Enhanced Exercise Therapy in Parkinson's disease: A comparative effectiveness trial

Abstract

Objectives Exercise can improve motor function in people with Parkinson’s disease but depression reduces the motivation to participate in regular exercise. The aim of this study was to develop a novel Enhanced Exercise Therapy program that uses manual-driven guided exercise and peer-facilitated psychoeducation for individuals with Parkinson’s disease and depression. Design 24 week randomized controlled design. Methods Thirty individuals were randomized to Enhanced Exercise Therapy or self-guided therapy, and evaluated at baseline, 12-weeks and at 24-weeks. Enhanced Exercise Therapy included group exercise and group psychoeducation for 12 weeks. Between 13–24 weeks, individuals had access to the fitness facility but group sessions were not held. Self-guided therapy included written guidelines for a self-paced exercise program and psychoeducation. Primary outcome measures included the number of exercise sessions and International Physical Activity Questionnaire score. Secondary measures included resting heart rate, supine blood pressure, estimated VO2max and incidence of orthostatic hypotension. Results Twenty four individuals completed the study (80% retention) and both groups attended similar number of exercise sessions. There were no significant changes in cardiovascular fitness measures but there was a significant increase in the amount of physical activity in the Enhanced Exercise Therapy group and a decrease in the self-guided therapy group during the post-intervention period. Conclusions Enhanced exercise therapy appears to promote engagement in an exercise program and more physical activity, even after group sessions were concluded in individuals with Parkinson’s disease and depression.

International Parkinson and movement disorder society evidence‐based medicine review: Update on treatments for the motor symptoms of Parkinson's disease

“…48 The remaining lower quality studies compared 2 interventions (a mixture of treadmill-based exercises and aerobics and resistance/ strengthening exercises; water-based physiotherapy or usual physical activity), and both interventions were generally positive with improvements when compared with baseline in both groups but not compared to each other. [49][50][51][52][53][54][55][56][57][58][59][60][61][62][63][64][65] Studies in which there was no active intervention or unclear final statistical analysis were all low quality, and therefore the interpretation of outcomes was limited. [66][67][68][69] Overall, although the 3 high-quality level I studies that compared 2 interventions had 1 positive outcome in 1 type of PT compared to another, none had a best medical therapy/control group; thus the overall conclusion is "likely efficacious."…”

A randomized trial of individual versus group-format exercise and self-management in individuals with Parkinson’s disease and comorbid depression

“…The 1-hour-long group sessions with 7–8 PD-Dep patients were co-lead by a nurse educator with expertise in PD and a trained peer educator with PD-Dep. Detailed instruction manuals for the exercise program helped assure consistency, and exercise sessions were led by a certified personal trainer 44. Exercise consisted of fast-paced, low-resistance cycling for 20 minutes followed by strength training for 20 minutes using a progressive sequence of resistance bands.…”

BrainCycles: Experimental Setup for the Combined Measurement of Cortical and Subcortical Activity in Parkinson's Disease Patients during Cycling

“…One may also speculate that the special conditions of bicycling, e.g., continuous resistance and angular momentum of the pedals, may provide feedback that is substantially different from walking. Bicycling has also been recently promoted as a viable therapy for PD (Mohammadi-Abdar et al, 2016), with evidence emerging that it may stimulate improvements in motor control (Ridgel et al, 2009, 2015) and cognitive performance (Alberts et al, 2011; Ridgel et al, 2011), as well as reduce severity of tremor, bradykinesia (Ridgel et al, 2012) and of orthostatic hypotension (Ridgel et al, 2016). …”