Introduction: For many, ice skating is an enjoyable form of exercise. For people living with Parkinson's disease, it could be much more. Ice skating is a complex motor skill that paradoxically persists amongst some people living with Parkinson's disease, and presents the possibility of providing Canadians living with Parkinson's disease with an exercise intervention that could be suitably vigorous, socially inclusive, and functionally relevant for improved gait, reduced falls, decreased fatigue and depression, and increased independence amongst people living with Parkinson disease. Moreover, many of the upper and lower extremity movement deficits typical of PD (small shuffling steps, limited arm swing, slow movements, poor balance) are antithetical to skillful ice skating, thus giving a progressive on-ice skating training program both the specificity and complexity suggested necessary to improve patients’ mobility. Recent research has shown that ice skating exercise drives neuroplasticity in cerebellar balance and coordination systems and restores neurotypical older adults to young adult postural control levels. Longitudinal evidence of functional improvement would be an important breakthrough for neurorehabilitation and improved quality of life amongst Canadians living with Parkinson disease, and could help advance clinical neurotherapy in rural and urban Canada. The purpose of this project was to compare kinematics and muscle activities in ice skating and standard gait amongst people living with PD, with the long-term goal of developing the paradoxically persistent skill of ice skating into an exercise neurotherapy for PD.
Methods: Seven mild to moderate PD patients and seven matched control subjects completed fourteen trials of walking and ten trials of ice skating, each 12 m in length, at self-selected rate. Trials were captured in sagittal plane video, and muscle activation in lower extremity agonists and antagonists was collected through electromyography. The central 4 m of walking and skating trials were hand-digitized, providing Cartesian coordinate data for critical anatomical landmarks in each video frame. Three kinematic parameters were compared between groups (PD, CTRL) and conditions (PRE-WALK, SKATE, POST-WALK): a) arm swing – maximum resultant distance between hip and hand; b) step length – maximum resultant distance between left and right heels; and c) velocity – average rate of horizontal displacement. Mean muscle activation ratios (SKATE:POST-WALK) from the tibialis anterior, gastrocnemius, vastus lateralis, and biceps femoris muscles of the right leg were also compared between groups.
Results: For the PD participants, SKATE:WALK activation ratios exceeded 1.5 for all muscles, and those ratios were significantly increased compared to CTRL subjects for TA and VL. PD had increased arm swing and greater velocity during skating trials compared to pre- walking trials. Post-walking showed some continued improvement, compared to pre-walking, suggesting short-term benefit from skating exercise. Control participants also changed performance in the skating trials. No PD patients fell in the course of these skating feasibility trials.
Conclusions: Vigorous ice skating appears to be safe, feasible, and skilful for some people living with Parkinson’s disease. The activity of ice skating may target some of the functional challenges people living with PD experience, providing a specific and appealing exercise intervention.