***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Purpose : To establish the effect of a 6-week programme of cycle ergometry training on exercise tolerance , balance , activities of daily living ( ADL ) and quality of life in individuals with Parkinson ’s disease ( PD ) . Method : Twenty-three subjects were recruited from the Parkinson ’s data base of the neurology service in a large urban teaching hospital . Quasi-experimental study of interrupted time-series design was conducted with subjects acting as their own control . Assessment s were carried out at baseline , week 7 following the control phase , and week 14 following the intervention phase . Intervention consisted of 30-min cycle ergometry training once weekly . Outcome measures included Six Minute Walk Test , Physiological Cost Index , Berg Balance Scale , Timed Up and Go Test ( TUAG ) , ADL and mobility sections of the Unified Parkinson ’s disease Rating Scale ( UPDRS ) and the Parkinson ’s disease question naire ( PDQ ) . Results : Statistically significant improvements were noted for the Berg Balance Scale ( p = 0.003 ) , TUAG ( p = 0.019 ) and ADL ( p = 0.006 ) and mobility ( p = 0.021 ) sections of the UPDRS . A trend towards improvement was found for exercise tolerance . No significant effect on quality of life was found . Conclusion : A 6-week programme of cycle ergometry training did not significantly influence exercise tolerance in this sample , but improved balance , functional abililty and PD-related disability were noted . Implication s for Rehabilitation Individuals with Parkinson ’s disease demonstrate lower levels of exercise tolerance than healthy controls . Individuals with Parkinson ’s disease could participate in 30 min of cycle ergometry training , with no rest periods required . Cycle ergometry training has a positive effect on balance , function and PD-related disability The purpose of this study was to determine if individuals with Parkinson 's disease ( PD ) who completed an 8-week , supervised PoleStriding exercise program  would undergo significant improvements in cognitive skills , activities of daily living , motor function , and quality of life . The Unified Parkinson 's Disease Rating Scale ( UPDRS ) and the Parkinson 's Disease Question naire ( PDQ-39 ) were used to measure functional independence .  Six male volunteers ( 72.7+/-3.7 years of age ) performed PoleStriding exercise three times per week for 37+/-3 minutes . Differences in the participants ' pre- and post-training scores on the UPDRS and PDQ-39 were analyzed using the Wilcoxin Signed Ranks Test . A statistically significant improvement occurred in the UPDRS ( P<0.026 ) and PDQ-39 ( P<0.028 ) scores following the moderate-intensity exercise intervention . The results of this nonr and omized clinical trial indicate that an 8-week individualized PoleStriding exercise program increases perceived functional independence and quality of life in individuals with PD Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more Background . Animal studies indicate forced exercise ( FE ) improves overall motor function in Parkinsonian rodents . Global improvements in motor function following voluntary exercise ( VE ) are not widely reported in human Parkinson 's disease ( PD ) patients . Objective . The aim of this study was to compare the effects of VE and FE on PD symptoms , motor function , and bimanual dexterity . Methods . Ten patients with mild to moderate PD were r and omly assigned to complete 8 weeks of FE or VE . With the assistance of a trainer , patients in the FE group pedaled at a rate 30 % greater than their preferred voluntary rate , whereas patients in the VE group pedaled at their preferred rate . Aerobic intensity for both groups was identical , 60 % to 80 % of their individualized training heart rate . Results . Aerobic fitness improved for both groups . Following FE , Unified Parkinson 's Disease Rating Scale ( UPDRS ) motor scores improved 35 % , whereas patients completing VE did not exhibit any improvement . The control and coordination of grasping forces during the performance of a functional bimanual dexterity task improved significantly for patients in the FE group , whereas no changes in motor performance were observed following VE . Improvements in clinical measures of rigidity and bradykinesia and biomechanical measures of bimanual dexterity were maintained 4 weeks after FE cessation . Conclusions . Aerobic fitness can be improved in PD patients following both VE and FE interventions . However , only FE results in significant improvements in motor function and bimanual dexterity . Biomechanical data indicate that FE leads to a shift in motor control strategy , from feedback to a greater reliance on feedforward processes , which suggests FE may be altering central motor control processes OBJECTIVES To evaluate the learning , retention and transfer of performance improvements after Nintendo Wii Fit ™ training in patients with Parkinson 's disease and healthy elderly people . DESIGN Longitudinal , controlled clinical study . PARTICIPANTS Sixteen patients with early-stage Parkinson 's disease and 11 healthy elderly people . INTERVENTIONS Warm-up exercises and Wii Fit training that involved training motor ( shifts centre of gravity and step alternation ) and cognitive skills . A follow-up evaluative Wii Fit session was held 60 days after the end of training . Participants performed a functional reach test before and after training as a measure of learning transfer . MAIN OUTCOME MEASURES Learning and retention were determined based on the scores of 10 Wii Fit games over eight sessions . Transfer of learning was assessed after training using the functional reach test . RESULTS Patients with Parkinson 's disease showed no deficit in learning or retention on seven of the 10 games , despite showing poorer performance on five games compared with the healthy elderly group . Patients with Parkinson 's disease showed marked learning deficits on three other games , independent of poorer initial performance . This deficit appears to be associated with cognitive dem and s of the games which require decision-making , response inhibition , divided attention and working memory . Finally , patients with Parkinson 's disease were able to transfer motor ability trained on the games to a similar untrained task . CONCLUSIONS The ability of patients with Parkinson 's disease to learn , retain and transfer performance improvements after training on the Nintendo Wii Fit depends largely on the dem and s , particularly cognitive dem and s , of the games involved , reiterating the importance of game selection for rehabilitation purpose OBJECTIVES Frailty is a state of vulnerability associated with increased risks of fall , hospitalization , cognitive deficits , and psychological distress . Studies with healthy senior suggest that physical exercise can help improve cognition and quality of life . Whether frail older adults can show such benefits remains to be documented . METHOD A total of 83 participants aged 61 - 89 years were assigned to an exercise-training group ( 3 times a week for 12 weeks ) or a control group ( waiting list ) . Frailty was determined by a complete geriatric examination using specific criteria . Pre- and post-test measures assessed physical capacity , cognitive performance , and quality of life . RESULTS Compared with controls , the intervention group showed significant improvement in physical capacity ( functional capacities and physical endurance ) , cognitive performance ( executive functions , processing speed , and working memory ) , and quality of life ( global quality of life , leisure activities , physical capacity , social/family relationships , and physical health ) . Benefits were overall equivalent between frail and nonfrail participants . DISCUSSION Physical exercise training leads to improved cognitive functioning and psychological well-being in frail older adults Background Following cued levodopa ( LD ) intake , endurance exercise showed a beneficial effect on scored motor performance in patients with Parkinson 's disease ( PD ) in comparison with rest . This may result from an exercise induced increase in endogenous dopamine synthesis . As a result , beneficial effects on movement and reactivity may occur . Objectives To measure reactivity and motor performance in a repeated fashion with instrumental tasks after cued administration of soluble 200 mg of LD/50 mg of benserazide . Design PD patients consecutively performed paradigms , which assess reactivity and movement performance , after a st and ardised period of rest or of age-related , heart rate adapted endurance exercise  on two consecutive days in a r and om order . Results Reactivity and execution of simple and complex motion series were significantly better following exercise than after rest . Discussion Endurance exercise has a beneficial effect on reactivity and movement behaviour in PD patients following cued application of LD probably due to an augmented synthesis and release of dopamine and other catecholamines and release in the prefrontal cortex , the nucleus accumbens and the basal ganglia . Small changes in catecholamine modulation of prefrontal cortex cells can have profound effects on the ability of the prefrontal cortex to guide behaviour . Previous exercise may also improve pedunculopontine nucleus function , which is involved in motor-related attention processes ABSTRACT The authors determined effects of community-based adapted tango on spatial cognition and disease severity in Parkinson 's disease ( PD ) while controlling for the effects of social interaction . Thirty-three individuals with mild-to-moderate PD ( stage I – III ) were assigned to twenty 90-min tango ( n = 24 ) or education ( n = 9 ) lessons over 12 weeks . Disease severity , spatial cognition , balance , and fall incidence were evaluated pre- , post- , and 10–12 weeks postintervention . The authors evaluated differences using t tests and analyses of variance . Twenty-three tango and 8 education participants finished . Tango participants improved on disease severity ( p = .008 ) , and spatial cognition ( p = .021 ) compared with education participants . Tango participants also improved in balance ( p = .038 ) , and executive function ( p = .012 ) . Gains were maintained 10–12 weeks postintervention . Multimodal exercise with structured syllabi may improve disease severity and spatial cognition in PD Homocysteine , cysteine , and cysteinyl-glycine are all metabolically interrelated . Levodopa/decarboxylase inhibitor ( LD/DCI ) administration increases total homocysteine ( tHcy ) plasma levels . Objectives were to investigate associations between LD/DCI intake , concentrations of tHcy , cysteine , and cysteinyl-glycine in PD patients and healthy controls .  Cysteine levels were significant lower in controls and PD patients with tHcy below the treshold of 15 [ micromol/L ] when compared with PD patients with tHcy above 15 . Cysteinyl-glycine did not significantly differ between the three cohorts . Significant associations appeared between tHcys and cysteine in PD patients .  tHcy and cysteine concentrations correlated to LD/DCI intake and severity of PD . The cysteine increase may be due to the significant higher dosing of daily LD/DCI and the significant higher morning LD/DCI dose 1 hour before blood sampling in PD patients with tHcy above 15 when compared with the remaining PD patients and the controls . The correlation outcomes support the view that LD/DCI intake may also increase cysteine OBJECTIVES To investigate the effect of Nintendo Wii ™ -based motor cognitive training versus balance exercise therapy on activities of daily living in patients with Parkinson 's disease . DESIGN Parallel , prospect i ve , single-blind , r and omised clinical trial . SETTING Brazilian Parkinson Association . PARTICIPANTS Thirty-two patients with Parkinson 's disease ( Hoehn and Yahr stages 1 and 2 ) . INTERVENTIONS Fourteen training sessions consisting of 30 minutes of stretching , strengthening and axial mobility exercises , plus 30 minutes of balance training . The control group performed balance exercises without feedback or cognitive stimulation , and the experimental group performed 10 Wii Fit ™ games . MAIN OUTCOME MEASURE Section II of the Unified Parkinson 's Disease Rating Scale ( UPDRS-II ) . R AND OMISATION Participants were r and omised into a control group ( n=16 ) and an experimental group ( n=16 ) through blinded drawing of names . STATISTICAL ANALYSIS Repeated- measures analysis of variance ( RM-ANOVA ) . RESULTS Both groups showed improvement in the UPDRS-II with assessment effect ( RM-ANOVA P<0.001 , observed power=0.999 ) . There was no difference between the control group and the experimental group before training { 8.9 [ st and ard deviation ( SD ) 2.9 ] vs 10.1 ( SD 3.8 ) } , after training [ 7.6 ( SD 2.9 ) vs 8.1 ( SD 3.5 ) ] or 60 days after training [ 8.1 ( SD 3.2 ) vs 8.3 ( SD 3.6 ) ] . The mean difference of the whole group between before training and after training was -0.9 ( SD 2.3 , 95 % confidence interval -1.7 to -0.6 ) . CONCLUSION Patients with Parkinson 's disease showed improved performance in activities of daily living after 14 sessions of balance training , with no additional advantages associated with the Wii-based motor and cognitive training . Registered on http://www . clinical trials.gov ( identifier : NCT01580787 ) We have previously demonstrated changes in dopaminergic neurotransmission after intensive exercise in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse model of Parkinson ’s disease ( PD ) , including an increase in the dopamine D2 receptor ( DA-D2R ) , using noninvasive PET imaging with the radiolig and [18F]fallypride . The purpose of this feasibility and translational study was to examine whether intensive exercise leads to similar alterations in DA-D2R expression using PET imaging with [18F]fallypride in individuals with early-stage PD . In this pilot study , four 
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The evidence from animal studies supports the role of exercise to improve cognition in humans through the promotion of neuronal proliferation , neuroprotection and neurogenesis .
These findings warrant more research to determine what roles these neural mechanisms play in clinical population s. The reports on cognitive changes in clinical studies demonstrate that a range of exercise programs can improve cognition in humans .
Overall , this systematic review found that in animal models exercise  results in behavioral and corresponding neurobiological changes in the basal ganglia related to cognition .
The clinical studies showed that various types of exercise , including aerobic , resistance and dance can improve cognitive function , although the optimal type , amount , mechanisms , and duration of exercise are unclear .