Disparate effects of training on brain activation in Parkinson disease

Neurology. 2017 Oct 24;89(17):1804-1810. doi: 10.1212/WNL.0000000000004576. Epub 2017 Sep 27.


Objective: To compare the effects of 2 forms of exercise, i.e., a 6-week trial of treadmill training with virtual reality (TT + VR) that targets motor and cognitive aspects of safe ambulation and a 6-week trial of treadmill training alone (TT), on brain activation in patients with Parkinson disease (PD).

Methods: As part of a randomized controlled trial, patients were randomly assigned to 6 weeks of TT (n = 17, mean age 71.5 ± 1.5 years, disease duration 11.6 ± 1.6 years; 70% men) or TT + VR (n = 17, mean age 71.2 ± 1.7 years, disease duration 7.9 ± 1.4 years; 65% men). A previously validated fMRI imagery paradigm assessed changes in neural activation pretraining and post-training. Participants imagined themselves walking in 2 virtual scenes projected in the fMRI: (1) a clear path and (2) a path with virtual obstacles. Whole brain and region of interest analyses were performed.

Results: Brain activation patterns were similar between training arms before the interventions. After training, participants in the TT + VR arm had lower activation than the TT arm in Brodmann area 10 and the inferior frontal gyrus (cluster level familywise error-corrected [FWEcorr] p < 0.012), while the TT arm had lower activation than TT + VR in the cerebellum and middle temporal gyrus (cluster level FWEcorr p < 0.001). Changes in fall frequency and brain activation were correlated in the TT + VR arm.

Conclusions: Exercise modifies brain activation patterns in patients with PD in a mode-specific manner. Motor-cognitive training decreased the reliance on frontal regions, which apparently resulted in improved function, perhaps reflecting increased brain efficiency.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Brain / diagnostic imaging*
  • Cognition Disorders / etiology
  • Exercise Test
  • Female
  • Follow-Up Studies
  • Gait / physiology
  • Humans
  • Image Processing, Computer-Assisted
  • Imagery, Psychotherapy / methods
  • Magnetic Resonance Imaging
  • Male
  • Mental Status Schedule
  • Oxygen / blood
  • Parkinson Disease / complications
  • Parkinson Disease / diagnostic imaging
  • Parkinson Disease / pathology*
  • Parkinson Disease / rehabilitation*
  • Surveys and Questionnaires
  • Virtual Reality Exposure Therapy / methods*


  • Oxygen