Objective: To determine the effect of exercise combined with self-initiated unclassified therapeutic tremors (SUTT), over 9 weeks, compared to exercise-alone, on gait in people with Parkinson’s disease (PwPD).

Background: PwPD experience challenges with activities of daily living, such as festinating gait and postural instability. Because anxiety and stress aggravate gait disturbances, an adjunctive modality targeting stress management, combined with exercise, may yield benefits. SUTT claims to leverage endogenous mechanisms of physiological tremors, while simultaneously having distinctive activation characteristics which may help individuals ameliorate stress. It was hypothesised that SUTT with exercise would lead to improved gait.

Method: 36 PwPD were randomly allocated: Exercise-SUTT (n=14; 72.7 ± 7.5 years), Exercise-Alone (n=10, 70.3 ± 5.7 years), and waitlist control group (n=12; 69.6 ± 8.3 years). Inclusion criteria were mild-to-moderate PD (Hoehn & Yahr stages I–III), physician approval, and ability to perform a 10m walk and sit-to-stand. Exclusion: other neurological/visual/vestibular problems, major surgery or orthopaedic/muscular injuries in previous 3 months, changes in routine medication in previous 4 weeks, and poor cognition (MoCA <17). Gait speed, stride velocity, and stride length asymmetry were measured through an instrumented 2-min walk test (APDM, USA) at baseline (T1), weeks 3 (T2), 6 (T3), and 9 (T4).

Results: Stride velocity. Between-group analysis was non-significant (p>0.05). Clinically meaningful effects were seen between the Exercise-SUTT and Exercise-Alone (Hedge’s g =0.54), and Exercise-SUTT compared to the control group (Hedge’s g =0.63). Within-group comparisons revealed significant findings for Exercise-SUTT between T1-T2 (p=0.014), and T2-T3 (p=0.009). Stride length asymmetry. Significant differences were identified for the following: at T1-T2 between Exercise-SUTT and Exercise-Alone (p=0.018), and Exercise-SUTT and control groups (p=0.014). Within group analysis revealed significant differences in the Exercise-SUTT group at T1-T2 (p=0.005) and at T2-T3 (p=0.005).

Conclusion: Preliminary findings suggest that a multimodal approach of exercise combined with SUTT may positively influence gait in PwPD. This highlights the potential role of stress management, alongside exercise, to improve the motor control. Future research with larger samples is needed to support these findings.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/exercise-and-sutt-a-9-week-randomized-double-blinded-controlled-intervention-on-parkinsonian-gait/