Objective: To describe how clinicians communicate about exercise with PD patients before and after DBS surgery.

Background: Physical activity has been shown to improve both motor and non-motor symptoms in Parkinson’s disease (PD). Evidence also suggests that exercise can have neuroprotective effects in Parkinson’s Disease. While deep brain stimulation (DBS) surgery can improve motor symptoms, it does not halt disease progression. There are many exercise programs specific to persons living with PD, however many patients lack access to these programs. Additionally, there are no standardized exercise interventions or treatment plans for providers to share with their patients. We propose that many clinical providers do not regularly discuss exercise with their patients both before and after DBS surgery.

Method: A retrospective chart review was performed from adult patients with PD who underwent DBS surgery at the NIH between 2013-2018 and completed 3 to 24 months of post-op programming and follow-up visits. Progress notes were searched for the words “exercise” or “physical activity” in sections including patient history, assessment, and treatment plan. The progress notes were also reviewed for the presence of recommendations regarding a specific exercise plan.

Results: 47 PD DBS patients were identified. Participants were mostly male (77%) with mean age 62 years (SD=8.7), range 40 – 79. All patients had significant improvement in UPDRS part III scores following DBS surgery (t=3.67, p<.001). Before DBS, most providers (60%) documented patient exercise practices, but more than half of providers (55%) did not document exercise in their treatment plans. Of those providers that did document exercise in their treament plan, many (30%) did not provide specific recommendations for what exercise to do. Following DBS surgery, most providers (62%) documented patient exercise practices and (55%) included exercise in their treatment plan. The majority of providers (79%) did not provide specific recommendations for what exercises to do following DBS surgery.

Conclusion: Our review showed that despite well-documented evidence on the importance of exercise for the treatment of PD, many providers do not include discussion about exercise as part of their patient evaluation and treatment plan. Future research should focus on development of standardized teaching plans and tools for use in every patient encounter.

References: [1] Rafferty MR, Prodoehl J, Robichaud JA, et al. Effects of 2 Years of Exercise on Gait Impairment in People With Parkinson Disease: The PRET-PD Randomized Trial. J Neurol Phys Ther. 2017;41(1):21-30. [2] J. Eric Ahlskog. Does vigorous exercise have a neuroprotective effect in Parkinson disease? Neurology Jul 2011, 77 (3) 288-294; DOI: 10.1212/WNL.0b013e318225ab66

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MDS Abstracts - https://www.mdsabstracts.org/abstract/provider-communication-about-exercise-in-parkinsons-disease-before-and-after-dbs-surgery-a-retrospective-chart-review/