Geriatrics Bundle (3 CEUs)

In 2009, walking speed was coined as the sixth vital sign in a white paper; in 2015, a scholarly review by the same 2 authors of the white paper called walking speed the functional vital sign. The scholarly review expands on the white paper in relation to specifics in testing to ensure it is a valid and reliable measurement, as previously there was some inconsistencies related to distance, pace, instructions, and instrumentation to name a few. Gait speed assists with functional outcomes in multiple settings. There is information related to gait speed in acute care, post acute care, long term care and outpatient. Finally, treatment ideas to improve walking speed will be discussed.

Upon completion of this course, the attendee will be able to:

• Apply the specifics of testing to ensure gait speed is a valid and reliable measurement tool.
• Analyze how to use gait speed in different treatment settings.
• Create effective treatment interventions to improve gait speed.

Aerobic exercise over short and moderate duration mitigates motor symptoms in Parkinson’s disease (PD). The role of aerobic exercise in altering disease progression is unclear. In this educational session, we will discuss the history of  exercise and PD and present the most recent evidence from the NIH-supported multi-site Pragmatic Cyclical Lower Extremity Exercise Trial (CYCLE-II) for PD. The CYCLE-II trial aimed to determine the effects of a 12-month aerobic exercise program on the progression of PD. A total of 250 PwPD were randomized to a home-based aerobic exercise group or a no-exercise control group. The home-based AE group was provided a commercially available  exercise cycle and asked to exercise at a moderate to high intensity 3x/wk for 12 months. Based on clinical ratings of PD symptoms, those in the AE group did not exhibit the expected level of disease progression, while those in the no-exercise control group progressed as expected. Arresting the progression of PD with AE indicates PD modification is possible with consistent, moderate-high intensity aerobic exercise. Detailed biomechanical measures of gait and  postural stability and non-motor outcomes will be provided to evaluate the effects of exercise on specific motor and non-motor features of PD. Data presented will provide insight into specific parameters of exercise prescription, moving  away from the generic “exercise is good for PD” and taking a concrete step towards “exercise is medicine”. Details of how the results complement to the published Clinical Practice Guideline for the Physical Therapist Management of PD  will be discussed to inform clinical practice. The presentation will end by discussing future directions of aerobic exercise research and PD, including the potential role of exercise genomics in PD rehabilitation.

Upon completion of the course, the attendee will be able to - 

• Understand the benefits and challenges of using a commercial exercise platform to deliver aerobic exercise.
• Describe the effects of a home-based moderate to high intensity aerobic exercise program on motor and non-motor performance in PD.
• Evaluate the disease-modifying potential of aerobic exercise based on results from laboratory-based, home-based, and community-based studies.
• Understand the importance of utilizing patient-specific aerobic exercise recommendations for PD.