# Exercise as it relates to Disease/Improving Mobility in Parkinson's Disease Patients Using Exercise

This Wikibooks fact sheet provides a summary and critiques the article “Exercise programs improve mobility and balance in people with Parkinson’s disease” written by L Gobbi, et al (2009).

## Research Background

Parkinson's Disease (PD) is a progressive neurological disorder which impacts on the function of motor and non-motor features to varying degrees.
It's the second most common neurodegenerative disorder, after Alzheimer’s disease, with a prevalence of approximately 0.5-1% among people aged 65-69, rising to 1-3% among people 80 and older.
Treatment options are becoming more of a real world importance as the projected number of people with PD by 2030 in European nations is between 8.7 and 9.3 million based off 2005 figures.
Total estimated cost in the UK for PD is between 449 million pounds and 3.3 billion pounds annually.
Exercise is not known to reduce the severity or the rate of progression of the disease but does contribute to improvements in quality of life, motor performance and ability to perform activities of daily living (ADL).
The article aimed to answer the suggestion:

## Research Origin

The study was conducted on 34 participants with idiopathic PD ranging from stage 1 to 3. The study was done in collaboration with a posture and gait studies lab, and physical activity and aging lab at Sao Paulo State University in Brazil for the Department of Physical Education and Faculty of Medical Sciences.
The authors state they have no conflicts of interest. Authors have previously written articles on falls in elderly patients with neurological diseases and articles on Brazilian PD patients and the quality of life. The focus has been on Brazilian patients.

## Research Type

The study was a multivariate analysis of a randomised clinical trial. Clinical trials are unbiased and have less risk of errors and are therefore ranked the highest level of evidence.

## Research Methodology

The study required 34 patients with PD to complete an exercise intervention over 6 months. Prior to the intervention, the participants completed pre-assessment tests which assessed balance and basic mobility through modified Timed Up and Go Test (TUG) and Bergs Functional Balance Scale (FBS).
The participants were separated into two groups.
* Group 1 engaged in a multi-mode exercise program to develop their functional capacity. This consisted of recreational activities, stretching exercises and rhythmic activities. Participants engaged in 72 sessions; 3 times a week for 60 minutes with progression occurring every 12 sessions.
* Group 2 participated in an adaptive program to alter the effects of inactivity. Exercises focused on flexibility, strength, motor coordination and balance. Participants engaged in 24 sessions; once per week for 60 minutes with no progression.
Limitations existed within the methodology of the study.
* The sample size of the study was small which can create larger margins for error.
* The tests are adequate performance measures of balance, mobility and walking speed for people with early to middle stages of PD. However, they are less effective at measuring performance in participants with later stages. The methodology would not be the best approach when measuring participants of different stages.
* The study focused on participants with stages 1-3 of Hoehn and Yahr Scale. These participants are categorised as physically independent with mild to moderate disability. Having a greater range of stages to include participants who are physically dependent could further emphasise benefits of exercise.

## Basic Results

Both interventions had positive effects from the program. The participants had improvements in mobility and balance from pre to post intervention tests. The adaptive program proved more beneficial, their reasoning for this is that low intensity interventions break the physical inactivity and slows the cyclic reaction associated with PD.
In the article, the authors state that there were no significant differences in pre-test results between groups. Prior to completing the program, interpretation of the graphs show that the FBS had a 5 point difference between intervention groups with multi-mode participants having higher results. The TUG test had a significant difference with the multi-mode participants having a result double that of the adaptive participants.
The authors again claimed that there were no significant differences in post-test results between intervention groups. Interpretation of graphs indicate there was a decrease in TUG test time by 9 seconds in the adaptive program, where as the multi-mode program had a decrease in time of 2-3 seconds. With the type of population tested, small changes in results would be recognised as significant as these patients live with a neurological disease and struggle performing ADL.

## Research Conclusions

Both interventions improved mobility and balance significantly in PD participants. Exercise interventions need to have a duration longer than 6 months for there to be significant improvements in balance and mobility.
The study states that no one form of exercise intervention is more beneficial as long as it mimics the movements of ADL. This aligns with more recent research that looks into different modes of exercise to slow down the process of the neurological disease.
The findings align with another study conducted on patients with PD and their rate of falling. Physiotherapy interventions are included in more recent studies that show it to be of benefit. An area of conflict is the duration of interventions. Recent studies have shown that smaller duration's of 10 weeks have significant benefit on movement.
Other, more recent studies, have focused on the influence of music on movement therapy. Studies concluded that there is significant improvement in walking velocity and gait related activities in PD patients with music based movement interventions.

## Practical Advice

Exercise improves quality of life, motor performance and the performance of ADL for people living with PD. Exercise can also decrease other health risks associated with older age.
Prior to undertaking an exercise intervention, consider the mode of exercise, intensity and duration.
Before taking on any type of exercise it is important to obtain medical clearance and advice from a general practitioner.
Working with an allied health professional to develop an appropriate exercise program to suit the individual could be considered.

## Further Information

http://www.parkinsons.org.au/
http://www.pdf.org/
Exercise is Medicine Australia – 2014 Parkinson’s Disease and Exercise Fact Sheet

## References

* 1 2 Gobbi L, Oliveriera-Ferreira M, Caetano J, Lirani-Silva E, Barbieri F, Stella F, Gobbi S. (2009) ‘Exercise Programs Improve Mobility and Balance in People with Parkinson’s Disease’. Parkinsonism Relat Disord. 15(3):49-52
* ↑ Jankovic J. (2008) ‘Parkinson’s Disease: Clinical Features and Diagnosis’. J Neurol Neurosug Psychiatry. 79(4):368-376
* ↑ Guttmacher AE, Collins FS. (2003) ‘Alzheimer’s Disease and Parkinson’s Disease’. N Engl J Med. 348:1356-1364.
* ↑ Dorsey ER, Constantinescu R, Thompson JP et al. (2007) ‘Projected Number of People with Parkinson Disease in the Most Populous Nations, 2005 Through 2030’. J Am Acad Neurol. 68(5):384-386.
* ↑ Findley LJ. (2007) ‘The Economic Impact of Parkinson’s Disease’. Parkinsonism Relat Disord. 13(1):8-12.
* ↑ Burns PB, Rohrich RJ, Chung KC. (2011) ‘The Levels of Evidence and their Role in Evidence-Based Medicine’. Plast Reconstr Surg. 128(1):305-310. [Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3124652/ ]
* ↑ Brusse KJ, Zimdars S, Zalewski KR, Steffen TM. (2005) ‘Testing Functional Performance in People With Parkinson Disease’. Phys Ther. 85(2):134-141. [Available from: https://academic.oup.com/ptj/article/85/2/134/2804975/Testing-Functional-Performance-in-People-With ]
* ↑ Bhidayasiri R, Tarsy D. (2012) ‘Parkinson’s Disease: Hoehn and Yahr Scale’. Movement Disorders: A Video Analysis. Pages: 4-5.
* ↑ Goodwin VA, Richards SH, Henley W, et al. (2011) ‘An Exercise Intervention to Prevent Falls in People with Parkinson’s Disease: a Pragmatic Randomised Controlled Trial’. J Neurol Neurosurg Psychiatry. 82(11):1232-1238.
* ↑ De Dreu MJ, Van Der Wilk ASD, Kwakkel G, Van Wegen EEH. (2012) ‘Rehabilitation, Exercise Therapy and Music in Patients with Parkinson’ Disease: a Meta-Analysis of the Effect of Music-Based Movement Therapy on Walking Ability, Balance and Quality of Life’. Parkinsonism Relat Disord. 18(1):114-119.