Large-Amplitude Group Exercise Training Programme For Individuals With Mild To Moderate Parkinson’s Disease: A Pilot Intervention Study

Parkinson’s disease (PD) is a complex neurodegenerative disorder, which affects the physical, psychological and functional status of individuals. It is the second most common neurodegenerative disease in the world today affecting approximately 8,000 people in Ireland. The most common motor disturbances related to PD are reduced balance and mobility which can lead to a reduction in physical functional performance and health-related quality of life. Pharmacology is the cornerstone of treatment in PD. However, even with optimal medical management people with PD (PwPD) still experience a deterioration in functional performance. Research relating to the efficacy of physiotherapy and exercise interventions in the management of PD has tripled in the last decade. However, uncertainty remains as to which type, intensity and frequency of exercise are most beneficial.

Aims

The aim of this study is to assess the feasibility of a six week large-amplitude group exercise class on physical functional performance in individuals with mild-moderate PD.

Objectives

To determine if a one hour weekly large-amplitude group exercise class incorporating a daily home exercise programme:

1) Is feasible and safe to carry out both in a hospital setting and a home environment as measured with a safety adverse events form. 


2) Improves physical functional performance measures of balance, gait, functional mobility and exercise tolerance with mild to moderate PD as measured with the Six Minute Walk Test (6MWT), Dynamic Gait Index (DGI) and Timed Up and Go (TUAG). 


3) Improves health-related quality of life (HRQOL) using the Parkinson’s Disease Questionnaire-39 (PDQ-39). 


4) Yields participant satisfaction as measured with a satisfaction questionnaire. 


5) Facilitates exercise motivation and adherence as measured with a daily home 
exercise logbook. 


Methods

A pretest-posttest single study pilot design was utilised to address the research question. Eligibility criteria included a diagnosis of idiopathic PD, a Hoehn and Yahr score of 1-3, independently mobile with or without a gait aid and the ability to give informed consent.

Feasibility outcome measures included safety, exercise compliance, adherence rates, retention rates and participant satisfaction.

The primary clinical outcome measure was the 6MWT.

Secondary clinical outcome measures of interest included the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) Part II and Part III, TUAG, DGI and the PDQ-39.

Results

Large-amplitude group exercise training is both feasible and safe to carry out in an acute hospital setting and at home.

Statistically significant changes in mean scores between T1 and T2 were found for the 6MWT (mean change 37.67m, 95% CI (-57.45, -17.89) p=0.01), TUAG and DGI and for the motor examination section (Part III) of the MDS-UPDRS.

Non-significant changes in mean scores between T1 and T2 were found for the ADL section (Part II) of the MDS-UPDRS and PDQ-39.

Conclusions and Implications of findings

A six-week large-amplitude group exercise programme is feasible and safe and demonstrated significant changes in functional performance outcomes in PwPD. The author suggests that a more rigorous study design, that is adequately powered, is warranted to evaluate the efficacy of this exercise intervention in PwPD.