Objective: To evaluate: (1) the adherence to long-term home-based aerobic exercise (AE) in patients with Parkinson’s disease (PD); and (2) whether AE affords clinically relevant improvements in sedentary PD patients.

Background: Exercise is increasingly recognized as an important non-pharmacological treatment in PD, with beneficial symptomatic effects on motor function. High-intensity interventions (i.e. endurance or resistance training) appear to provide the greatest benefit. To test the feasibility and efficacy of AE therapies in real life, we need pragmatic home-based or community-based studies. Current technologic advances can support such studies in various ways: by aiding in increasing motivation; by providing remote supervision; and by offering reliable adherence data

Methods: We tested AE performed at home in two studies: (1) a feasibility trial (n=37; control: no intervention) [1]; and (2) a randomized double-blind controlled trial (n=130; active control: stretching) [2]. In both trials, AE is performed on a stationary bicycle at least 3x/week, 30-45min/session for 6 months with a target heart rate of 50-80% of their heart rate reserve (HRR). The bicycle was equipped with gaming elements to promote compliance, and data were stored online allowing remote supervision. Coaching with regular telephone contact was provided. In the large trial, an additional motivational app was provided to patients in both groups. Assessments were performed at baseline and after 6 months. The primary feasibility outcome was adherence and the UPDRS III (off) after 6 months served as primary clinical outcome. Other outcomes included scores on balance, dexterity, quality of life, mood, sleep, cognition and physical fitness.

Results: 1) Feasibility: participants exercised for a median of 27.4 weeks, 2.8x/wk and for 40 min/session. Median time within the prescribed heart rate zone per session was 23 min (IQ1;3: 15;29) and on average patients exercised at 59% of their HRR (76% of their HRmax). No SAE occurred. 2) clinical outcomes: Physical fitness improved significantly in the intervention group (+17.6%). UDPRS III showed a median difference of 3.1 point in favour of AE in the feasibility trial. Results from the large trial will follow this summer.

Conclusions: patients with PD can safely perform and reliably comply with a moderately intensive AE at home for 6 months with limited remote supervision.

References: 1. van der Kolk, N.M., et al., A remotely supervised home-based aerobic exercise programme is feasible for patients with Parkinson’s disease: results of a small randomised feasibility trial. J Neurol Neurosurg Psychiatry, 2017. 2. van der Kolk, N.M., et al., Design of the Park-in-Shape study: a phase II double blind randomized controlled trial evaluating the effects of exercise on motor and non-motor symptoms in Parkinson’s disease. BMC Neurol, 2015. 15: p. 56.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/remotely-supervised-home-based-aerobic-exercise-for-parkinson-patients/