Cognitively Challenging Agility Boot Camp Program for Freezing of Gait in Parkinson Disease.

This was a small proof-of-concept sub-study, so it was designed to test feasibility and provide effect sizes, not to prove efficacy. Only 46 participants were enrolled, and 17% dropped out, including 24% during exercise. The objective freezing measure showed only a small effect size after exercise, so the study did not show a clear overall reduction in freezing. Self-reported freezing may reflect recollection of medication-on periods at home, because testing was done after at least 12 hours without anti-parkinson medication. The finding that worse baseline freezing improved more after exercise was exploratory and lacked a threshold for clinically important change. Brain connectivity results came from only 13 participants who had imaging at all three timepoints. The intervention lasted 6 weeks, which the authors say may be too short for complex gait and balance problems in Parkinson disease. There was no washout period between the crossover phases, which may have affected the results. Exercise and education did not have equal staff contact, because education included home relaxation practice with lower compliance. One participant fell during exercise and sustained a hip fracture, so safety monitoring is needed for this population. The groups differed at baseline on the MoCA, with a higher score in the exercise-first group (p=0.04). Freezing is context-dependent, so laboratory turning and a questionnaire may not capture daily freezing.

Dr. Horak has an equity interest in APDM, a company that may have a commercial interest in the results. The study used APDM inertial sensors to measure the objective FoG Ratio. The conflict was reviewed and managed by the Research & Development Committee at the VA Portland Health Care System and Oregon Health & Science University.

Do not conclude that ABC-C reduces freezing of gait. The questionnaire improved, but the objective FoG Ratio showed only a small effect size after exercise and no overall change. The program also combined many exercise stations and cognitive challenges, so no single component can be credited.