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Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson’s disease

Original article: Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson’s disease: a double-blind, randomised controlled trial. The Lancet: September 11, 2019

The takeaway

Aerobic exercise in the form of cycling on a home trainer for 30-45 mins, three times a week for 6 months, appears to reduce the progression of Parkinson’s.

Why is it important?

This study offers high quality evidence from a well-controlled study that aerobic exercise at home with remote supervision can deliver important benefits that meet the criteria for a positive clinical trial.

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IMPACT

  • Novelty 90% 90%
  • Proximity 70% 70%
  • Deliverability 80% 80%

Impact Opinion

This is a very pleasing study. Not only does it provide the Parkinson’s community with a positive clinical trial result, but also with actionable information that can be implemented at home. All to often the focus is on disease modifying drugs for Parkinson’s. It is refreshing to see a simple exercise regime demonstrating beneficial effects in Parkinson’s. It will be interesting to see whether longer term exercise can maintain these positive trends, and to further investigate the biological mechanisms involved in this effect.

Background

Research into the beneficial effects of exercise in Parkinson’s has been undertaken in a variety of different studies spanning the last 30 years. To date, efforts to distill all this work into a meaningful result have been hampered by the vast differences between studies in what kind of exercise was undertaken and for how long, what constitutes an effective regime and so on. Yet the importance of exercise is stressed by clinicians and researchers, based on our understanding of the condition and what aggrevates it. The gold standard source of evidence is generally the double blinded, randomized clinical trial, but in the case of exercise, this can often prove challenging to organize and participate in, especially in the longer term.

The details

The Park-In-Shape trial was carried out by a Dutch research team lead by Prof Bas Bloem. The aim was to establish in a reliable and controlled manner whether aerobic exercise at home can improve symptoms in 130 people with Parkinson’s who had relatively mild symptoms and receiving usual medications. Ensuring that the groups had the same number of men and women, as well as medicated or as yet not medicated people, participants were assigned to either 1) aerobic exercise on a stationary home trainer with virtual reality software and videos that enhanced the experience by including gamified elements (aerobic intervention group), or 2) stretching (active control group). The exercise regimes consisted in 30–45 min training three times a week, over 6 months. Importantly, both groups of participants were given a motivational app as well as remote supervision. The instruction to the aerobic group was to get their heart rate up to a particular level, which increased as they became fitter. Neurological assessments using the Unified Parkinson’s Disease Rating Scale (UPDRS) were undertaken at the start and end of the study, by raters who were not aware what kind of exercise was undertaken by whom, and neither were participants aware that another exercise group was running in parallel.

Next steps

It will be important to assess the long-term feasibility of regular aerobic exercise, ie, beyond 6 months, as well as whether these benefits are sustained over time. It will also be important to understand exactly how these benefits come about at the chemical and neural level.

Original article: van der Kolk, N, de Vries, NM, Kessels, RPC, Joosten, H, Zwinderman, AH, Post, B, Bloem, BR. September 11, 2019. Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson’s disease: a double-blind, randomised controlled trial. 

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