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.

BACKGROUND: Parkinson's disease is a progressive neurodegenerative disorder. Eccentric upper limb exercises can reduce tremors and improve strength, while virtual reality has shown promise in enhancing upper limb function. PURPOSE: The study compared the effects of eccentric upper limb exercises, added to Nintendo Wii games, vs exclusive eccentric exercises, on upper limb tremor and function in Parkinson's disease. STUDY DESIGN: Randomized clinical trial. METHODS: Twenty-five participants were allocated to eccentric exercises added to Nintendo Wii games (EWG) or an exclusive eccentric exercise (EEG). Both groups trained for eight weeks, twice a week, for a total of 16 sessions. Tremor, strength, and manual dexterity were assessed pre-training, post-training, and 1 month follow-up (FU) using MDS-UPDRS, StudyMyTremor, Manual Hydraulic Dynamometer, Box and Block Test, and Nine Hole Peg Test. ReBEC under code RBR-7p2jfnz. RESULTS: Eccentric training reduced kinetic tremor amplitude pre x post-training (X2(1) = [4.5], p = [0.03] and (X2(1) = [7.3], p = [0.007]) (p < 0.05), and between pre-training x FU (X2(1) = [4.5], p = [0.03]) and (X2(1) = [4.4], p = [0.03]) for EEG and EWG. EWG improved the fine manual dexterity by 4 seconds, surpassing the minimal detectable change of 2.6 seconds, between pre x post-training and between pre-training x FU (X2(2) = [6.8], p =[0.03]). Handgrip strength increased in both groups between pre x post-training (p = [<0.001]; p = [0.02]) and between pre-training x FU (p = [0.02]; p = [0.04]) for EEG and EWG, respectively, with no ANOVA interaction effect (F(2) = 0.09; p = 0.91; ηp2 < 0.001). CONCLUSIONS: Eccentric exercises alone or added to Nintendo Wii games can mitigate tremors and improve strength and gross manual dexterity in Parkinson's disease. Adding virtual reality further benefits fine manual dexterity, suggesting a valuable role for gamified rehabilitation.