Exercise for People in Early- or Mid-Stage Parkinson Disease: A 16-Month Randomized Controlled Trial
Identifieur interne : 000103 ( Ncbi/Merge ); précédent : 000102; suivant : 000104Exercise for People in Early- or Mid-Stage Parkinson Disease: A 16-Month Randomized Controlled Trial
Auteurs : Margaret Schenkman [États-Unis] ; Deborah A. Hall ; Anna E. Bar N ; Robert S. Schwartz ; Pamela Mettler ; Wendy M. KohrtSource :
- Physical Therapy [ 0031-9023 ] ; 2012.
Abstract
Exercise confers short-term benefits for individuals with Parkinson disease (PD).
The purpose of the study was to compare short- and long-term responses among 2 supervised exercise programs and a home-based control exercise program.
The 16-month randomized controlled exercise intervention investigated 3 exercise approaches: flexibility/balance/function exercise (FBF), supervised aerobic exercise (AE), and home-based exercise (control).
This study was conducted in outpatient clinics.
The participants were 121 individuals with PD (Hoehn & Yahr stages 1–3).
The FBF program (individualized spinal and extremity flexibility exercises
followed by group balance/functional training) was supervised by a physical
therapist. The AE program (using a treadmill, bike, or elliptical trainer)
was supervised by an exercise trainer. Supervision was provided 3 days per
week for 4 months, and then monthly (16 months total). The control group
participants exercised at home using the National Parkinson Foundation
Outcomes, obtained by blinded assessors, were determined at 4, 10, and 16 months. The primary outcome measures were overall physical function (Continuous Scale—Physical Functional Performance [CS-PFP]), balance (Functional Reach Test [FRT]), and walking economy (oxygen uptake [mL/kg/min]). Secondary outcome measures were symptom severity (Unified Parkinson's Disease Rating Scale [UPDRS] activities of daily living [ADL] and motor subscales) and quality of life (39-item Parkinson's Disease Quality of Life Scale [PDQ-39]).
Of the 121 participants, 86.8%, 82.6%, and 79.3% completed 4, 10, and 16 months, respectively, of the intervention. At 4 months, improvement in CS-PFP scores was greater in the FBF group than in the control group (mean difference=4.3, 95% confidence interval [CI]=1.2 to 7.3) and the AE group (mean difference=3.1, 95% CI=0.0 to 6.2). Balance was not different among groups at any time point. Walking economy improved in the AE group compared with the FBF group at 4 months (mean difference=−1.2, 95% CI=−1.9 to −0.5), 10 months (mean difference=−1.2, 95% CI=−1.9 to −0.5), and 16 months (mean difference=−1.7, 95% CI=−2.5 to −1.0). The only secondary outcome that showed significant differences was UPDRS ADL subscale scores: the FBF group performed better than the control group at 4 months (mean difference=−1.47, 95% CI=−2.79 to −0.15) and 16 months (mean difference=−1.95, 95% CI=−3.84 to −0.08).
Absence of a non-exercise control group was a limitation of the study.
Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy (up to 16 months) in the AE group.
Url:
DOI: 10.2522/ptj.20110472
PubMed: 22822237
PubMed Central: 3488266
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16-Month Randomized Controlled Trial</title><author><name sortKey="Schenkman, Margaret" sort="Schenkman, Margaret" uniqKey="Schenkman M" first="Margaret" last="Schenkman">Margaret Schenkman</name><affiliation wicri:level="2"><nlm:aff id="aff1">M. Schenkman, PT, PhD, FAPTA, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mailstop C-244, 13121 E 17th Ave, ED II South, Room L28–3106, Aurora, CO 80045 (USA).</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Colorado</region></placeName><wicri:cityArea>M. Schenkman, PT, PhD, FAPTA, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mailstop C-244, 13121 E 17th Ave, ED II South, Room L28–3106, Aurora</wicri:cityArea></affiliation></author><author><name sortKey="Hall, Deborah A" sort="Hall, Deborah A" uniqKey="Hall D" first="Deborah A." last="Hall">Deborah A. Hall</name><affiliation><nlm:aff id="aff2">D.A. Hall, MD, PhD, Department of Neurology, Rush Medical Center, Chicago, Illinois.</nlm:aff><wicri:noCountry code="subfield">Illinois.</wicri:noCountry></affiliation></author><author><name sortKey="Bar N, Anna E" sort="Bar N, Anna E" uniqKey="Bar N A" first="Anna E." last="Bar N">Anna E. Bar N</name><affiliation><nlm:aff id="aff3">A.E. Barón, PhD, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus.</nlm:aff><wicri:noCountry code="subfield">University of Colorado Anschutz Medical Campus.</wicri:noCountry></affiliation></author><author><name sortKey="Schwartz, Robert S" sort="Schwartz, Robert S" uniqKey="Schwartz R" first="Robert S." last="Schwartz">Robert S. Schwartz</name><affiliation><nlm:aff id="aff4">R.S. Schwartz, MD, Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus.</nlm:aff><wicri:noCountry code="subfield">University of Colorado Anschutz Medical Campus.</wicri:noCountry></affiliation></author><author><name sortKey="Mettler, Pamela" sort="Mettler, Pamela" uniqKey="Mettler P" first="Pamela" last="Mettler">Pamela Mettler</name><affiliation><nlm:aff id="aff5">P. Mettler, BS, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus.</nlm:aff><wicri:noCountry code="subfield">University of Colorado Anschutz Medical Campus.</wicri:noCountry></affiliation></author><author><name sortKey="Kohrt, Wendy M" sort="Kohrt, Wendy M" uniqKey="Kohrt W" first="Wendy M." last="Kohrt">Wendy M. Kohrt</name><affiliation><nlm:aff id="aff6">W.M. Kohrt, PhD, Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus.</nlm:aff><wicri:noCountry code="subfield">University of Colorado Anschutz Medical Campus.</wicri:noCountry></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22822237</idno><idno type="pmc">3488266</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3488266</idno><idno type="RBID">PMC:3488266</idno><idno type="doi">10.2522/ptj.20110472</idno><date when="2012">2012</date><idno type="wicri:Area/Pmc/Corpus">000237</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000237</idno><idno type="wicri:Area/Pmc/Curation">000125</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000125</idno><idno type="wicri:Area/Pmc/Checkpoint">000111</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000111</idno><idno type="wicri:Area/Ncbi/Merge">000103</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Exercise for People in Early- or Mid-Stage Parkinson Disease: A
16-Month Randomized Controlled Trial</title><author><name sortKey="Schenkman, Margaret" sort="Schenkman, Margaret" uniqKey="Schenkman M" first="Margaret" last="Schenkman">Margaret Schenkman</name><affiliation wicri:level="2"><nlm:aff id="aff1">M. Schenkman, PT, PhD, FAPTA, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mailstop C-244, 13121 E 17th Ave, ED II South, Room L28–3106, Aurora, CO 80045 (USA).</nlm:aff><country xml:lang="fr">États-Unis</country><placeName><region type="state">Colorado</region></placeName><wicri:cityArea>M. Schenkman, PT, PhD, FAPTA, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mailstop C-244, 13121 E 17th Ave, ED II South, Room L28–3106, Aurora</wicri:cityArea></affiliation></author><author><name sortKey="Hall, Deborah A" sort="Hall, Deborah A" uniqKey="Hall D" first="Deborah A." last="Hall">Deborah A. Hall</name><affiliation><nlm:aff id="aff2">D.A. Hall, MD, PhD, Department of Neurology, Rush Medical Center, Chicago, Illinois.</nlm:aff><wicri:noCountry code="subfield">Illinois.</wicri:noCountry></affiliation></author><author><name sortKey="Bar N, Anna E" sort="Bar N, Anna E" uniqKey="Bar N A" first="Anna E." last="Bar N">Anna E. Bar N</name><affiliation><nlm:aff id="aff3">A.E. Barón, PhD, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus.</nlm:aff><wicri:noCountry code="subfield">University of Colorado Anschutz Medical Campus.</wicri:noCountry></affiliation></author><author><name sortKey="Schwartz, Robert S" sort="Schwartz, Robert S" uniqKey="Schwartz R" first="Robert S." last="Schwartz">Robert S. Schwartz</name><affiliation><nlm:aff id="aff4">R.S. Schwartz, MD, Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus.</nlm:aff><wicri:noCountry code="subfield">University of Colorado Anschutz Medical Campus.</wicri:noCountry></affiliation></author><author><name sortKey="Mettler, Pamela" sort="Mettler, Pamela" uniqKey="Mettler P" first="Pamela" last="Mettler">Pamela Mettler</name><affiliation><nlm:aff id="aff5">P. Mettler, BS, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus.</nlm:aff><wicri:noCountry code="subfield">University of Colorado Anschutz Medical Campus.</wicri:noCountry></affiliation></author><author><name sortKey="Kohrt, Wendy M" sort="Kohrt, Wendy M" uniqKey="Kohrt W" first="Wendy M." last="Kohrt">Wendy M. Kohrt</name><affiliation><nlm:aff id="aff6">W.M. Kohrt, PhD, Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus.</nlm:aff><wicri:noCountry code="subfield">University of Colorado Anschutz Medical Campus.</wicri:noCountry></affiliation></author></analytic><series><title level="j">Physical Therapy</title><idno type="ISSN">0031-9023</idno><idno type="eISSN">1538-6724</idno><imprint><date when="2012">2012</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title><bold>Background</bold></title><p>Exercise confers short-term benefits for individuals with Parkinson disease
(PD).</p></sec><sec><title><bold>Objective</bold></title><p>The purpose of the study was to compare short- and long-term responses among
2 supervised exercise programs and a home-based control exercise
program.</p></sec><sec><title><bold>Design</bold></title><p>The 16-month randomized controlled exercise intervention investigated 3
exercise approaches: flexibility/balance/function exercise (FBF), supervised
aerobic exercise (AE), and home-based exercise (control).</p></sec><sec><title><bold>Setting</bold></title><p>This study was conducted in outpatient clinics.</p></sec><sec><title><bold>Patients</bold></title><p>The participants were 121 individuals with PD (Hoehn & Yahr stages
1–3).</p></sec><sec><title><bold>Interventions</bold></title><p>The FBF program (individualized spinal and extremity flexibility exercises
followed by group balance/functional training) was supervised by a physical
therapist. The AE program (using a treadmill, bike, or elliptical trainer)
was supervised by an exercise trainer. Supervision was provided 3 days per
week for 4 months, and then monthly (16 months total). The control group
participants exercised at home using the National Parkinson Foundation
<italic>Fitness Counts</italic> program, with 1 supervised, clinic-based
group session per month.</p></sec><sec><title><bold>Measurements</bold></title><p>Outcomes, obtained by blinded assessors, were determined at 4, 10, and 16
months. The primary outcome measures were overall physical function
(Continuous Scale—Physical Functional Performance
[CS-PFP]), balance (Functional Reach Test
[FRT]), and walking economy (oxygen uptake
[mL/kg/min]). Secondary outcome measures were symptom severity
(Unified Parkinson's Disease Rating Scale [UPDRS]
activities of daily living [ADL] and motor subscales) and
quality of life (39-item Parkinson's Disease Quality of Life Scale
[PDQ-39]).</p></sec><sec><title><bold>Results</bold></title><p>Of the 121 participants, 86.8%, 82.6%, and 79.3%
completed 4, 10, and 16 months, respectively, of the intervention. At 4
months, improvement in CS-PFP scores was greater in the FBF group than in
the control group (mean difference=4.3, 95% confidence
interval [CI]=1.2 to 7.3) and the AE group (mean
difference=3.1, 95% CI=0.0 to 6.2). Balance was not
different among groups at any time point. Walking economy improved in the AE
group compared with the FBF group at 4 months (mean
difference=−1.2, 95% CI=−1.9 to
−0.5), 10 months (mean difference=−1.2, 95%
CI=−1.9 to −0.5), and 16 months (mean
difference=−1.7, 95% CI=−2.5 to
−1.0). The only secondary outcome that showed significant differences
was UPDRS ADL subscale scores: the FBF group performed better than the
control group at 4 months (mean difference=−1.47, 95%
CI=−2.79 to −0.15) and 16 months (mean
difference=−1.95, 95% CI=−3.84 to
−0.08).</p></sec><sec><title><bold>Limitations</bold></title><p>Absence of a non-exercise control group was a limitation of the study.</p></sec><sec><title><bold>Conclusions</bold></title><p>Findings demonstrated overall functional benefits at 4 months in the FBF
group and improved walking economy (up to 16 months) in the AE group.</p></sec></div></front></TEI><pmc article-type="research-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Phys Ther</journal-id><journal-id journal-id-type="iso-abbrev">Phys Ther</journal-id><journal-id journal-id-type="hwp">ptjournal</journal-id><journal-id journal-id-type="pmc">ptjournal</journal-id><journal-id journal-id-type="publisher-id">PTJOURNAL</journal-id><journal-title-group><journal-title>Physical Therapy</journal-title></journal-title-group><issn pub-type="ppub">0031-9023</issn><issn pub-type="epub">1538-6724</issn><publisher><publisher-name>American Physical Therapy Association</publisher-name><publisher-loc>Alexandria, VA</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22822237</article-id><article-id pub-id-type="pmc">3488266</article-id><article-id pub-id-type="publisher-id">2011-0472</article-id><article-id pub-id-type="doi">10.2522/ptj.20110472</article-id><article-categories><subj-group subj-group-type="hwp-journal-coll"><subject>1312</subject><subject>1508</subject><subject>2900</subject></subj-group><subj-group subj-group-type="heading"><subject>Research Reports</subject></subj-group></article-categories><title-group><article-title>Exercise for People in Early- or Mid-Stage Parkinson Disease: A
16-Month Randomized Controlled Trial</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Schenkman</surname><given-names>Margaret</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Hall</surname><given-names>Deborah A.</given-names></name><xref ref-type="aff" rid="aff2"></xref></contrib><contrib contrib-type="author"><name><surname>Barón</surname><given-names>Anna E.</given-names></name><xref ref-type="aff" rid="aff3"></xref></contrib><contrib contrib-type="author"><name><surname>Schwartz</surname><given-names>Robert S.</given-names></name><xref ref-type="aff" rid="aff4"></xref></contrib><contrib contrib-type="author"><name><surname>Mettler</surname><given-names>Pamela</given-names></name><xref ref-type="aff" rid="aff5"></xref></contrib><contrib contrib-type="author"><name><surname>Kohrt</surname><given-names>Wendy M.</given-names></name><xref ref-type="aff" rid="aff6"></xref></contrib><aff id="aff1">M. Schenkman, PT, PhD, FAPTA, Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mailstop C-244, 13121 E 17th Ave, ED II South, Room L28–3106, Aurora, CO 80045 (USA).</aff><aff id="aff2">D.A. Hall, MD, PhD, Department of Neurology, Rush Medical Center, Chicago, Illinois.</aff><aff id="aff3">A.E. Barón, PhD, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus.</aff><aff id="aff4">R.S. Schwartz, MD, Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus.</aff><aff id="aff5">P. Mettler, BS, Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus.</aff><aff id="aff6">W.M. Kohrt, PhD, Division of Geriatric Medicine, School of Medicine, University of Colorado Anschutz Medical Campus.</aff></contrib-group><author-notes><corresp>Address all correspondence to Dr Schenkman at:
<email>margaret.schenkman@ucdenver.edu</email>.</corresp></author-notes><pub-date pub-type="ppub"><month>11</month><year>2012</year></pub-date><pub-date pub-type="epub"><day>19</day><month>7</month><year>2012</year></pub-date><pub-date pub-type="pmc-release"><day>1</day><month>5</month><year>2013</year></pub-date><pmc-comment> PMC Release delay is 6 months and 0 days and was based on the
<volume>92</volume><issue>11</issue><fpage>1395</fpage><lpage>1410</lpage><history><date date-type="received"><day>17</day><month>12</month><year>2011</year></date><date date-type="accepted"><day>10</day><month>7</month><year>2012</year></date></history><permissions><copyright-statement>© 2012 American Physical Therapy
Association</copyright-statement><copyright-year>2012</copyright-year></permissions><self-uri xlink:title="pdf" xlink:type="simple" xlink:href="zad01112001395.pdf"></self-uri><abstract><sec><title><bold>Background</bold></title><p>Exercise confers short-term benefits for individuals with Parkinson disease
(PD).</p></sec><sec><title><bold>Objective</bold></title><p>The purpose of the study was to compare short- and long-term responses among
2 supervised exercise programs and a home-based control exercise
program.</p></sec><sec><title><bold>Design</bold></title><p>The 16-month randomized controlled exercise intervention investigated 3
exercise approaches: flexibility/balance/function exercise (FBF), supervised
aerobic exercise (AE), and home-based exercise (control).</p></sec><sec><title><bold>Setting</bold></title><p>This study was conducted in outpatient clinics.</p></sec><sec><title><bold>Patients</bold></title><p>The participants were 121 individuals with PD (Hoehn & Yahr stages
1–3).</p></sec><sec><title><bold>Interventions</bold></title><p>The FBF program (individualized spinal and extremity flexibility exercises
followed by group balance/functional training) was supervised by a physical
therapist. The AE program (using a treadmill, bike, or elliptical trainer)
was supervised by an exercise trainer. Supervision was provided 3 days per
week for 4 months, and then monthly (16 months total). The control group
participants exercised at home using the National Parkinson Foundation
<italic>Fitness Counts</italic> program, with 1 supervised, clinic-based
group session per month.</p></sec><sec><title><bold>Measurements</bold></title><p>Outcomes, obtained by blinded assessors, were determined at 4, 10, and 16
months. The primary outcome measures were overall physical function
(Continuous Scale—Physical Functional Performance
[CS-PFP]), balance (Functional Reach Test
[FRT]), and walking economy (oxygen uptake
[mL/kg/min]). Secondary outcome measures were symptom severity
(Unified Parkinson's Disease Rating Scale [UPDRS]
activities of daily living [ADL] and motor subscales) and
quality of life (39-item Parkinson's Disease Quality of Life Scale
[PDQ-39]).</p></sec><sec><title><bold>Results</bold></title><p>Of the 121 participants, 86.8%, 82.6%, and 79.3%
completed 4, 10, and 16 months, respectively, of the intervention. At 4
months, improvement in CS-PFP scores was greater in the FBF group than in
the control group (mean difference=4.3, 95% confidence
interval [CI]=1.2 to 7.3) and the AE group (mean
difference=3.1, 95% CI=0.0 to 6.2). Balance was not
different among groups at any time point. Walking economy improved in the AE
group compared with the FBF group at 4 months (mean
difference=−1.2, 95% CI=−1.9 to
−0.5), 10 months (mean difference=−1.2, 95%
CI=−1.9 to −0.5), and 16 months (mean
difference=−1.7, 95% CI=−2.5 to
−1.0). The only secondary outcome that showed significant differences
was UPDRS ADL subscale scores: the FBF group performed better than the
control group at 4 months (mean difference=−1.47, 95%
CI=−2.79 to −0.15) and 16 months (mean
difference=−1.95, 95% CI=−3.84 to
−0.08).</p></sec><sec><title><bold>Limitations</bold></title><p>Absence of a non-exercise control group was a limitation of the study.</p></sec><sec><title><bold>Conclusions</bold></title><p>Findings demonstrated overall functional benefits at 4 months in the FBF
group and improved walking economy (up to 16 months) in the AE group.</p></sec></abstract></article-meta></front></pmc><affiliations><list><country><li>États-Unis</li></country><region><li>Colorado</li></region></list><tree><noCountry><name sortKey="Bar N, Anna E" sort="Bar N, Anna E" uniqKey="Bar N A" first="Anna E." last="Bar N">Anna E. Bar N</name><name sortKey="Hall, Deborah A" sort="Hall, Deborah A" uniqKey="Hall D" first="Deborah A." last="Hall">Deborah A. Hall</name><name sortKey="Kohrt, Wendy M" sort="Kohrt, Wendy M" uniqKey="Kohrt W" first="Wendy M." last="Kohrt">Wendy M. Kohrt</name><name sortKey="Mettler, Pamela" sort="Mettler, Pamela" uniqKey="Mettler P" first="Pamela" last="Mettler">Pamela Mettler</name><name sortKey="Schwartz, Robert S" sort="Schwartz, Robert S" uniqKey="Schwartz R" first="Robert S." last="Schwartz">Robert S. Schwartz</name></noCountry><country name="États-Unis"><region name="Colorado"><name sortKey="Schenkman, Margaret" sort="Schenkman, Margaret" uniqKey="Schenkman M" first="Margaret" last="Schenkman">Margaret Schenkman</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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