Exercise Has Benefits in Parkinson's Disease

Megan Brooks

January 14, 2015

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.

The significant 69% reduction in fall rate for the lower disease severity subgroup achieved in the trial is on par with the 67% reduction in fall rate in a 6-month, fully supervised trial of tai chi, the authors note.

But timing is important. "Currently, fall prevention interventions are only considered in Parkinson's treatment once a sufferer has fallen. Our study shows that exercise should be recommended early in the disease process; we should not be waiting until the person has already fallen," Dr Canning said.

Fall Prevention Program

Heather Cianci, PT, MS, GCS, from The Dan Aaron Parkinson's Rehabilitation Center, Penn Therapy & Fitness in Philadelphia, Pennsylvania, who was not involved in the study, agrees.

The finding that exercise can help reduce fall risk in less severe PD "supports what we have been preaching — that sooner is better. If we can get these patients on an anti-fall program doing the correct kind of exercises as soon as they are diagnosed, than we probably can affect their lives," she told Medscape Medical News.

Dr Canning urged caution in prescribing minimally supervised exercise for people with more severe PD. "These individuals may benefit from more extensive fall risk factor assessment and management, including medication review, more closed supervised exercise, and specific training in strategies to minimize fall risk. However, this multifactorial approach has not been tested to date and so a large randomized controlled trial is required to test this approach," she said.

The study was supported by the Australian National Health and Medical Research Council and the Harry Secomb Foundation. A complete list of author disclosures is provided with the original article.

Neurology. 2015;84:304-312. Published online December 31, 2014. Abstract

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