Telerehabilitation versus traditional centre-based pulmonary rehabilitation for people with chronic respiratory disease: protocol for a randomised controlled trial Benefits and costs of home-based pulmonary rehabilitation in chronic obstructive pulmonary disease - a multi-centre randomised controlled equivalence trial Effects of Group, Individual, and Home Exercise in Persons With Parkinson Disease: A Randomized Clinical Trial What effect does a structured home-based exercise programme have on people with Huntington’s disease? A randomized, controlled pilot study Home-based treadmill training for individuals with Parkinson’s disease: a randomized controlled pilot trial Is Irish set dancing feasible for people with Parkinson's disease in Ireland? Balance training in individuals with Parkinson's disease: Therapist-supervised vs. home-based exercise programme. Exercise for People in Early- or Mid-Stage Parkinson Disease: A 16-Month Randomized Controlled Trial The PIT: SToPP Trial—A Feasibility Randomised Controlled Trial of Home-Based Physiotherapy for People with Parkinson's Disease Using Video-Based Measures to Preserve Assessor Blinding Comparison of the effects of a physiotherapist-supervised exercise programme and a self-supervised exercise programme on quality of life in patients with Parkinson’s disease A comparison of Irish set dancing and exercises for people with Parkinson’s disease: A phase II feasibility study A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease A pilot study of a minimally supervised home exercise and walking program for people with Parkinson's disease in Jordan. Feasibility, safety and preliminary evidence of the effectiveness of a home-based exercise programme for older people with Alzheimer’s disease: a pilot randomized controlled trial Effectiveness of a Targeted Exercise Intervention in Reversing Older People's Mild Balance Dysfunction: A Randomized Controlled Trial Home-based exercise improves the quality of life and physical function but not the psychological status of people with chronic heart failure: a randomised trial. Exercise therapy for prevention of falls in people with Parkinson's disease: A protocol for a randomised controlled trial and economic evaluation Evaluation of the effectiveness of home based or hospital based calisthenic exercises in patients with multiple sclerosis. Efficacy of home-based exercise for improving quality of life among elderly women with symptomatic osteoporosis-related vertebral fractures Integration of balance and strength training into daily life activity to reduce rate of falls in older people (the LiFE study): randomised parallel trial Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson’s A controlled clinical trial investigating the effects of cycle ergometry training on exercise tolerance, balance and quality of life in patients with Parkinson’s disease Do home-based exercise interventions improve outcomes for frail older people? Findings from a systematic review.
Background Pulmonary rehabilitation is an effective therapeutic intervention for people with chronic respiratory disease . However , fewer than 5 % of eligible individuals receive pulmonary rehabilitation on an annual basis , largely due to limited availability of services and difficulties associated with travel and transport . The Rehabilitation Exercise At Home ( REAcH ) study is an assessor-blinded , multi-centre , r and omised controlled equivalence trial design ed to compare the efficacy of home-based telerehabilitation and traditional centre-based pulmonary rehabilitation in people with chronic respiratory disease . Methods Participants will undertake an 8-week group-based pulmonary rehabilitation program of twice-weekly supervised exercise training , either in-person at a centre-based pulmonary rehabilitation program or remotely from their home via the Internet . Supervised exercise training sessions will include 30 min of aerobic exercise ( cycle and /or walking training ) . Individualised education and self-management training will be delivered . All participants will be prescribed a home exercise program of walking and strengthening activities . Outcomes will be assessed by a blinded assessor at baseline , after completion of the intervention , and 12-months post intervention . The primary outcome is change in dyspnea score as measured by the Chronic Respiratory Question naire – dyspnea domain ( CRQ-D ) . Secondary outcomes will evaluate the efficacy of telerehabilitation on 6-min walk distance , endurance cycle time during a constant work rate test , physical activity and quality of life . Adherence to pulmonary rehabilitation between the two models will be compared . A full economic analysis from a societal perspective will be undertaken to determine the cost-effectiveness of telerehabilitation compared to centre-based pulmonary rehabilitation . Discussion Alternative models of pulmonary rehabilitation are required to improve both equity of access and patient-related outcomes . This trial will establish whether telerehabilitation can achieve equivalent improvement in outcomes compared to traditional centre-based pulmonary rehabilitation . If efficacious and cost-effective , the proposed telerehabilitation model is design ed to be rapidly deployed into clinical practice .Trial registration Clinical trial registered with the Australian and New Zeal and Clinical Trials Register at ( ACTRN12616000360415 ) . Registered 21 March 2016 Background Pulmonary rehabilitation is widely advocated for people with chronic obstructive pulmonary disease ( COPD ) to improve exercise capacity , symptoms and quality of life , however only a minority of individuals with COPD are able to participate . Travel and transport are frequently cited as barriers to uptake of centre-based programs . Other models of pulmonary rehabilitation , including home-based programs , have been proposed in order to improve access to this important treatment . Previous studies of home-based pulmonary rehabilitation in COPD have demonstrated improvement in exercise capacity and quality of life , but not all elements of the program were conducted in the home environment . It is uncertain whether a pulmonary rehabilitation program delivered in its entirety at home is cost effective and equally capable of producing benefits in exercise capacity , symptoms and quality of life as a hospital-based program . The aim of this study is to compare the costs and benefits of home-based and hospital-based pulmonary rehabilitation for people with COPD . Methods / Design This r and omised , controlled , equivalence trial conducted at two centres will recruit 166 individuals with spirometrically confirmed COPD . Participants will be r and omly allocated to hospital-based or home-based pulmonary rehabilitation . Hospital programs will follow the traditional outpatient model consisting of twice weekly supervised exercise training and education for eight weeks . Home-based programs will involve one home visit followed by seven weekly telephone calls , using a motivational interviewing approach to enhance exercise participation and facilitate self management . The primary outcome is change in 6-minute walk distance immediately following intervention . Measurements of exercise capacity , physical activity , symptoms and quality of life will be taken at baseline , immediately following the intervention and at 12 months , by a blinded assessor . Completion rates will be compared between programs . Direct healthcare costs and indirect ( patient-related ) costs will be measured to compare the cost-effectiveness of each program . Discussion This trial will identify whether home-based pulmonary rehabilitation can deliver equivalent benefits to centre-based pulmonary rehabilitation in a cost effective manner . The results of this study will contribute new knowledge regarding alternative models of pulmonary rehabilitation and will inform pulmonary rehabilitation guidelines for COPD .Trial registration Clinical Trials.gov : NCT01423227 Background and Purpose : Comparative studies of exercise interventions for people with Parkinson disease ( PD ) rarely considered how one should deliver the intervention . The objective of this study was to compare the success of exercise when administered by ( 1 ) home exercise program , ( 2 ) individualized physical therapy , or ( 3 ) a group class . We examined if common comorbidities associated with PD impacted success of each intervention . Methods : Fifty-eight people ( age = 63.9 ± 8 years ) with PD participated . People were r and omized into ( 1 ) home exercise program , ( 2 ) individual physical therapy , or ( 3 ) group class intervention . All arms were st and ardized and based on the Agility Boot Camp exercise program for PD , 3 times per week for 4 weeks . The primary outcome measure was the 7-item Physical Performance Test . Other measures of balance , gait , mobility , quality of life , balance confidence , depressions , apathy , self-efficacy and UPDRS-Motor , and activity of daily living scores were included . Results : Only the individual group significantly improved in the Physical Performance Test . The individual exercise showed the most improvements in functional and balance measures , whereas the group class showed the most improvements in gait . The home exercise program improved the least across all outcomes . Several factors effected success , particularly for the home group . Discussion and Conclusions : An unsupervised , home exercise program is the least effective way to deliver exercise to people with PD , and individual and group exercises have differing benefits . Furthermore , people with PD who also have other comorbidities did better in a program directly supervised by a physical therapist . Video Abstract available for additional insights from the authors ( see Video , Supplemental Digital Content 1 , http://links.lww.com/JNPT/A112 ) Objective : The aim of this study was to explore feasibility , safety and outcome of an exercise intervention in people with Huntington ’s disease . Design : A r and omized controlled pilot trial . Setting : A home-based exercise programme . Subjects : A total of 25 subjects with early to mid-stage Huntington ’s disease . Intervention : Subjects were r and omly allocated to either an exercise intervention ( n = 13 ) or a control group ( n = 12 ) . Subjects in the exercise intervention group were asked to perform exercises at home three times a week for eight weeks using an exercise DVD , specifically developed for this purpose . The control group received their usual care . Measures : Adherence in the intervention group was calculated from exercise diaries . Measures of gait , balance , function , level of physical activity and quality of life were evaluated . Analysis of covariance was used to compare follow-up scores across groups after adjustment for chance baseline differences . Effect sizes were calculated . Results : Eleven participants from the intervention and ten from the control group completed the study . Mean adherence was 29.4 SD 1.8 for the 32 prescribed sessions . There were no related adverse events . Differences between groups were observed in gait speed , balance , function and level of physical activity , but not quality of life as measured by the SF36 . Effect sizes were large ( > 0.8 ) for the majority of the outcomes . Conclusions : Short-term structured home exercise programmes are feasible , beneficial and safe for people with early to mid-stage of Huntington ’s disease . Our findings support the implementation of a larger trial of longer-term home exercise Objective : To investigate the feasibility and effectiveness of six weeks of home-based treadmill training in people with mild Parkinson ’s disease . Design : Pilot r and omized controlled trial of a six-week intervention followed by a further six weeks follow-up . Setting : Home-based treadmill training with outcome measures taken at a hospital clinic . Participants : Twenty cognitively intact participants with mild Parkinson ’s disease and gait disturbance . Two participants from the treadmill training group and one from the control group dropped out . Interventions : The treadmill training group undertook a semi-supervised home-based programme of treadmill walking for 20–40 minutes , four times a week for six weeks . The control group received usual care . Main outcome measures : The feasibility of the intervention was assessed by recording exercise adherence and acceptability , exercise intensity , fatigue , muscle soreness and adverse events . The primary outcome measure of efficacy was walking capacity ( 6-minute walk test distance ) . Results : Home-based treadmill training was feasible , acceptable and safe with participants completing 78 % ( SD 36 ) of the prescribed training sessions . The treadmill training group did not improve their walking capacity compared to the control group . The treadmill training group showed a greater improvement than the control group in fatigue at post test ( P = 0.04 ) and in quality of life at six weeks follow-up testing ( P = 0.02 ) . Conclusions : Semi-supervised home-based treadmill training is a feasible and safe form of exercise for cognitively intact people with mild Parkinson ’s disease . Further investigation regarding the effectiveness of home-based treadmill training is warranted OBJECTIVE To investigate if community-based Irish set dancing is feasible in Irish adults with Parkinson 's disease . METHODS Over an eight week period , ten participants attended one set dancing class per week and completed a home programme in parallel . Feasibility was assessed by monitoring adverse effects , participants ' verbal feedback , compliance rates and feedback from an exit question naire . Participants were assessed using the Berg balance scale , 6-min walk test , UPDRS-3 and PDQ-39 , before and after the intervention . RESULTS No adverse effects were detected . Attendance at classes was 86 % . Compliance with the home programme was 67 % . Findings from the exit question naire showed participants enjoyed participating and reported improvements in aspects of health including balance . Quality of life improved with the dance programme and there was a trend toward improvement on the UPDRS-3 . CONCLUSION These findings suggest community-based Irish set dancing is a feasible form of exercise that can positively influence quality of life BACKGROUND Poor locomotion and balance in Parkinson 's disease ( PD ) often diminishes independence . Accordingly , gait is considered one of the most relevant rehabilitation outcomes , and home-based balance exercises might be a viable mode of exercise delivery for individuals with PD . However , research on PD interventions rarely indicate best practice s to deliver exercises . Therefore , this study endeavoured to compare the efficacy of a home-based and therapist-supervised balance programme on gait parameters , dynamic balance , balance confidence and motivation in individuals diagnosed with PD . METHODS An experimental study design , including a cluster r and omized convenience sample , of 40 participants with idiopathic PD ( Hoehn and Yahr stage I-III ; age : 65.0±7.7years ) . Participants were divided into a therapist-supervised ( n=24 ) and home-based group ( n=16 ) . Groups received either eight weeks of balance training with an exercise therapist or a DVD . Outcome measures include the instrumented Timed-Up- and -Go , Functional Gait Analysis ( FGA ) , Activity-specific Balance confidence ( ABC ) scale and Intrinsic Motivation Inventory ( IMI ) . RESULTS Both groups improved in stride length ( p<0.05 ) . Similar FGA improved by 9 % and 16 % in the therapist-supervised and home-based group , respectively ( p<0.01 ) . Only the therapist-supervised group showed improvements in ABC ( p=0.051 ) , stride velocity ( p=0.0006 ) and cadence ( p=0.046 ) over the intervention ; the latter two were also better compared to home-based ( p<0.05 ) . Furthermore the therapist-supervised group were more motivated ( p=002 ) . CONCLUSION The home-based balance programme was effective in improving some aspects of gait , albeit the programme supervised by an exercise therapist included somewhat more benefits after the intervention i.e. stride velocity and cadence in individuals with mild to moderate PD Background Exercise confers short-term benefits for individuals with Parkinson disease ( PD ) . Objective 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 . Design The 16-month r and omized controlled exercise intervention investigated 3 exercise approaches : flexibility/balance/function exercise ( FBF ) , supervised aerobic exercise ( AE ) , and home-based exercise ( control ) . Setting This study was conducted in outpatient clinics . Patients The participants were 121 individuals with PD ( Hoehn & Yahr stages 1–3 ) . Interventions 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 . Measurements 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 ] ) . Results 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 ) . Limitations Absence of a non-exercise control group was a limitation of the study . Conclusions Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy ( up to 16 months ) in the AE group Purpose . To trial four-week 's physiotherapy targeting chair transfers for people with Parkinson 's disease ( PwPD ) and explore the feasibility of reliance on remote outcome measurement to preserve blinding . Scope . We recruited 47 PwPD and r and omised 24 to a focused home physiotherapy programme ( exercise , movement strategies , and cueing ) and 23 to a control group . We evaluated transfers ( plus mobility , balance , posture , and quality of life ) before and after treatment and at followup ( weeks 0 , 4 , 8 , and 12 ) from video produced by , and question naires distributed by , treating physiotherapists . Participants fed back via end-of- study question naires . Thirty-five participants ( 74 % ) completed the trial . Excluding dropouts , 20 % of question naire data and 9 % of video data were missing or unusable ; we had to evaluate balance in situ . We noted trends to improvement in transfers , mobility , and balance in the physiotherapy group not noted in the control group . Participant feedback was largely positive and assessor blinding was maintained in every case . Conclusions . Intense , focused physiotherapy at home appears acceptable and likely to bring positive change in those who can participate . Remote outcome measurement was successful ; question naire followup and further training in video production would reduce missing data . We advocate a fully powered trial , design ed to minimise dropouts and preserve assessor blinding , to evaluate this intervention Objectives : To compare the effects of a physiotherapist-supervised exercise programme in an exercise unit and self-supervised home exercise programme on quality of life in patients with Parkinson ’s disease . Design : Assessor-blinded , quasi-r and omized trial ( alternate allocation ) . Setting : An outpatient exercise unit ; home setting s. Participants : Thirty patients with idiopathic Parkinson ’s disease , Hoehn & Yahr I — III , stable medication use . Interventions : Patients were included in the physiotherapist-supervised or home group . The exercise programme was performed for 10 weeks , three times/week either under the supervision of a physiotherapist or at home without supervision . Main outcome measures : Parkinson ’s Disease Quality of Life Question naire ( PDQLQ ) , Nottingham Health Profile ( NHP ) , Unified Parkinson ’s Disease Rating Scale ( UPDRS ) , Beck Depression Inventory ( BDI ) . Results : Patients in the supervised physiotherapy group improved more than the home exercise group in Parkinson ’s Disease Quality of Life Question naire ( total score , Parkinson ’s symptoms , emotional function ) , Nottingham Health Profile total , Unified Parkinson ’s Disease Rating Scale ( all domains ) and Beck Depression Inventory scores . Conclusions : The exercise programme under physiotherapist supervision was found to be more effective at improving activities of daily living , motor , mental , emotional functions and general health quality in patients with Parkinson ’s disease compared with a self-supervised home programme Background People with idiopathic Parkinson ’s disease ( PD ) frequently have low activity levels , poor mobility and reduced quality of life . Although increased physical activity may improve mobility , balance and wellbeing , adherence to exercises and activity programs over the longer term can be challenging , particularly for older people with progressive neurological conditions such as PD . Physical activities that are engaging and enjoyable , such as dancing , might enhance adherence over the long term . The objective of this study was to evaluate the feasibility of a r and omized controlled trial of Irish set dancing compared with routine physiotherapy for people with mild to moderately severe PD . Methods Twenty-four people with idiopathic PD referred for movement rehabilitation were r and omized to receive  st and ard physiotherapy exercises or Irish set dancing classes  once per week plus a weekly home program for 6 months ( 12 in each group ) . The feasibility and safety of the proposed RCT protocol was the main focus of this evaluation . The primary outcome was motor disability measured by the motor component of the UPDRS , which was assessed prior to and after therapy by trained assessors blinded to group assignment . The Timed Up and Go , the Berg Balance Scale and the modified Freezing of Gait Question naire were secondary measures . Quality of life of the people with PD was evaluated using the PDQ-39 . Results Both the Irish set dancing and physiotherapy exercise program were shown to be feasible and safe . There were no differences between groups in the rate of adverse events such as falls , serious injuries , death or rates of admission to hospital . The physiotherapists who provided usual care remained blind to group allocation , with no change in their st and ard clinical practice . Compliance and adherence to both the exercise and dance programs were very high and attrition rates were low over the 6 months of therapy . Although improvements were made in both groups , the dance group showed superior results to st and ard physiotherapy in relation to freezing of gait , balance and motor disability . Conclusions Irish dancing and physiotherapy were both safe and feasible in this sample from Venice , with good adherence over a comparatively long time period of 6 months . A larger multi-centre trial is now warranted to establish whether Irish set dancing is more effective than routine physiotherapy for enhancing mobility , balance and quality of life in people living with idiopathic PD.Trial registration EudraCT number 2012 - 005769 - Objective : To evaluate the effectiveness of a personalised home programme of exercises and strategies for repeat fallers with Parkinson ’s disease ( PD ) . Method : Patients with a confirmed diagnosis of idiopathic PD , independently mobile , living at home in the community , experiencing more than one fall in the previous 12 months and with intact gross cognitive function were invited to participate in this r and omised controlled trial . Usual care was compared with a personalised 6 week , home based exercise and strategy programme . The primary outcomes were rates of falling at 8 weeks and 6 months . Whether participants had repeat fallen , nearly fallen or experienced injurious falls were also examined . Functional Reach , the Berg Balance Test , PD Self- assessment Scale and the Euro Quol were rated by a blinded assessor . Results : Participants were r and omised to the exercise ( n = 70 ) and control ( n = 72 ) groups . There was a consistent trend towards lower fall rates in the exercise group at both 8 weeks and 6 months and lower rates of injurious falls needing medical attention at 6 months . Lower rates of repeat near falling were evident for the exercise group at 8 weeks ( p = 0.004 ) and 6 months ( p = 0.007 ) . There was a positive effect of exercises at 6 months on Functional Reach ( p = 0.009 ) and quality of life ( p = 0.033 ) . No significant differences were found on other secondary outcomes measures . Conclusion : There was a trend towards a reduction in fall events and injurious falls with a positive effect of exercises on near falls and quality of life AIM This study aim ed to evaluate the feasibility and cultural considerations of a minimally supervised , home-based exercise program in Jordan . METHODS Quantitative and qualitative approaches were used . Thirty participants were r and omly allocated to either an 8-week intervention group ( n = 16 ) , or a st and ard care group ( n = 14 ) . The intervention incorporated the home use of an exercise DVD , walking program and initial instructional sessions and weekly phone calls provided by a physiotherapist . Interviews were used to explore feasibility . Unified Parkinson 's disease rating scale ( UPDRS-III ) ; balance and walking speed were assessed . RESULTS The retention rate was 86.7 % and mean adherence rate was 77 % . Personal and sociocultural barriers of adherence to the exercise program were identified . UPDRS-III at follow-up was lower in the intervention group . CONCLUSION A home exercise program was feasible . Sociocultural barriers specific to Arabic culture may affect the uptake of such an intervention in Parkinson 's disease in these countries Objective : To evaluate the feasibility and safety of a home-based exercise programme for people with Alzheimer ’s disease , and to provide preliminary evidence of programme effectiveness in improving balance and mobility and reducing falls risk . Design : A r and omized controlled trial . Setting : Community . Participants : Forty people with mild to moderate Alzheimer ’s disease ( mean age 81.9 , SD 5.72 ; 62.5 % female ) . Interventions : Participants were r and omized to a six-month home-based individually tailored balance , strengthening and walking exercise programme ( physiotherapist ) or a six-month home-based education programme ( control ) ( occupational therapist ) . Both programmes provided six home-visits and five follow-up phone calls . Main measures : Balance , mobility , falls and falls risk were measured at baseline and programme completion . Intention-to-treat analysis using a generalized linear model with group allocation as a predictor variable was performed to evaluate programme effectiveness . Feasibility and adverse events were systematic ally recorded at each contact . Results : Fifty-eight per cent of the exercise group finished the programme , completing an average of 83 % of prescribed sessions , with no adverse events reported . Functional Reach improved significantly ( P = 0.002 ) in the exercise group ( mean ( SD ) , 2.28 ( 4.36 ) ) compared to the control group ( –2.99 ( 4.87 ) ) . Significant improvement was also observed for the Falls Risk for Older People – Community score ( P = 0.008 ) and trends for improvement on several other balance , mobility , falls and falls risk measures for the exercise group compared to the control group . Conclusions : The exercise programme was feasible and safe and may help improve balance and mobility performance and reduce falls risk in people with Alzheimer ’s disease Background Previous research has mainly targeted older people with high risk of falling . The effectiveness of exercise interventions in older people with mild levels of balance dysfunction remains unexplored . Objective This study evaluated the effectiveness of a home balance and strength exercise intervention in older people systematic ally screened as having mild balance dysfunction . Design This was a community-based , r and omized controlled trial with assessors blinded to group allocation . Participants Study participants were older people who reported concerns about their balance but remained community ambulant ( n=225 ) . After a comprehensive balance assessment , those classified as having mild balance dysfunction ( n=165 ) were r and omized into the trial . Intervention Participants in the intervention group ( n=83 ) received a 6-month physical therapist – prescribed balance and strength home exercise program , based on the Otago Exercise Program and the Visual Health Information Balance and Vestibular Exercise Kit . Participants in the control group ( n=82 ) continued with their usual activities . Outcome Measures Laboratory and clinical measures of balance , mobility , and strength were assessed at baseline and at a 6-month re assessment . Results After 6 months , the intervention group ( n=59 ) significantly improved relative to the control group ( n=62 ) for : the Functional Reach Test ( mean difference=2.95 cm , 95 % confidence interval [CI]=1.75 to 4.15 ) , the Step Test ( 2.10 steps/15 seconds , 95 % CI=1.17 to 3.02 ) , hip abductor strength ( 0.02 , 95 % CI=0.01 to 0.03 ) , and gait step width ( 2.17 cm , 95 % CI=1.23 to 3.11 ) . There were nonsignificant trends for improvement on most other measures . Fourteen participants in the intervention group ( 23.7 % ) achieved balance performance within the normative range following the exercise program , compared with 3 participants ( 4.8 % ) in the control group . Limitations Loss to follow-up ( 26.6 % ) was slightly higher than in some similar studies but was unlikely to have biased the results . Conclusions A physical therapist – prescribed home exercise program targeting balance and strength was effective in improving a number of balance and related outcomes in older people with mild balance impairment QUESTIONS Are anxiety and depression correlated with physical function , disability , and quality of life in people with chronic heart failure ? Does 8 weeks of home-based exercise improve anxiety , depression , physical function , disability , and quality of life in these patients ? Do the changes in these outcomes correlate ? DESIGN R and omised trial . PARTICIPANTS 51 people with clinical ly stable chronic heart failure were r and omised into an experimental group ( n=24 ) or a control group ( n=27 ) . INTERVENTION The experimental group undertook an individualised home-based exercise program , 30 minutes per session , 3 sessions per week for 8 weeks , with regular telephone follow-up and consultations . The control group maintained their usual activity during this period . OUTCOME MEASURES The Hospital Anxiety and Depression Scale , six-minute walk test , Groningen Activity Restriction Scale , and Minnesota Living with Heart Failure Question naire were administered at baseline and 8 weeks . RESULTS At baseline , anxiety and depression were inversely moderately correlated with walking distance , activity , and quality of life . Compared with controls , the experimental group improved significantly more in their walking distance ( by 21 m , 95 % CI 7 to 36 ) and their quality of life ( by 7 points on the 105-point Minnesota score , 95 % CI 1 to 12 ) . In the experimental group , the changes in quality of life correlated moderately strongly with changes in anxiety ( r=0.539 , p=0.01 ) . CONCLUSIONS Anxiety and depression were associated with physical function , disability , and quality of life in people with chronic heart failure .  Home-based exercise improved quality of life and physical function significantly but not psychological status in these patients Background People with Parkinson 's disease are twice as likely to be recurrent fallers compared to other older people . As these falls have devastating consequences , there is an urgent need to identify and test innovative interventions with the potential to reduce falls in people with Parkinson 's disease . The main objective of this r and omised controlled trial is to determine whether fall rates can be reduced in people with Parkinson 's disease using exercise targeting three potentially remediable risk factors for falls ( reduced balance , reduced leg muscle strength and freezing of gait ) . In addition we will establish the cost effectiveness of the exercise program from the health provider 's perspective . Methods / Design 230 community-dwelling participants with idiopathic Parkinson 's disease will be recruited . Eligible participants will also have a history of falls or be identified as being at risk of falls on assessment . Participants will be r and omly allocated to a usual-care control group or an intervention group which will undertake weight-bearing balance and strengthening exercises and use cueing strategies to address freezing of gait . The intervention group will choose between the home-based or support group-based mode of the program . Participants in both groups will receive st and ardized falls prevention advice . The primary outcome measure will be fall rates . Participants will record falls and medical interventions in a diary for the duration of the 6-month intervention period . Secondary measures include the Parkinson 's Disease Falls Risk Score , maximal leg muscle strength , st and ing balance , the Short Physical Performance Battery , freezing of gait , health and well being , habitual physical activity and positive and negative affect schedule . Discussion No adequately powered studies have investigated exercise interventions aim ed at reducing falls in people with Parkinson 's disease . This trial will determine the effectiveness of the exercise intervention in reducing falls and its cost effectiveness . This pragmatic program , if found to be effective , has the potential to be implemented within existing community services . Trial registration The protocol for this study is registered with the Australian New Zeal and Clinical Trials Registry ( ACTRN12608000303347 ) OBJECTIVES The aim of this study is to evaluate the effects of calisthenic exercises on balance , walking speed , fatigue , quality of life , and psychological status in patients with Multiple Sclerosis ( MS ) . PATIENTS AND METHODS Forty patients diagnosed with MS were r and omized into two exercise groups ( group 1 = hospital-based , group 2 = home-based ) . Outcome measures including the MS International Quality of Life Scale , 10-meter walking test , Berg Balance Scale , Fatigue Severity Scale and the Hospital Anxiety Depression Inventory were assessed at the baseline and at 12-weeks . RESULTS Thirty-six participants completed the exercise programme ( hospital based = 16 , home based = 20 ) . The mean age was 32.83 ± 3.64 years . The mean duration of disease was 6.97 ± 3.15 years . Hospital-based and home-based exercise groups had significant improvements in the balance , 10-meter walking test , anxiety , and the quality of life after the 12-week exercise programme . There was a significant improvement in the hospital-based patients in terms of the depression scores . No significant improvement was observed in terms of fatigue in any of the groups . When both groups were compared , the improvement in the balance and depression scores of the hospital-based patients was significantly higher than the home-based patients . CONCLUSIONS Calisthenic exercises can be easily performed both at home and in hospital setting . In patients with MS  , calisthenic exercises performed at home or at the hospital may improve the balance , quality of life , and the functional and psychological status , while no significant effect has been observed on fatigue This r and omized controlled trial was design ed to investigate the effect of a 6-month home-based exercise program versus control ( usual activities ) on quality of life for postmenopausal women with osteoporosis who had at least one vertebral fracture . Twelve-month assessment s of outcomes were completed to determine if women would continue exercising with minimal supervision and if benefit could be sustained . The home exercise program followed a " lifestyle exercise " approach where participants completed exercises 60 min per day , 3 days a week and could complete exercises in small periods of time throughout the day . Exercise activities included stretching , strength training and aerobics ( i.e. walking ) . Participants were assessed at baseline , 6 months , and 12 months using the Osteoporosis Quality of Life Question naire ( OQLQ ) , the Sickness Impact Profile ( SIP ) , a balance test , and the Timed Up And Go test . Bone mineral density was assessed at baseline and 12 months for both the lumbar spine and femoral neck . Quality of life ( OQLQ ) improved over 6 months in the exercise group compared to the control group in the domains of symptoms ( P=0.003 ) , emotion ( P=0.01 ) and leisure ( P=0.03 ) . Results from the balance test indicated a greater effect in the exercise group over 12 months ( P<0.05 ) . There were no significant differences between groups in measures of Timed Up and Go , SIP at 6 and 12 months , and femoral neck and lumbar spine bone mineral density at 12 months . Home-based exercise with minimal supervision improves quality of life in elderly women with vertebral fractures . Future research is needed to determine if home exercise programs reduce falls and fall-related injuries in the elderly Objectives To determine whether a lifestyle integrated approach to balance and strength training is effective in reducing the rate of falls  in older , high risk people living at home . Design Three arm , r and omised parallel trial ; assessment s at baseline and after six and 12 months . R and omisation done by computer generated r and om blocks , stratified by sex and fall history and concealed by an independent secure website . Setting Residents in metropolitan Sydney , Australia . Participants Participants aged 70 years or older who had two or more falls or one injurious fall in past 12 months , recruited from Veteran ’s Affairs data bases and general practice data bases . Exclusion criteria were moderate to severe cognitive problems , inability to ambulate independently , neurological conditions that severely influenced gait and mobility , resident in a nursing home or hostel , or any unstable or terminal illness that would affect ability to do exercises . Interventions Three home based interventions : Lifestyle integrated Functional Exercise ( LiFE ) approach ( n=107 ; taught principles of balance and strength training and integrated selected activities into everyday routines ) , structured programme ( n=105 ; exercises for balance and lower limb strength , done three times a week ) , sham control programme ( n=105 ; gentle exercise ) . LiFE and structured groups received five sessions with two booster visits and two phone calls ; controls received three home visits and six phone calls . Assessment s made at baseline and after six and 12 months . Main outcome measures Primary measure : rate of falls over 12 months , collected by self report . Secondary measures : static and dynamic balance ; ankle , knee and hip strength ; balance self efficacy ; daily living activities ; participation ; habitual physical activity ; quality of life ; energy expenditure ; body mass index ; and fat free mass . Results After 12 months ’ follow-up , we recorded 172 , 193 , and 224 falls in the LiFE , structured exercise , and control groups , respectively . The overall incidence of falls in the LiFE programme was 1.66 per person years , compared with 1.90 in the structured programme and 2.28 in the control group . We saw a significant reduction of 31 % in the rate of falls for the LiFE programme compared with controls ( incidence rate ratio 0.69 ( 95 % confidence interval 0.48 to 0.99 ) ) ; the corresponding difference between the structured group and controls was non-significant ( 0.81 ( 0.56 to 1.17 ) ) . Static balance on an eight level hierarchy scale , ankle strength , function , and participation were significantly better in the LiFE group than in controls . LiFE and structured groups had a significant and moderate improvement in dynamic balance , compared with controls . Conclusions The LiFE programme provides an alternative to traditional exercise to consider for fall prevention . Functional based exercise should be a focus for interventions to protect older , high risk people from falling and to improve and maintain functional capacity . Trial registration Australia and New Zeal and Clinical Trials Registry 12606000025538 Objective To estimate the effect of a physiotherapist-delivered fall prevention programme for people with Parkinson ’s ( PwP ) . Methods People at risk of falls with confirmed Parkinson ’s were recruited to this multicentre , pragmatic , investigator blind , individually r and omised controlled trial with prespecified subgroup analyses . 474 PwP ( Hoehn and Yahr 1–4 ) were r and omised : 238 allocated to a physiotherapy programme and 236 to control .  All participants had routine care ; the control group received a DVD about Parkinson ’s and single advice session at trial completion . The intervention group ( PDSAFE ) had an individually tailored , progressive home-based fall avoidance strategy training programme with balance and strengthening exercises . The primary outcome was risk of repeat falling , collected by self-report monthly diaries , 0–6 months after r and omisation . Secondary outcomes included Mini-BESTest for balance , chair st and test , falls efficacy , freezing of gait , health-related quality of life ( EuroQol EQ-5D ) , Geriatric Depression Scale , Physical Activity Scale for the Elderly and Parkinson ’s Disease Question naire , fractures and rate of near falling . Results Average age is 72 years and 266 ( 56 % ) were men . By 6 months , 116 ( 55 % ) of the control group and 125 ( 61.5 % ) of the intervention group reported repeat falls ( controlled OR 1.21 , 95 % CI 0.74 to 1.98 , p=0.447 ) . Secondary subgroup analyses suggested a different response to the intervention between moderate and severe disease severity groups . Balance , falls efficacy and chair st and time improved with near falls reduced in the intervention arm . Conclusion PDSAFE did not reduce falling in this pragmatic trial of PwP. Other functional tasks improved and reduced fall rates were apparent among those with moderate disease . Trial registration number IS RCT N48152791 Purpose : To establish the effect of a 6-week programme of cycle ergometry training on exercise tolerance , balance , activities of daily living ( ADL ) and quality of life in individuals with Parkinson ’s disease ( PD ) . Method : Twenty-three subjects were recruited from the Parkinson ’s data base of the neurology service in a large urban teaching hospital . Quasi-experimental study of interrupted time-series design was conducted with subjects acting as their own control . Assessment s were carried out at baseline , week 7 following the control phase , and week 14 following the intervention phase . Intervention consisted of 30-min cycle ergometry training once weekly . Outcome measures included Six Minute Walk Test , Physiological Cost Index , Berg Balance Scale , Timed Up and Go Test ( TUAG ) , ADL and mobility sections of the Unified Parkinson ’s disease Rating Scale ( UPDRS ) and the Parkinson ’s disease question naire ( PDQ ) . Results : Statistically significant improvements were noted for the Berg Balance Scale ( p = 0.003 ) , TUAG ( p = 0.019 ) and ADL ( p = 0.006 ) and mobility ( p = 0.021 ) sections of the UPDRS . A trend towards improvement was found for exercise tolerance . No significant effect on quality of life was found . Conclusion : A 6-week programme of cycle ergometry training did not significantly influence exercise tolerance in this sample , but improved balance , functional abililty and PD-related disability were noted . Implication s for Rehabilitation Individuals with Parkinson ’s disease demonstrate lower levels of exercise tolerance than healthy controls . Individuals with Parkinson ’s disease could participate in 30 min of cycle ergometry training , with no rest periods required . Cycle ergometry training has a positive effect on balance , function and PD-related disability BACKGROUND Frailty is common in older age , and is associated with important adverse health outcomes including increased risk of disability and long-term care admission . OBJECTIVES To evaluate whether home-based exercise interventions improve outcomes for frail older people . DATA SOURCES We search ed systematic ally for r and omised controlled trials ( RCTs ) and cluster RCTs , with literature search ing to February 2010 . STUDY SELECTION All trials that evaluated home-based exercise interventions for frail older people were eligible . Primary outcomes were mobility , quality of life and daily living activities . Secondary outcomes included long-term care admission and hospitalisation . RESULTS Six RCTs involving 987 participants met the inclusion criteria . Four trials were considered of high quality . One high quality trial reported improved disability in those with moderate but not severe frailty . Meta- analysis of long-term care admission rates identified a trend towards reduced risk . Inconsistent effects on other primary and secondary outcomes were reported in the other studies . CONCLUSIONS There is preliminary evidence that home-based exercise interventions may improve disability in older people with moderate , but not severe , frailty . There is considerable uncertainty regarding effects on important outcomes including quality of life and long-term care admission .  Home-based exercises are a potentially simple , safe and widely applicable intervention to prevent dependency decline for frail older people
Home-based prescribed exercise improves balance-related activities and gait speed in people with Parkinson 's disease , and these improvements are similar to improvements with equivalent centre-based exercise .
QUESTIONS In people with Parkinson 's disease , does home-based prescribed exercise improve balance-related activities and quality of life compared with no intervention ?
Are the effects of home-based exercise similar to those of equivalent centre-based exercise ?