A Swing and a Hit? Golf Beneficial in Parkinson's Disease

Erik Greb

March 05, 2021

Playing golf improves mobility and balance in Parkinson's disease (PD) better than tai chi, the gold standard exercise for improved balance and falls prevention in this patient population, early research suggests.

"We are optimistic that golf could be a good form of exercise therapy for Parkinson's because participants in our study enjoyed learning golf and reported that they were more likely to continue the sport than the people in the tai chi arm," Anne-Marie Wills, MD, MPH, a neurologist at Massachusetts General Hospital in Boston, told Medscape Medical News. "We know that exercise is underutilized by people with Parkinson's disease, so finding an exercise that people will adhere to is one of our main goals as clinicians."

The findings will be presented at the American Academy of Neurology (AAN) 2021 Annual Meeting in April.

A Popular Sport

Golf is the most popular sport for people over age 55, Wills said, and previous research indicates it improves balance and quality of life in patients with stroke. Golf and tai chi focus mainly on anticipatory balance and spine rotation, both of which are affected in PD. However, unlike tai chi, golf incorporates manipulation tasks and requires slow and fast movements.

"I first noticed that my patients who played golf seemed to be doing better than average in terms of their disease progression, and so hypothesized that this might be a good exercise for people with Parkinson's disease," said Wills. "Because swinging a golf club demands a high level of balance, we hypothesized that this might be particularly helpful for preserving balance."

The investigators also hypothesized that golf would be better tolerated and have greater patient adherence than other forms of exercise.

To test this hypothesis, the investigators conducted a single-center, randomized trial using tai chi as an active comparator. Tai chi has been shown to benefit balance and quality of life in patients who have suffered a stroke and is considered the gold standard exercise to improve mobility and preventing falls in PD.

The study included 20 patients with moderate PD, defined as stage 2 to 3 on the Hoehn and Yahr scale for PD progression. Participants were offered 10 weeks of two 1-hour group classes per week of golf or tai chi at no cost.

The study's primary outcomes were the feasibility and tolerability of the interventions. Among the secondary outcomes were the Mini-BESTest of Balance and the Activities-Specific Balance Confidence Scale. The Mini-BESTest of Balance incorporates the Timed Up and Go (TUG), which measures functional mobility and the TUG-Cognitive. Clinicians who rated participants' performance were blinded to the treatment assignments.

Attendance did not differ significantly between groups. Approximately 62% of patients in the golf group completed 80% of classes or more vs 42% of patients in the tai chi group. However, the difference between groups in the rate of completion was not statistically significant.

Physical and Mental Health Benefits?

On one measure, the interventions' effects on mobility were significantly different. Performance on the TUG improved by 0.96 seconds in patients who golfed but worsened by 0.33 seconds in patients who participated in tai chi (P = .023).

Participant satisfaction with the assigned activity was similar between groups. Yet 86% of golfers reported that they were "definitely" likely to continue the activity, compared with 33% of tai chi participants.

There was no difference between groups in terms of adverse events, with the exception of muscle pain in the golf group. There was no difference in falls between groups.

"Getting patients outdoors and exercising should be good for mental health as well, although we did not measure that in our study," said Wills. "Golf is also a great sport for right now, during the pandemic, because it is an outdoor sport and can be played safely with proper precautions."

The investigators intend to conduct a larger randomized study of golf in patients with Parkinson's disease to confirm their findings.

"A multicenter clinical trial to see if golf actually slows down disease progression would be ideal," said Wills. "At a minimum, we are hoping to convince other golf centers to provide free instruction to people with Parkinson's."

Cost a Potential Barrier

Commenting on the findings for Medscape Medical News, Danielle Larson, MD, a movement disorders specialist at Northwestern University Feinberg School of Medicine in Chicago, Illinois, said golf is relevant as an exercise that could improve symptoms because it's already a hobby for many people in the age range of patients with Parkinson's. Unlike tai chi, golf entails walking, which provides additional benefit, she said.

"This study, though small, suggests that individuals are likely to continue with golf," said Larson. "It is important to have a variety of exercise options to offer to patients as well, as their interest in the exercise will ensure their commitment to it, so adding golf to this list would be beneficial."

Future research should assess whether access to golf is a barrier to sustaining this activity for patients with Parkinson's disease.

"In this study, golf was offered free of cost. However, golf typically could be a costly activity vs tai chi, which can be done at home," said Larson. "In addition to potential socioeconomic barriers, there may be logistical barriers, such as location relative to the golf course, or cultural barriers to golf participation that should be explored in future research."

The study was funded by Jim and Lucy Fox. Wills and Larson have disclosed no relevant financial relationships.

American Academy of Neurology (AAN) 2021 Annual Meeting: Abstract 1962. To be presented April 2021.

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