***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: OBJECTIVES The effectiveness of an exercise intervention for people in early and midstage Parkinson 's disease ( stages 2 and 3 of Hoehn and Yahr ) in improving spinal flexibility and physical performance in a sample of community-dwelling older people is described . DESIGN AND SETTING Fifty-one men and women , aged 55 - 84 years , identified through advertisement , local support groups , and local neurologists were enrolled into a r and omized , controlled trial . Subjects were assigned r and omly to an intervention or a usual care arm ( i.e. , no specific exercise ) . Of the original 51 participants , 46 completed the r and omized , controlled trial . Participants in the exercise arm ( n = 23 ) received individual instruction three times per week for 10 weeks . Participants in the usual care arm ( n = 23 ) were " wait listed " for intervention . MEASUREMENTS Changes over 10 weeks in spinal flexibility ( i.e. , functional axial rotation ) and physical performance ( i.e. , functional reach , timed supine to st and ) were the primary outcome measures . RESULTS MANOVA conducted for the three primary outcome variables demonstrated significant differences ( P < or = .05 ) between the two groups . Further analysis using ANOVA demonstrated significant differences between groups in functional axial rotation and functional reach for the intervention compared with the control group . There was no significant difference in supine to sit time . CONCLUSION Study results demonstrate that improvements in axial mobility and physical performance can be achieved with a 10-week exercise program for people in the early and midstages of PD The impact of dyskinesias and motor fluctuations on quality of life ( QOL ) at various stages in the course of Parkinson 's disease ( PD ) is not well understood . In 301 subjects with early PD enrolled in a clinical trial ( CALM-PD ) , we quantified the impact of motor complications on QOL and investigated how this changes over time . We also compared QOL related to demographic and treatment characteristics . The presence of dyskinesias was associated with visual analogue scale ( VAS ) scores 3.0 of 100 points higher ( better ) than those without dyskinesias in years 1 to 2 , even when adjusting for Unified Parkinson 's Disease Rating Scale ( UPDRS ) motor scores . The positive association between dyskinesias and QOL scores was more marked in older patients . In years 3 to 4 , dyskinesias no longer had a significant relationship with QOL . Younger subjects had higher VAS scores . Gender , motor fluctuations , and treatment regimen had no significant association with QOL , although a trend was found toward a small negative effect of motor fluctuations on QOL . We conclude that motor complications that occur within the first 4 years of treatment of PD do not have a significant negative effect on quality of life as measured by a visual analogue scale for most patients AIM To investigate the effects of an aerobic training in subjects with Parkinson 's disease ( PD ) as compared to a medical Chinese exercise ( Qigong ) . METHODS DESIGN r and omized controlled trial with a cross over design . SETTING PD out- patients referred to a Neurorehabilitation facility for the management of motor disability . SUBJECTS 26 PD patients in Hoehn and Yahr stage II to III under stable medication were r and omly allocated to either Group AT1+QG2 ( receiving 20 aerobic training sessions followed by 20 ' ' Qigong ' ' group sessions with 2 month interval between the interventions ) , or Group QG1+AT2 ( performing the same treatments with an inverted sequence ) . MAIN OUTCOME MEASURES clinical effects of treatment were sought through the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Brown 's Disability Scale ( B'DS ) , six-Minute Walking Test ( 6MWT ) , Borg scale for breathlessness , Beck Depression Inventory ( BDI ) and Parkinson 's Disease Question naire-39 items ( PDQ-39 ) . A spirometry test and maximum cardiopulmonary exercise test ( CPET ) were also performed to determine the pulmonary function , the metabolic and cardio-respiratory requests at rest and under exercise . All measures were taken immediately before and at the completion of each treatment phase . RESULTS The statistical analysis focusing on the evolution of motor disability and quality of life revealed a significant interaction effect between group and time for the 6MWT ( time x group effect : F : 5.4 P=0.002 ) and the Borg scale ( time x group effect : F : 4.2 P=0.009 ) . Post hoc analysis showed a significant increase in 6MWT and a larger decrease in Borg score after aerobic training within each subgroup , whereas no significant changes were observed during Qigong . No significant changes over time were detected through the analysis of UPDRS , B'DS , BDI and PDQ-39 scores . The analysis of cardiorespiratory parameters showed significant interaction effects between group and time for the Double Productpeak ( time x group effect : F : 7.7 P=0.0003 ) , the VO(2peak ) ( time x group effect : F : 4.8 P=0.007 ) , and the VO(2)/kg ratio ( time x group effect : F : 4.3 P=0.009 ) , owing to their decrease after aerobic training to an extent that was never observed after Qigong treatment . CONCLUSIONS Aerobic training exerts a significant impact on the ability of moderately disabled PD patients to cope with exercise , although it does not improve their self-sufficiency and quality of life Objective : To detect the effectiveness of incremental speed-dependent treadmill training on postural instability , dynamic balance and fear of falling in patients with idiopathic Parkinson 's disease . Design : R and omized controlled trial . Setting : Ankara Education and Research Hospital , 2nd PM&R Clinic , Cardiopulmonary Rehabilitation Unit . Subjects : Fifty-four patients with idiopathic Parkinson 's disease in stage 2 or 3 of the Hoehn Yahr staging entered , and 31 patients ( 21 training , 10 control ) had outcome data . Interventions : Postural instability of patients with Parkinson 's disease was assessed using the motor component of the Unified Parkinson 's Disease Rating Scale ( UPDRS ) , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale .  Twenty-one patients with Parkinson 's disease participated in an eight-week exercise programme using incremental speed-dependent treadmill training . Before and after the training programme , balance , gait , fear of falling and walking distance and speed on treadmill were assessed in both Parkinson 's disease groups . Main measures : Walking distance and speed on treadmill , UPDRS , Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale . Results : Initial total walking distance of the training group on treadmill was 266.45 ± 82.14 m and this was progressively increased to 726.36 ± 93.1 m after 16 training session ( P < 0.001 ) . Tolerated maximum speed of the training group on treadmill at baseline was 1.9 ± 0.75 km/h and improved to 2.61 ± 0.77 km/h ( P < 0.001 ) . Berg Balance Test , Dynamic Gait Index and Falls Efficacy Scale scores of the training group were improved significantly after the training programme ( P < 0.01 ) . There was no significant improvement in any of the outcome measurements in the control group ( P > 0.05 ) . Conclusions : Specific exercise programmes using incremental speed-dependent treadmill training may improve mobility , reduce postural instability and fear of falling in patients with Parkinson 's disease 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 The aim of our study was to evaluate the influence of low-intensity exercise on levodopa absorption and levodopa motor effect . We studied the pharmacokinetics and pharmacodynamics of levodopa under resting conditions and under a workload of 50 watts for 2 hours on a cycle ergometer in 12 parkinsonian patients with predictable fluctuations of motor disability . The patients attended the hospital on both days in a provoked off state . After a baseline assessment of motor disability using the Columbia University rating scale ( CURS scale ) and a blood test for measurement of the baseline levodopa concentration in the plasma , 100 mg levodopa and 25 mg benserazide were administered as a single dose orally .  Blood sample  s for measurement of the levodopa concentration in the plasma were taken , and motor assessment s were conducted at 15-minute intervals for 240 minutes and at 30-minute intervals from 240 to 360 minutes . All patients were able to perform the exercise program . The baseline Columbia University rating scale score did not differ significantly between both days . The mean levodopa concentration in plasma at half-maximal motor effect tended to be higher during exercise and indicated that the patients needed a higher levodopa concentration in plasma to achieve the half-maximal motor effect . The maximal levodopa concentration in plasma tended to be higher with exercise . Both trends did not reach statistical significance . In summary , there was not a negative or a positive net effect of exercise on pharmacokinetics and pharmacodynamics of levodopa . However , there were two counteracting trends : a trend toward better levodopa absorption and a trend toward a deteriorated concentration-effect correlation Objective : To determine whether the Alex and er Technique , alongside normal treatment , is of benefit to people disabled by idiopathic Parkinson 's disease . Design : A r and omized controlled trial with three groups , one receiving lessons in the Alex and er Technique , another receiving massage and one with no additional intervention . Measures were taken pre and post-intervention , and at follow-up , six months later . Setting : The Polyclinic at the University of Westminster , Central London . Subjects : Ninety-three people with clinical ly confirmed idiopathic Parkinson 's disease . Interventions : The Alex and er Technique group received 24 lessons in the Alex and er Technique and the massage group received 24 sessions of massage . Main outcome measures : The main outcome measures were the Self- assessment Parkinson 's Disease Disability Scale ( SPDDS ) at best and at worst times of day . Secondary measures included the Beck Depression Inventory and an Attitudes to Self Scale . Results : The Alex and er Technique group improved compared with the no additional intervention group , pre-intervention to post-intervention , both on the SPDDS at best , p = 0.04 ( confidence interval ( CI ) –6.4 to 0.0 ) and on the SPDDS at worst , p = 0.01 ( CI –11.5 to –1.8 ) . The comparative improvement was maintained at six-month follow-up : on the SPDDS at best , p = 0.04 ( CI –7.7 to 0.0 ) and on the SPDDS at worst , p = 0.01 ( CI –11.8 to –0.9 ) . The Alex and er Technique group was comparatively less depressed post-intervention , p = 0.03 ( CI –3.8 to 0.0 ) on the Beck Depression Inventory , and at six-month follow-up had improved on the Attitudes to Self Scale , p = 0.04 ( CI –13.9 to 0.0 ) . Conclusions : There is evidence that lessons in the Alex and er Technique are likely to lead to sustained benefit for people with Parkinson 's disease Background and Purpose . The application of motor imagery practice in the treatment of Parkinson ’s disease ( PD ) is a novel treatment approach for improving motor function . The purpose of this study was to compare group treatment using a combination of physical and motor imagery practice with group treatment using only physical practice in subjects with PD . Methods . Of 23 patients with idiopathic PD , 12 received combined therapy  , whereas 11 received physical therapy alone . Exercises for both groups were applied during 1-h sessions held twice a week for 12 weeks . Comparable motor tasks provided to both groups included callisthenic exercises , functional tasks , and relaxation exercises . However , the experimental group was treated with both imagery and real practice , whereas the control group received only physical exercises . Outcome measures included the time required to complete sequences of movements , the performance of balance tasks , impairment and functional scores on the Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , and specific cognitive abilities ( Stroop and clock drawing tests ) . Results . Following the intervention , the combined treatment group exhibited significantly faster performance of movement sequences than the control group . In addition , the experimental subjects demonstrated higher gains in the mental and motor subsets of the UPDRS and in the cognitive tests . Both groups improved on the activities of daily living scale . Conclusions . The combination of motor imagery and real practice may be effective in the treatment of PD , especially for reducing bradykinesia . The implementation of this treatment regimen allows for the extension of practice time with negligible risk and low cost INTRODUCTION Frequent falls and risk of injury are evident in individuals with Parkinson 's disease ( PD ) 
    Output:
    
RESULTS Within the Body Structure and Function category , there was moderate evidence that exercise result ed in improvements in postural instability .
Within the Activity category , there was moderate evidence that exercise was effective for improving balance task performance .
In contrast , within the Participation category , there was limited evidence that exercise result ed in improvements in QOL measures or fall events .
DISCUSSION AND CONCLUSIONS Regardless of the strength of the evidence , the studies review ed all report that exercise result ed in improvements in postural stability and balance task performance .