界上观｜支晓：Sports Medicine and Health Science

作|者|简|介

支  晓

影视艺术学院辅导员，大一年级主任。大连理工大学硕士研究生，大学期间曾获研究生一等奖学金，辽宁省“优秀毕业生”。CBBA国家级东方舞教练员、裁判员。发表多篇国家级、省级学术论文。

In daily functional activities, the body needs the ability to perform two or more tasks at the same time (such as talking while walking). However, the gait disorder of patients with Parkinson's disease is aggravated when performing dual tasks, which seriously affects their quality of life. Therefore, the medical management plan should offer effective exercise training programming to improve Parkinson's disease patients' ability to perform dual tasks. Most traditional exercise intervention methods only focus on the perspective of exercise or cognition, ignoring their interaction, and fail to adequately resolve the dual task obstacles associated with Parkinson's disease. Some scholars put forward the concept of dual-task training and have applied dual-task training to pa- tients with neurological disorders and have achieved good therapeutic effects. Therefore, this article summarizes the research literature concerning dual-task training to improve cognitive impairment and walking function of Parkinson's disease patients, to evaluate and discuss possible mechanisms of action, and provide a basis for adjuvant treatment and rehabilitation of Parkinson's disease patients.

Parkinson's disease (PD), also known as paralysis agitans, is becoming a common chronic neurodegenerative disease,1 especially in the elderly. Clinical motor PD symptoms include resting tremor, muscle rigidity, abnormal posture, and gait. In addition to motor symptoms, cognitive dysfunction is one of the most common non-motor comorbidities in PD patients.2–5 The prevalence of mild cognitive impairment in early PD patients is as high as 34%6 of the population. PD is associated with dysfunction in daily life that seriously affecting the quality of life and increased mortality.7,8 As the population ages, the number of PD patients increases.9 The World Health Organization predicts that by 2030, China's PD patients will number approximately 5 million individuals. At present, the cause of PD is not clear but is likely related to heredity, age, and the environment. Clinical treatment includes surgery, drug control, and rehabilitation.10 Long-term drug use has large side effects, and surgical treatment is effective, but the cost is high. Exercise as an ancillary method has few side effects, easy to do, economically beneficial, proven to positively affect gait, posture control, and balance ability of PDpatients.

The human body's control of gait and posture depends on the motor system's ability to properly regulate the participation of sensory andcognitive functions and is the common interaction link between the sensory system and the central nervous system.13 The simplest activity is talking, walking, picking up a cup to drink, and writing. Participating in any one of these activities while listening to music requires the ability to perform two or more activities at the same time. Thus, the ability to perform two or more activities at the same time in daily functional ac- tivities is very important.14 Non-PD people or PD patients' daily activities include cognitive participation. When PD patients perform motor and cognitive tasks at the same time, motor tasks that rely on visual guidance are not significantly impaired, but cognitive tasks that do not rely on visual guidance are significantly impaired. PD researchers have proposed that improvement of motor and cognitive functions in PD patients is achieved by modification of different motor and cognitive pathways.15 While traditional exercise interventions often focus only on the ability to perform skill-based sports, the relationship between sports skills and cognition has been ignored. This lack of investigations regarding the interaction between these variables has failed to adequately resolve to overcom obstacles for properly completing dual-task in PD patients. Scholars have put forward the concept of dual tasks and applied dual-task training (DT) methods for improving the health of patients with neuro-

logical diseases such as brain injury and Alzheimer's disease to achieveimproved therapeutic effects,16 and to successfully perform two tasks at the same time.17 Most daily functional activities process external information while performing motor tasks, but distractions such as making mobile telephone calls while walking distract from performing these daily functional activities.18 DT generally involves a primary ex- ercise or balance task such as walking, standing on the front or rear of one's feet, and a distracting secondary task. The secondary task is composed of different forms of cognitive activities such as a simple motor task like holding a water cup or turning one's head. Other secondary tasks are a memory task such as memorizing numbers, or a calculation task such as addition or subtraction.19,20 DT refers to the simultaneous training of individuals to do two tasks; the main motor task and the secondary distracting task.13 Recently, some new literature reviews on the effects of DT on PD have been published. For example, Li, ZL, De Freitas, TB and others have explored the effects of DT on PD patients and proposed that the use of DT during training can improve the gait per- formance, motor symptoms, and balance ability of patients.21,22 How- ever, there are still few scholars studying the effect of DT on the cognitive dysfunction of PD patients, and the control of gait and posture in PD patients depends on the ability to regulate sensory and cognitive func- tions of the motor system. At the same time, many review studies only explore the impact of DT on the walking or balance ability of PD patients, but they lack the exploration of its internal mechanism. This study aims to discuss the theoretical basis and methods of DT, the effect of DT application in PD patients, and the efficacy mechanism of how DT affects PD patients in depth. Therefore, this article summarizes the research literature concerning the use of DT to improve cognitive impairment and walking function of PD patients, evaluate and present possible mecha- nisms of action, and provide a basis for adjuvant treatment and reha- bilitation of PD patients.

A literature search from the Web of Science, PubMed, Medline, CNKI, Elsevier, Wanfang databases, and other websites was completed, and data were collected and analyzed. The keywords were Parkinson's Dis- ease AND dual-task training AND cognitive impairment AND walking function, Parkinson's Disease AND dual-task therapy AND cognitive dysfunction AND walking ability, Parkinson's Disease AND dual-task intervention AND cognitive impairment AND walking ability. Two in- dependent researchers con-ducted the search. If there was disagreement between them, a third examiner was recruited. After sorting and evalu- ating the retrieved studies, the literature was summarized regarding the effects of DT on cognitive impairment and walking function of PD pa- tients. In order to better understand the relationship between exercise and PD, a follow-up literature search was completed within CNKI, CSSCI, WOS databases using the key-words Parkinson's disease, exercise training, and walking ability as the subject terms. Citespace was used to perform statistical analysis to construct a visual mapConstructing a knowledge map of related information regarding Sports- Parkinson's disease. Through visual analysis and literature review, it is found that physical exercise or physical exercise can promote the recovery of motor dysfunction in Parkinson's disease patients to a certain extent. In the past few years of research, there have been a lot of evidences that exercise has a pro- tective effect on the brain. The study of Parkinson's disease animal model found that exercise promotes the remodeling process of brain function, and finally changes the behavior.

Constructing a knowledge map of related information regarding Sports- Parkinson's disease. Through visual analysis and literature review, it is found that physical exercise or physical exercise can promote the recovery of motor dysfunction in Parkinson's disease patients to a certain extent. In the past few years of research, there have been a lot of evidences that exercise has a pro- tective effect on the brain. The study of Parkinson's disease animal model found that exercise promotes the remodeling process of brain function, and finally changes the behavior.

Conclusion

In summary, the damage to the central nervous system of PD patients makes completing complex activities of daily living most difficult. This article summarizes the existing literature regarding the use of DT in the treatment of PD patients. Generally, DT is effective for improving cognitive impairment and walking function of PD patients, but the spe- cific neurophysiological mechanism for the beneficial effect remains to be determined. Whether increased DT in PD patients improves the quality of life of patients after discharge needs further verified. In the future, the efficacy of DT should be actively evaluated to provide a basis for the ancillary treatment and rehabilitation of PD patients, so as to allow patients to return to society as soon as possible and regain a higher- quality life.

Submission statement

This manuscript is an original work that has not been previously published, nor will it be under consideration for publication by any other journal before a decision has been made by Sports Medicine and Health Science. If accepted, this manuscript will not be published elsewhere.

本文发表于《sports medicience and health science》杂志。