A minimally supervised exercise program improved balance, mobility, fear of falling, and quality of life in a randomized controlled trial of patients with Parkinson's disease (PD).

The exercise program also led to a reduction in falls in patients with milder PD but not in those with more severe disease.

"These results are unique because they were achieved with an exercise program in which more than 87% of the prescribed exercises were undertaken independently by participants at home," Colleen Canning, PhD, associate professor, physiotherapy, University of Sydney in Australia, told Medscape Medical News.

"The low-cost, minimally-supervised exercise program tested is this study should be recommended as an intervention for improving mobility and reducing fall risk in people with mild PD," she added.

The study was published online December 31 in Neurology.

 

Common, Costly Problem

Falling is a common problem in patients with PD, with 60% falling each year and two thirds of those falling repeatedly. "The resulting injuries, pain, limitations of activity and fear of falling again can really affect people's health and well-being," Dr Canning commented in a statement.

The researchers designed their study to see whether a minimally supervised exercise program targeting poor balance and leg strength and freezing gait could help prevent falls in patients with PD.

Participants included 231 adults (mean age, 71 years) with idiopathic PD who were able to walk independently with or without a walking aid, were receiving stable antiparkinsonian medication for at least 2 weeks, had fallen at least one time in the past year, or were deemed at risk for falls on the basis of physical assessment.

They were randomly allocated to usual care (n = 116) or to 40 to 60 minutes of balance and leg strengthening exercises 3 times a week for 6 months (n = 115). Patients in the exercise group attended a monthly group exercise class led by a physical therapist and did the remaining exercises on their own at home. On average, only 13% of the exercise sessions were supervised by a physical therapist.

Overall, there were no significant between-group differences in the rate of falls (incidence rate ratio [IRR], 0.73; 95% confidence interval [CI], 0.45 - 1.17; P = .18) or proportion of fallers (P = .45), the two primary outcomes.

However, a preplanned subgroup analysis showed a significant interaction for disease severity (P < .001).

In patients with lower disease severity at baseline (United Parkinson's Disease Rating Scale [UPDRS] motor score of 26 or less), there were 69% fewer falls in the exercise group (IRR, 0.31; 95% CI, 0.15 - 0.62; P < .001) compared with the usual care group. In patients with more severe PD (UPDRS motor score of 27 or greater), however, there was a trend toward more falls in the exercise group (IRR, 1.61; 95% CI, 0.86 - 3.03; P = .13).

At 6 months, after adjustment for baseline performance, the exercise group scored significantly better (P < .05) than the control group on measures of balance and mobility, had less fear of falling, and had improved mood and overall quality of life.

"Our study is the largest randomized controlled trial investigating any intervention aimed at reducing falls in people with PD. To date, no pharmacological or surgical intervention has demonstrated a reduction in falls in people with PD," Dr Canning told Medscape Medical News.

Full Article - Exercise Has Benefits in Parkinson's DiseaseHas Benefits in Parkinson's Disease Megan Brooks, January 14, 2015 found on Medscape Medical News > Neurology