Promotion of physical activity and fitness in sedentary patients with Parkinson's disease: randomised controlled trial

Nimwegen, Marlies van; Speelman, A.D.; Overeem, Sebastiaan; Warrenburg, Bart P. van de; Smulders, Katrijn; Dontje, Manon L.; Borm, George F.; Backx, Frank; Bloem, Bastiaan R.; Munneke, Marten

doi:10.1136/bmj.f576

Cited by 139 publications

(178 citation statements)

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“…Different exercise interventions including aerobic exercises, hydrotherapy, balance exercises and walking could have significant treatment advantages with the increase of functional capacity among patients with Parkinson [7,30]. There are different theories about the effect of exercise program on the improvement of balance [31]. Considering results of researches conducted, it was determined that exercises accompanied by resistance and balance exercises affected the improvement of balance disorders, especially in patients with mild and moderate levels of Parkinson more than other exercises [8].…”

Section: Discussionmentioning

confidence: 99%

The Effect of a Selective Pilates Program on Functional Balance and Falling Risk in Patients with Parkinson’s Disease

Daneshmandi

Sayyar

Bakhshayesh

2017

Zahedan J Res Med Sci

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Background: Parkinsonism is a progressive disorder of the nervous system for which only symptomatic treatment exists. Balance dysfunction and postural instability observed in persons with Parkinson's disease are important components of the disability. Objectives: To investigate the effect of a selective 8-week Pilates exercises on the functional balance and falling risk in patients with idiopathic Parkinson's disease. Methods: This randomized controlled trial included 30 patients with idiopathic Parkinson's disease who were selected as subjects non-randomly and purposely, and assigned into exercise groups or control group. Participants in exercise and control groups attended an 8-week Pilate's program or walking program respectively. Functional balance and falling risk was evaluated using Fullerton balance scale (FAB) and timed up and go test (TUG), before and after interventions. In order to analyze the data paired samples T-test and independent samples T-test and SPSS version 22 were used. Results: Attending an eight-week Pilates exercise was associated with a significant improvement in functional balance and falling risk (P = 0.001), while the difference of the functional balance and falling risk, before and after performing the protocol, in control group was not significant (P = 0.364). Also the difference between the results of functional balance and falling risk scale scores of two groups in post-test were significant (P = 0.001). Conclusions: Given that Pilate's exercises involve both musculoskeletal system and nervous system, can be an effective intervention to improving balance and reducing falling risk, especially in people with postural control disabilities.

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Section: Discussionmentioning

confidence: 99%

The Effect of a Selective Pilates Program on Functional Balance and Falling Risk in Patients with Parkinson’s Disease

Daneshmandi

Sayyar

Bakhshayesh

2017

Zahedan J Res Med Sci

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“…The PD REHAB (n = 762), the Dutch ParkFit 42 (n = 540) and the ParkNet 29 (n = 699) trials show that large pragmatic rehabilitation trials are feasible in PD and that long-term follow-up is mandatory and achievable. Previous PT trials in PD have been relatively small (range 6-153) and with follow-up of less than 3 months.…”

Section: Size and Durationmentioning

confidence: 99%

Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson’s disease: a large pragmatic randomised controlled trial (PD REHAB)

Clarke

Patel

Ives

et al. 2016

Health Technol Assess

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BackgroundCochrane reviews of physiotherapy (PT) and occupational therapy (OT) for Parkinson’s disease found insufficient evidence of effectiveness, but previous trials were methodologically flawed with small sample size and short-term follow-up.ObjectivesTo evaluate the clinical effectiveness and cost-effectiveness of individualised PT and OT in Parkinson’s disease.DesignLarge pragmatic randomised controlled trial.SettingThirty-eight neurology and geriatric medicine outpatient clinics in the UK.ParticipantsSeven hundred and sixty-two patients with mild to moderate Parkinson’s disease reporting limitations in activities of daily living (ADL).InterventionPatients were randomised online to either both PT and OT NHS services (n = 381) or no therapy (n = 381). Therapy incorporated a patient-centred approach with individual assessment and goal setting.Main outcome measuresThe primary outcome was instrumental ADL measured by the patient-completed Nottingham Extended Activities of Daily Living (NEADL) scale at 3 months after randomisation. Secondary outcomes were health-related quality of life [Parkinson’s Disease Questionnaire-39 (PDQ-39); European Quality of Life-5 Dimensions (EQ-5D)], adverse events, resource use and carer quality of life (Short Form questionnaire-12 items). Outcomes were assessed before randomisation and at 3, 9 and 15 months after randomisation.ResultsData from 92% of the participants in each group were available at the primary time point of 3 months, but there was no difference in NEADL total score [difference 0.5 points, 95% confidence interval (CI) –0.7 to 1.7;p = 0.4] or PDQ-39 summary index (0.007 points, 95% CI –1.5 to 1.5;p = 1.0) between groups. The EQ-5D quotient was of borderline significance in favour of therapy (–0.03, 95% CI –0.07 to –0.002;p = 0.04). Contact time with therapists was for a median of four visits of 58 minutes each over 8 weeks (mean dose 232 minutes). Repeated measures analysis including all time points showed no difference in NEADL total score, but PDQ-39 summary index (curves diverging at 1.6 points per annum, 95% CI 0.47 to 2.62;p = 0.005) and EQ-5D quotient (0.02, 95% CI 0.00007 to 0.03;p = 0.04) showed significant but small differences in favour of the therapy arm. Cost-effective analysis showed that therapy was associated with a slight but not significant gain in quality-adjusted life-years (0.027, 95% CI –0.010 to 0.065) at a small incremental cost (£164, 95% CI –£141 to £468), resulting in an incremental cost-effectiveness ratio of under £4000 (£3493, 95% –£169,371 to £176,358). There was no difference in adverse events or serious adverse events.ConclusionsNHS PT and OT did not produce immediate or long-term clinically meaningful improvements in ADL or quality of life in patients with mild to moderate Parkinson’s disease. This evidence does not support the use of low-dose, patient-centred, goal-directed PT and OT in patients in the early stages of Parkinson’s disease. Future research should include the development and testing of more structured and intensive PT and OT programmes in patients with all stages of Parkinson’s disease.Trial registrationCurrent Controlled Trials ISRCTN17452402.FundingThis project was funded by the NIHR Health Technology Assessment programme and will be published in full inHealth Technology Assessment; Vol. 20, No. 63. See the NIHR Journals Library website for further project information. The Birmingham Clinical Trials Unit, University of Birmingham, received support from the UK Department of Health up to March 2012. Catherine Sackley was supported by a NIHR senior investigator award, Collaboration for Leadership in Applied Health Research and Care East of England and West Midlands Strategic Health Authority Clinical Academic Training award.

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“…There are different theories as to how exercise programs improve balance. Generally, physical activities improve balance through modifying the central and peripheral balance systems in the body [5]. The results of most researchers suggest that resistance training and balance exercises are more effective on improving balance disorders, especially in patients with mild and moderate levels of PD, compared to other exercise methods [10,36].…”

Section: Discussionmentioning

confidence: 99%

“…The physical exercises prescribed for these patients should be short-term, simple and closely monitored and the barriers to exercises including high expectations of the outcome, the lack of time and fear of falls should also be overcome. Given the decreased motor learning ability in this group of patients, the exercises should be designed based on amplifying the sensory inputs and doing basic functional trainings and also the familiarity and safety of the training atmosphere [3][4][5]. Research results suggest that aerobic exercises are significantly more effective than stretching and strengthening exercises on improving parameters such as walking, balance, motor function and muscle strength and reducing the risk of falls [3][4][5][6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

“…Given the decreased motor learning ability in this group of patients, the exercises should be designed based on amplifying the sensory inputs and doing basic functional trainings and also the familiarity and safety of the training atmosphere [3][4][5]. Research results suggest that aerobic exercises are significantly more effective than stretching and strengthening exercises on improving parameters such as walking, balance, motor function and muscle strength and reducing the risk of falls [3][4][5][6][7][8][9]. Studies also suggest that regular physical exercises have both long-term and short-term beneficial effects on patients with PD, and that a combination of balance, flexibility and resistance exercises, especially in groups, maximizes the improvement of motor function in the patients [10].…”

Section: Introductionmentioning

confidence: 99%

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Pilates Exercise and Functional Balance in Parkinson's Disease

Bakhshayesh

Sayyar

Daneshmandi

2017

Caspian.J.Neurol.Sci

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Promotion of physical activity and fitness in sedentary patients with Parkinson's disease: randomised controlled trial

Abstract: Marlies van Nimwegen AbstractObjective To evaluate whether a multifaceted behavioural change programme increases physical activities in patients with Parkinson's disease.

Cited by 139 publications

References 47 publications

The Effect of a Selective Pilates Program on Functional Balance and Falling Risk in Patients with Parkinson’s Disease

The Effect of a Selective Pilates Program on Functional Balance and Falling Risk in Patients with Parkinson’s Disease

Clinical effectiveness and cost-effectiveness of physiotherapy and occupational therapy versus no therapy in mild to moderate Parkinson’s disease: a large pragmatic randomised controlled trial (PD REHAB)

Pilates Exercise and Functional Balance in Parkinson's Disease

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