The majority of participants fell during a 1-year prospective follow-up. Only 2 balance performance measures and 1 balance confidence measure accurately distinguished between fallers and nonfallers as well as possessed clinically useful levels of sensitivity and specificity. These results also emphasized the inaccuracy of retrospective fall history in an MS sample.

Objective Relatively short duration studies have demonstrated that high-intensity aerobic exercise improves aspects of motor and nonmotor function in people with Parkinson disease (PwPD); however, the effectiveness of a long-term exercise intervention on slowing disease progression is unknown. The primary aim of this study is to determine the disease-altering effects of high-intensity aerobic exercise, administered on an upright stationary cycle, on the progression of PD. A secondary aim is to develop a prognostic model for 12-month changes of Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS III) scores of people undergoing the aerobic exercise intervention. Methods This pragmatic, multisite, single-rater blinded randomized controlled trial will be conducted in 2 large, urban, academic medical centers. The exercise intervention will be administered remotely in the homes of 250 participants with mild to moderate idiopathic PD who will be followed for 12 months. Participants will be randomized to (1) home-based aerobic exercise (AE) or (2) usual and customary care (UCC). People in the AE arm will be asked to complete in-home aerobic exercise sessions at 60% to 80% of heart rate reserve 3 times per week for 12 months utilizing a commercially available upright exercise cycle. The UCC group will continue normal activity levels. Daily activity will be monitored for both groups throughout the 12-month study period. The primary outcome, both to assess disease-modifying response to aerobic exercise and for prognostic modeling in the aerobic exercise arm, is 12-month rate of change in MDS-UPDRS III. Clinical and biomechanical measures will also be used to assess upper and lower extremity motor function, and non-motor functions. Impact If long-term aerobic exercise demonstrates disease-modifying capabilities, this study will provide evidence that “Exercise is Medicine” for PwPD. If so, the derived prognostic model will inform a more patient-specific exercise prescription for PwPD and inform expected disease progression.

Background and Purpose: Cognitive impairment has been linked to poor motor learning and rehabilitation outcomes in older adult and stroke populations, but this remains unexplored in individuals with Parkinson disease (PD). The purpose of this secondary data analysis from a recent clinical trial (NCT02600858) was to determine if global cognition was related to nine-day skill retention after upper-extremity motor training in individuals with PD. Methods: Twenty-three participants with idiopathic PD completed three consecutive days of training on an upper-extremity task. For the purposes of the original clinical trial, participants trained either on or off their dopamine replacement medication. Baseline, training, and shorter-term (48-hour) retention data have been previously published. Global cognition was evaluated using the Montreal Cognitive Assessment (MoCA). Participant age, baseline performance, MoCA score, and group (medication on/off) were included in a multivariate linear regression model to predict longer-term (nine day) follow-up performance. Baseline and follow-up performance were assessed for all participants while on their medication. Results: MoCA score was positively related to follow-up performance, such that individuals with better cognition performed better than those with poorer cognition. Participant age, baseline performance, and medication status were unrelated to follow-up performance. Discussion and Conclusions: Results of this secondary analysis align with previous work that suggest cognitive impairment may interfere with motor learning in PD, and that assessing cognition could provide prognostic information about an individuals responsiveness to motor rehabilitation for a number of clinical populations.

Background and Purpose: Cognition has been linked to rehabilitation outcomes in stroke populations, but this remains unexplored in individuals with Parkinson's disease (PD). The purpose of this secondary data analysis from a recent clinical trial (NCT02600858) was to determine if global cognition was related to skill performance after motor training in individuals with PD.Methods: Twenty-three participants with idiopathic PD completed 3 days of training on an upper-extremity task. For the purposes of the original clinical trial, participants trained either “on” or “off” their dopamine replacement medication. Baseline, training, and 48-h retention data have been previously published. Global cognition was evaluated using the Montreal Cognitive Assessment (MoCA). Linear regression examined whether MoCA score predicted longer-term retention at nine-day follow-up; baseline motor task performance, age, PD severity, depressive symptoms, and group (medication “on”/“off”) were included as covariates. Baseline and follow-up motor task performance were assessed for all participants while “on” their medication.Results: MoCA score was positively related to follow-up motor task performance, such that individuals with better cognition were faster than those with poorer cognition. Baseline task performance, age, PD severity, depressive symptoms, and medication status were unrelated to follow-up performance.Discussion and Conclusions: Results of this secondary analysis align with previous work that suggest cognitive impairment may interfere with motor learning in PD and support the premise that cognitive training prior to or concurrent with motor training may enhance rehabilitative outcomes for individuals with PD. Findings also suggest that assessing cognition in individuals with PD could provide prognostic information about their responsiveness to motor rehabilitation.