Exercise Training in Dystonia

The study team plan to conduct a randomized prospective, parallel-group, controlled study to
examine the effects of exercises in dystonia and other involuntary movement disorders.
Patients will be randomized to receive either progressive resistance training or a control
treatment following the modified fitness protocol. The study team hypothesize that
progressive resistance training will result in better outcomes compared to modified fitness
protocol.

Data collect includes 1) data about clinical movement disorder history, age, gender, height,
weight, and other medical conditions; 2) clinical neurological examination; 3) tests
assessing cognitive abilities (the Montreal Cognitive Assessment, Stroop, Digit Span, Hopkins
Verbal Learning Test, COWA and Animals, and Brief Test of Attention); 4) tests assessing
motor abilities including Toronto Western Spasmodic Rating Scale (TWSTRS) and
Burke-Fahn-Marsden Dystonia Rating Scale (BFMDRS); 5) measures of anxiety and depression
(Beck Depression Index, Hamilton Anxiety and Depression Rating Scales); 5) Cervical dystonia
related quality of life (CDQ-24); 6) Visual Analog Scales-Quality of Life (VAS QOL)
evaluating of health related quality of life.

Inclusion Criteria:

Patients with dystonia and other involuntary movement disorders will be recruited whose
diagnosis will be confirmed by a Movement Disorders specialist following the criteria
recommended by movement disorders society.

- Patients will be eligible if they are ages 30 to 80 years,

- Receive stable doses of regular botulinum toxin injections and are on stable doses of
oral pharmacological therapy if applicable, and are able to walk for 6 minutes.

- Age-matched healthy individuals will be recruited for normative data.

- All individuals must be capable of providing informed consent and complying with the
study related procedures.

Exclusion Criteria:

Patients will be ineligible if they have a neurological history other than dystonia, have
significant arthritis

- Fail the Physical Activity Readiness Questionnaire, have cognitive impairment as
indicated by a Mini Mental State Examination score <23,

- Already exercising.

- As necessitated by the risks of Magnetic Resonance Imaging (MRI) or transcranial
magnetic stimulation (TMS), patients who have any type of implanted electrical device
(such as a cardiac pacemaker or a neurostimulator), or a certain type of metallic clip
in their body (i.e., an aneurysm clip in the brain)

- Active seizure disorder are not eligible for participation in the MRI or TMS portion
of the study.

- Individuals who are claustrophobic will also be excluded from participation.

- Women who are or might be pregnant and nursing mothers are not eligible. Pregnancy
tests will be carried out for each female subject of child bearing potential prior to
the participation in the study and prior to each follow up visit.