## 4 Discussion  
The purpose of the present study was to investigate the impact of an exercise program on balance, functional ability, quality of life, anxiety, and depression in an individual at an early stage of PSP. The results revealed some improvements in functional status and quality of life, as well as some reductions in anxiety and depression symptoms. However, the exercise program appeared to not have influenced balance. The current case study found that a 12-week exercise program may not contribute to an improvement in balance; thus, more research with a larger group sample is needed. \begin{table}
\begin{tabular}{c c c c c c c c c} \hline \hline  & **Baseline** & **4 Weeks** & **8 Weeks** & **12 Weeks** & **MCID** & **MCID** & **MCID** & **MCID** \\  & **E1** & **E2** & **E3** & **E4** & **1E2** & **-E1** & **1E3** & **-E2** & **1E4** & **-E3** & **Value** \\ \hline PDQ-39 & 5.12 & 7.5 & 5 & 5625 & 2.38 * & 2.5 * & 0.625 * & 0.6 \\ PDQ-39-Mobility & 50 & 65 & 52.5 & 45 & 15 * & 12.5 * & 7.5 * & 1.5 \\ PDQ-39-ADL & 29.1 & 29.1 & 20 & 20.8 & - & 9.1 * & 0.8 * & 0.7 \\ PDQ-39-Emotional & 25 & 29.1 & 33.3 & 25 & 4.1 * & 4.2 * & 8.3 * & 0.3 \\ well-being & & & & & & & & & \\ PDQ-39-Stigma & 12.5 & 43.7 & 0 & 31.2 & 31.2 * & - & 31.2 * & 0.8 \\ PDQ-39-Social support & 0 & 8.3 & 0 & 16.6 & 8.3 * & - & 16.6 * & 1.2 \\ PDQ-39-Cognition & 18.7 & 37.5 & 6.2 & 31.25 & 18.8 * & 31.3 * & 25.05 * & 0.4 \\ PDQ-39-Communication & 0 & 8.3 & 8.3 & 8.3 & 8.3 * & - & - & 0.8 \\ PDQ-39-Bodily discomfort & 25 & 41.6 & 33.3 & 25 & 16.6 * & 7.3 * & 8.3 * & 1.3 \\ TUG & 18 & 14 & 16 & 14 & 4 * & 2 & 2 & 3.4 \\ FTSST & 17 & 14 & 21 & 17 & 3 * & 7 * & 4 * & 2.3 \\ HADS & 20 & 22 & 14 & 16 & 2 * & 7 * & 2 * & 1.7 \\ HADS-Anxiety & 14 & 10 & 10 & 11 & 4 * & - & 1 & 1.5 \\ HADS-Depression & 6 & 12 & 4 & 5 & 6 * & 8 * & 1 * & 0.5 \\ \hline \hline \end{tabular} Abbreviations: PDQ-39: The Parkinson’s Disease Questionnaire-39; ADL: activities of daily living; TUG: timed-up-and-go; FTSST: five times sit-to-stand test; HADS: hospital anxiety and depression scale. * * \(p<\) 0.05.  
\end{table} 
Table 3: Differences between the four assessments on functional ability, balance, quality of life, and depression of the participant. This finding appears to be in contrast with some previous research on the effects of exercise interventions in individuals with PSP. Several case studies and small trials, included in a systematic review [38], did report improvements in balance and functional mobility following exercise interventions [10; 18; 39; 40]. The exercise programs' duration and frequency of these four aforementioned studies were from 4 weeks to 3 years and from three to five times per week, respectively. The authors concluded that exercise therapy may help maintain or improve physical function, including balance, in people with PSP. However, the findings of the current case study are not entirely surprising, as the progressive nature of PSP presents significant challenges for rehabilitation. It is possible that the 12-week exercise program at the early stage of the PSP was not intensive or long-lasting enough to overcome the underlying neurological deficits contributing to the participant's balance difficulties. Additionally, the single-case design of the current study limits the generalizability of the findings. Individual responses to exercise can vary greatly, especially in a complex neurodegenerative condition like PSP. Larger-scale studies with more participants would be needed to better understand the role of exercise in managing balance problems in this population. The findings of this case study reported some improvements in functional ability after a 12-week exercise program. This finding is generally consistent with the existing literature on the benefits of exercise for individuals with PSP [14; 40; 41; 42]. [PERSON] et al.