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Reviver: Enabling Exercise For the Balance and Mobility Impaired

February 14, 2020

Exercise is crucial for brain health, but those most in need may struggle to obtain it.

 

Physical activity is critical for the maintenance of good physical health, and the evidence is strong that physical activity promotes neurological health [1]. However, 55% of Australians do not meet government guidelines for amount of physical activity [2]. The elderly, those with disabilities, and those with neurological disorders face additional barriers to exercise [3], for example those with Parkinson’s disease (PD) achieve ~30% less physical exercise than their healthy peers [4, 5]. So while physical activity helps prevent cardiovascular events, diabetes mellitus, and osteoporosis [6], suppresses depression symptoms and cognitive decline [7, 8], those with neurological conditions rarely reap these benefits.

For those with neurodegenerative diseases such as Parkinson’s Disease, exercise is an innovative approach to managing disease with research already showing it may directly alter the neurodegenerative process [9], have a positive effect on cognitive performance both acute and accumulatively [10], and modulate cortico-spinal pathways commonly associated with motor dysfunction [11-13]. Given these protective and preventative aspects of physical activity, any strategy or technology which increases access to exercise, or provides exercise in a more effective and efficient manner, will have profound preventative and public health implications. We are currently focusing on Parkinsonism as an exemplar of a neurodegenerative condition, ensuring that findings are easily interpretable and not confounded by the use of an overly heterogenous patient population. However, the findings will be relevant to any condition where exercise ameliorates physical decline, but there are barriers to participation, e.g. Alzheimer’s Disease (342,000 in Australia), Multiple Sclerosis (25,600) and ageing (3.8 million over 65).


Parkinson’s Disease effects over 80,000 people in Australia, presenting with impairments to gait and balance and an increased risk of falls and debility. Atypical Parkinsonism shares the motor deficits of Parkinson’s Disease, but is unresponsive to Parkinson’s Disease treatments, including Levodopa, in fact no clinical trial has yielded a positive treatment result for Atypical Parkinsonism. Physical activity is routinely prescribed as an intervention to treat the motor symptoms of Parkinson’s Disease, and clinical trials support its efficacy in improving these symptoms [14-17]. Physical activity could therefore offer similar benefits to patients with Atypical Parkinsonism. However, exercise interventions that increase physical activity are often time consuming, difficult and unmotivating. This makes the development of high volume, intensive rehabilitation strategies that are both accessible and engaging an important challenge [5, 18].

To address this challenge, we are running a trial of an exercise assistance device which provides a new method of strengthening and balance training, allowing people to exercise far beyond their unassisted capacity, including those who are so debilitated that they are no longer able to engage in any form of exercise. The Reviver, has been developed in Australia by the Isodynamics Company. The device works by placing the user at a tilted angle and rotating them around (video demonstration: [19]). This form of motion requires minimal dynamic movement, and with no risk of falling it is widely accessible, regardless of state of disability. This exercise assistance machine has been proven tolerable by paraplegics, those with motor-neuron disease, late stage PD patients and wheelchair-bound multiple-sclerosis patients. While the Reviver builds on concepts from machine-aided physical therapies, the use of gravity and reflex movements to facilitate exercise in impaired populations is a novel innovation, providing the primary point of difference between this and previous research on traditional exercises provided in rehabilitation.


How to get involved


If you live in Melbourne, have Parkinson’s Disease, and want to be involved in this trial, please get in touch:



1. Hillman, C.H., et al., Nat Rev Neurosci, 2008. 9(1): p. 58-65.

2. Health, A.I.o., et al., Insufficient physical activity. 2019, AIHW: Canberra.

3. Jaarsma, E.A., et al., Scandinavian journal of medicine & science in sports, 2014. 24(6): p. 871-881.

4. Toth, M.J., et al., Neurology, 1997. 48(1): p. 88-91.

5. van Nimwegen, M., et al., J Neurol, 2011. 258(12): p. 2214-21.

6. Warburton, D.E., et al., CMAJ, 2006. 174(6): p. 801-9.

7. Blumenthal, J.A., et al., Arch Intern Med, 1999. 159(19): p. 2349-56.

8. Lautenschlager, N.T., et al., JAMA, 2008. 300(9): p. 1027-37.

9. Petzinger, G.M., et al., J Neurosci, 2007. 27(20): p. 5291-300.

10. Chang, Y.-K., et al., Brain research, 2012. 1453: p. 87-101.

11. Cantone, M., et al., Clinical Neurophysiology, 2014. 125(8): p. 1509-1532.

12. Teo, W.-P., et al., Clinical Neurophysiology, 2014. 125(3): p. 562-568.

13. Ternes, A.-M., et al., Journal of clinical and experimental neuropsychology, 2019. 41(3): p. 320-329.

14. Tomlinson, C.L., et al., BMJ, 2012. 345: p. e5004.

15. Shu, H.F., et al., PLoS One, 2014. 9(7): p. e100503.

16. Chung, C.L., et al., Clin Rehabil, 2016. 30(1): p. 11-23.

17. Allen, N.E., et al., Mov Disord, 2011. 26(9): p. 1605-15.

18. Abbruzzese, G., et al., Parkinsonism Relat Disord, 2016. 22 Suppl 1: p. S60-4.

19. Reviver-Demonstration:, https://www.youtube.com/watch?v=JvpVNvvDYd0.


 

©2020 by Ben Sinclair.