Effect of multidisciplinary therapy in Huntington's disease

Patients in Perth were allocated to receive nine months of supervised outpatient multidisciplinary therapy in addition to their standard care. Patients in Melbourne were allocated to receive their standard care. Details of the multidisciplinary therapy intervention are provided below. The intervention was designed by a highly experienced team of exercise physiologists, cognitive training specialists and strength and conditioning specialists. It consisted of nine months of three times weekly supervised exercise, cognitive training, dual task training, bilingual exercises, healthy lifestyle guidance and social activities. These rehabilitation methods were purposefully selected as they have been demonstrated to have positive effects on neural and clinical outcomes in HD individuals and other clinical populations. To maximise physiological and clinical benefits the intervention was organised into distinct training blocks (mesocycles), which were designed to train different physiological systems and clinical function. Training blocks were six weeks in duration and consisted of a training phase (weeks 1-4), tapered phase (week 5) and rest phase (week 6). Training blocks were designed to train different physiological systems and clinical functions. Exercise training The exercise training program comprised individualised (ie, adjusted to baseline strength (1RM) and cardiorespiratory fitness (HRmax obtained via VO2max)), block periodised (ie, systematically organised exercise variation (volume, intensity and use of specific exercises) into mesocycles (six week blocks)), progressive and autoregulated (ie, adjustments to the volume and intensity of training based on the well-being of patients on training days (ie, soreness and motivation)) aerobic and resistance exercise training. Autoregulated block periodization was used to maximise physiological and clinical benefits and to reduce the risk of injury for participants. Aerobic exercise training was undertaken on cycle ergometers and ellipticals. The intensity of aerobic exercise was prescribed using heart rate maximum and RPE values. The speed and resistance on aerobic machines was adjusted by exercise physiologists to ensure that participants reached their target heart rate and RPE. Resistance training was performed on resistance machine and targeted major upper, lower and core muscle groups. Resistance training intensity was prescribed using the repetition method (RM). The resistance training stimulus was adjusted by exercise physiologists as necessary in 1.25, 2.5 or 5kg increments to ensure muscular failure at the prescribed RM. Cognitive training The cognitive training program consisted of supervised computerised and manual cognitive training. Computerised cognitive training was undertaken using NeuroNation and Captain’s Log Mind Power Builder software three times per week for one hour. The prescription and dose of computerised cognitive training were informed by previous work (Lampit et al) and targeted a number of cognitive domains including, working memory, executive control, divided attention and response inhibition which are comprised early in HD. Training performance was automatically recorded by the computerised cognitive training software. Manual cognitive training was undertaken once per week for thirty minutes and consisted of performing response inhibition, working memory and sustained attention exercises. Dual task training Dual task training consisted of learning and memorising Spanish, Italian and German phrases whilst simultaneously performing aerobic exercise on an elliptical or cycle ergometer. The difficulty of phrases was increased throughout each mesocycle. Healthy Lifestyle Guidance Healthy lifestyle guidance consisted of educating participants on the importance of regular exercise and cognitive stimulation, sleep hygiene and a good nutrition. Recommendations on exercise were made according to American College of Sports Medicine Guidelines for adults. Recommendations on cognitive stimulation were made based on available evidence indicating that regular engagement in educational activities (learning new information, attending classes and seminars), reading books, playing cognitively stimulating games, playing musical instruments and learning a new language is beneficial for older adults and individuals with neurodegenerative diseases. Sleep hygiene recommendations outlined by Morton (2013) for individuals with HD were provided to participants throughout the intervention. Nutritional recommendations were made according to the Australian Dietary Guidelines (2013). Socialisation Socialisation was stimulated through group training sessions, group Facebook pages and tri-monthly social events including barbecues, picnics and restaurant outings. Training adherence and compliance Adherence and compliance to the interventions were recorded by exercise physiologists via training logs.