A pilot randomised controlled trial of a vestibular-stimulation, isometric exercise machine to manage symptoms of Parkinsonism

Patients randomised to the intervention will undertake two supervised sessions per week on the Reviver exercise machine (http://isodynamics.com.au), each with 15 minutes machine time, for a period of 12 weeks, taking place at the Alfred Hospital, Melbourne. The sessions will be one-on-one. The machine rotates the body at an angle of 5-30 degrees and subjects must tense their core and peripheral muscles in order to maintain an upright posture. A strap is placed around the patient’s waist to secure them to the machine and prevent falling. This machine design induces isometric exercise via a reflex response to falling, potentially recruiting involuntary muscular activation and deeply ingrained motor programs. The inclined nature of the machine’s motion periodically displaces cochlear fluid and presumably delivers a periodic stimulus to the vestibular nerves. In each session, patients will undertake 6 exercises on the machine designed by exercise physiologist, which target various aspects of strength and balance: 1) Squatting exercise for leg strength 2) Balancing forward exercise 3) Balancing backward exercise 4) Forward incline exercise, patient supported by straps, for back strength 5) Backward incline exercise, patient supported by straps, for abdominal strength 6) Forward incline exercise, patient supported by own arms, for whole body strength. The machine will be operated by a trained assistant. Adherence to the protocol will be recorded as the percentage of sessions attended. Patients will be asked beforehand whether they are willing and able to attend the required number of sessions over the three month period.