## 4 Discussion  
PD is a degenerative disease with progression increasing impairment, limitations to functional activities and restrictions, despite medical management using appropriate drugs or modern neurosurgical techniques [1; 7; 17]. In this context, physiotherapy interventions--in particular, exercise--have been proposed as methods to limit the progressive nature of the disease and maintain function [1; 7]. Recently, the use of home-based programmes for individuals with PD has become a popular area for exploration [13; 14; 15; 18; 19]. Our study investigated the effect of a home-based exercise programme with the view to try and reduce axial rigidity and improve gait characteristics in individuals with PD at stage 2 or 3 on the modified Hoenh and Yahr scale. The results showed that individuals with PD in the HOME group had a statistically significant improvement in primary outcomes, including the MDS-UPDRS rigidity item, FAR-p, step length, and gait velocity, and also in secondary outcomes including FRT and FES-I. In addition, the GROC scores showed a clinically important change in the HOME group. There were no statistically significant differences recorded in the CON group, although some outcome measures did show improvements--step width, step length, cadence, which was accompanied by a clinically important change in the grouped GROC scores. Previous studies have had similar outcomes to our study in the exploration of home-based exercise programmes. [PERSON] et al. (2012) [20] conducted a home-based exercise programme with 31 individuals with PD. Changes in UPDRS were measured and they found an improvement in the UPDRS motor scores in individuals with PD who were younger than 60 years of age. However, the researcher did not specify in which components of the UPDRS motor scale they had observed the improvements. Another comparative study between home-based and therapist-supervised exercise was carried out in 2017 by [PERSON] and [PERSON] using gait and balance outcomes [21]. They demonstrated that individuals with PD in the home-based group showed an improvement in some aspects of gait. In addition, [PERSON] et al. (2009) investigated a home-based programme in 10 individuals with PD in 2 to 3 on the modified H&Y scale over a 10-week period and observed improvements in postural control [13]. These findings were consistent with those in our study and suggest that exercise is an essential intervention adjunct to medication treatment in cases of PD. In contrast there is some evidence which indicates that exercise supervised by a therapist is more effective than a home-based exercise programme. A study by [PERSON] in 2010 [12] found that the exercise programme under physiotherapist supervision was more effective in improving activities of daily living, motor, mental and emotional functions and general health quality of life in individuals with PD compared with those on a self-supervised home programme. Similarly, a study by [PERSON] et al. (2017) [15] investigated the rate of falls and quality of life between a home programme for individuals with PD which consisted of strength and movement strategy training and falls education over 6 weeks and a control group. The results indicated that fall rates were not substantially different between the groups. Finally, [PERSON] et al. [11] showed that home-based exercise improves balance-related activities and gait speed in individuals with PD. However, the COVID-19 pandemic has severely disrupted outpatient physiotherapy services in Thailand. As a result of social distancing, immobilization, outpatient restrictions in clinic attendance and the risk of contracting COVID-19 in this vulnerable group, home-based exercise may be the only option for individuals with PD in preventing the deterioration of the motor and non-motor symptoms in this population. Taken together, in the case of the home-based exercise programme in this study, we have carried out a scoping review and modified an axial mobility programme designed by [PERSON] et al.