Objective: To present a guide that characterizes the safest and most challenging motor and cognitive exercises performed in our multilevel Parkinson-specific community exercise classes using exercise program considerations from authors’ recently published physical therapy decision-making tool (DMT).

Background: Physical therapy and community exercise programs are effective treatment options for persons with Parkinson disease (PD). Little is known about how to optimize safety and challenge in community exercise programs for participants with varying ages, fitness levels, comorbidities, and disease severities. Authors’ recent publication described a DMT for stratifying persons with PD (PwP) into multilevel classes. Results indicated therapists were able to assign PwP to homogeneous groups using clinical judgment and functional outcome measures. While the DMT may be useful for establishing functional goals within the physical therapy plan of care, specific descriptions of the most challenging class exercises may be useful to the instructor for identifying and communicating decline in class participation; or to the therapist for establishing a goal for therapy intervention or the need for updating class recommendations.

Method: Authors created a Challenge Point Guide (CPG) for each class based upon class observation and on-site physical therapist and class instructor feedback. In this clinic, physical therapists recommend a class level based upon evaluation. Classes are an hour-long, offered 3x/week, ongoing and include progressive aerobic training and functional skill training. Instructors vary levels of cognitive and motor challenge by class depending on abilities of participants within the group.

Results: The CPG describes the most challenging exercises performed in multiple positions (e.g. standing, overground, floor, seated) along with instruction mode and environmental complexity respective to each level of class and relative to the authors’ published clinical outcomes.

Conclusion: Characterizing safe and challenging class exercises within multilevel classes can enhance communication between physical therapists and instructors for appropriate class recommendations to prevent decline in function, proactively address changes in status, avoid adverse events (e.g. falls, injuries), and decrease likelihood of participant dropout.

References: Domingos J, Dean J, Godinho C, Melo F. Proliferation of community exercise programs with limited evidence and expertise: Safety implications. Mov Disord. 2018;33(8):1365-1366. doi:10.1002/mds.27373 Domingos J, Radder D, Riggare S, et al. Implementation of a Community-Based Exercise Program for Parkinson Patients: Using Boxing as an Example. J Park Dis. 2019;9:615-623. doi:10.3233/JPD-191616 Morris ME, Ellis TD, Jazayeri D, et al. Boxing for Parkinson’s Disease: Has Implementation Accelerated Beyond Current Evidence? Front Neurol | www.frontiersin.org. 2019;10(1222). doi:10.3389/fneur.2019.01222 Borchers EE, McIsaac TL, Bazan-Wigle JK, Elkins A, Bay C, and Farley BG. A physical therapy decision-making tool for stratifying persons with Parkinson disease into community exercise classes. Neurodegener Dis Manag (Epub ahead of print), doi: 10.2217/nmt-2019-0019.

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