0.001), sleep quality by -28.4 % (p < 0.001), fatigue by -22.0% (p < 0.001), and fibromyalgia impact by -29.1 % (p < 0.001). The changes in the control group were not significant in pain (-8.0%), sleep quality (-6.8%), fatigue (-8.1%), except in fibromyalgia impact by -11.6% (p < 0.05). The changes in all four measurements were significantly different (p<0.001) between two groups. We are planning a future comparative pragmatic trial to compare the outcomes between the Qigong and aerobic exercise.

People with knee osteoarthritis (KOA) often complain of worsening joint pain after walking exercise and most of them fail to meet the recommended physical exercise. Several key factors have been suggested for the low adherence to walking exercise including joint pain, joint stiffness, low fitness level and possibly fear of KOA worsening. However, the dose-response of join pain to walking exercise has not been studied systematically. A past study indicated that one bout of interval walking (IW) may reduce pain, but one bout of continuous walking (CW) may raise pain level in people with KOA.

In a pilot randomized trial study in our laboratory, we examined the changes of joint pain and exercise compliance after each session of IW or CW exercise over 6 weeks in people with KOA. Twenty-two participants were enrolled and randomly assigned to either an IW or CW group. The intervention involved 30 minutes of walking exercise, 3 times/week for 6 weeks. The IW was a 30-minute walking in 2 bouts (15 minutes each) with 30-40 minutes of a resting interval, while the CW was a 30-minute walking in one continuous bout.

The joint pain at rest prior to each walking exercise showed a similar trend of decreasing over time in both IW and CW groups (right figure). However, after each walking session, the joint pain decreased in the IW group but increased in the CW group across the intervention period (middle figure). The compliance to walking exercise were high in both groups until the late phase of the intervention, during which the IW group maintained a stable compliance while CW group showed a dramatic decrease in the compliance (left figure). 

These results may imply that the perception-reaction system may be the first to break down due to fear of KOA worsening in individuals with KOA when they participate in CW exercise, despite the gradual decrease in resting joint pain.  IW may be a solution for this important issue. Future large-scale trials are needed.