Exercise for People in Early- or Mid-Stage Parkinson Disease: A 16-Month Randomized Controlled Trial

Abstract

<jats:sec><jats:title>Background</jats:title><jats:p>Exercise confers short-term benefits for individuals with Parkinson disease (PD).</jats:p></jats:sec><jats:sec><jats:title>Objective</jats:title><jats:p>The purpose of the study was to compare short- and long-term responses among 2 supervised exercise programs and a home-based control exercise program.</jats:p></jats:sec><jats:sec><jats:title>Design</jats:title><jats:p>The 16-month randomized controlled exercise intervention investigated 3 exercise approaches: flexibility/balance/function exercise (FBF), supervised aerobic exercise (AE), and home-based exercise (control).</jats:p></jats:sec><jats:sec><jats:title>Setting</jats:title><jats:p>This study was conducted in outpatient clinics.</jats:p></jats:sec><jats:sec><jats:title>Patients</jats:title><jats:p>The participants were 121 individuals with PD (Hoehn &amp; Yahr stages 1–3).</jats:p></jats:sec><jats:sec><jats:title>Interventions</jats:title><jats:p>The FBF program (individualized spinal and extremity flexibility exercises followed by group balance/functional training) was supervised by a physical therapist. The AE program (using a treadmill, bike, or elliptical trainer) was supervised by an exercise trainer. Supervision was provided 3 days per week for 4 months, and then monthly (16 months total). The control group participants exercised at home using the National Parkinson Foundation Fitness Counts program, with 1 supervised, clinic-based group session per month.</jats:p></jats:sec><jats:sec><jats:title>Measurements</jats:title><jats:p>Outcomes, obtained by blinded assessors, were determined at 4, 10, and 16 months. The primary outcome measures were overall physical function (Continuous Scale—Physical Functional Performance [CS-PFP]), balance (Functional Reach Test [FRT]), and walking economy (oxygen uptake [mL/kg/min]). Secondary outcome measures were symptom severity (Unified Parkinson's Disease Rating Scale [UPDRS] activities of daily living [ADL] and motor subscales) and quality of life (39-item Parkinson's Disease Quality of Life Scale [PDQ-39]).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 121 participants, 86.8%, 82.6%, and 79.3% completed 4, 10, and 16 months, respectively, of the intervention. At 4 months, improvement in CS-PFP scores was greater in the FBF group than in the control group (mean difference=4.3, 95% confidence interval [CI]=1.2 to 7.3) and the AE group (mean difference=3.1, 95% CI=0.0 to 6.2). Balance was not different among groups at any time point. Walking economy improved in the AE group compared with the FBF group at 4 months (mean difference=−1.2, 95% CI=−1.9 to −0.5), 10 months (mean difference=−1.2, 95% CI=−1.9 to −0.5), and 16 months (mean difference=−1.7, 95% CI=−2.5 to −1.0). The only secondary outcome that showed significant differences was UPDRS ADL subscale scores: the FBF group performed better than the control group at 4 months (mean difference=−1.47, 95% CI=−2.79 to −0.15) and 16 months (mean difference=−1.95, 95% CI=−3.84 to −0.08).</jats:p></jats:sec><jats:sec><jats:title>Limitations</jats:title><jats:p>Absence of a non-exercise control group was a limitation of the study.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy (up to 16 months) in the AE group.</jats:p></jats:sec>

Are the Effects of Community-Based Dance on Parkinson Disease Severity, Balance, and Functional Mobility Reduced with Time? A 2-Year Prospective Pilot Study

“…Of the long-term exercise studies, this appears to be one of the longest-duration interventions yet to be studied. 31,32 This and other studies continue to support the importance and potential impact of exercise in the management of PD, and support the notion that exercise should be adopted by individuals with PD for the duration of the disease.…”

Feldenkrais method and functionality in Parkinson’s disease: a randomized controlled clinical trial

“…The current phenomenon seen is that an increasing number of elderly individuals not only live longer, but also live with more chronic conditions [2].…”

“…Moreover, the increase in chronic diseases is directly related to greater functional disabilities [2]. Besides, the presence of motor dysfunction in PD increases dependence, inactivity and social isolation, factors that substantially affect the quality of life of these patients [5][6][7].…”

“…About 1% of the population aged over 60 years develops PD, but its prevalence increases up to 4% in individuals aged 80 years or more. Thus, it has become increasingly common in countries where high rates of longevity are seen in the population [2,[4][5][6].…”

Rehabilitation in Parkinson's disease the challenge to provide early and ongoing, evidence-based, patient-centred care

“…This model is particularly well-suited to delivering rehabilitation interventions to people with Parkinson's disease, where several interventions are evidence-based, but there is no evidence to indicate which intervention is best. For example, if one of the goals of rehabilitation is to improve aerobic exercise capacity, there is currently supporting evidence for group aerobic exercise 11 , cycle ergometry 12,13 and treadmill walking [12][13][14] . Using the patient-centred healthcare model, the individual patient and his/her rehabilitation professionals jointly consider the evidence, the patient's goals and preferences for exercise, as well as pragmatics, such as access to exercise programs, equipment and cost.…”