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

<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 & 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>