Promotion of physical activity and fitness in sedentary patients with Parkinsons disease

Marlies van Nimwegen, Arlne D Speelman, Sebastiaan Overeem, Bart P van de Warrenburg,Katrijn Smulders,Manon L Dontje,George F Borm,Frank J G Backx,Bastiaan R Bloem,Marten Munneke

Harley Jean April 8, 2013

Thesis Marlies van Nimwegen and colleagues conducted research on sedentary patients. They were looking to see the effects of promoted physical activity would have on said patients. There hypothesis was that there would be a resulted increase in fitness in the sedentary patients relative to the start of the program.

Methods The authors used several aspects to first find there study participants and then access them. Ideal participants had Parkinsons disease and live a sedentary lifestyle with less than 60 minutes of intense physical activity or less than 150 minutes of moderate physical activity a week. They were also stage 3 or lower on the Hoehn and Yahr scale, which is a system used to describe the symptoms of Parkinsons. LAPAQ, a physical questionnaire was used as a primary endpoint. It was correlated with a seven day dairy and pedometer, which was used to track activities such as walking, cycling, gardening, or household work. The main endpoint was the level of physical activity during the follow-up periods at 6, 12, 18, and 24 months. Secondary endpoints were six minute walks at 12 and 24 months, combined with dairy of strenuous actively and worn accelerometer. Dairies also included detailed frequency of activities. Participants went through a tailored ParkFit program or physiotherapy intervention which was aimed to achieve a sustained increase in physical activity. The appropriate methods were used and were employed correctly considering this was research pertaining to a group of individuals such as creating a baseline and time table were they are surveyed. Some complications may lie with the dairy which can become subjective and pedometers or accelerometers not monitoring movement properly. Also the focus of the endpoints is on duration activities primarily which does not accurately measure overall

fitness. Only the secondary six minute walk test could show improvements in different areas of fitness.

Evidence of Thesis Overall evidence did not support the thesis of the authors. ParkFit, the multifaceted change program had no effect on the overall volume of physical activity in sedentary patients. 540 of the 586 (92.2%) participants completed the LAPAQ after 24 months. 299 of 586 patients were randomly placed in the ParkFit program and 287 in the control intervention. Among both groups there were similar demographics and disease characteristics. According to primary endpoints (table 2) the thesis is not supported as the Median (IQR) is less at 24 months than the baseline for both ParkFit and controls. Secondary Outcome measures (Table 3) indicates an increase in levels of activity in ParkFit patients. But the quality of life did not differ much between the groups and was -.09 points. Also quality of life did not significantly improve enough to support the thesis in both groups. In ParkFit only .1 mean change while in controls 1.7 mean change. The data strengths included the outlines of the primary and secondary endpoints. Although there is an increase seen in the secondary endpoints among ParkFit the data of overall quality of life supersedes it. Weakness includes that may be the second endpoints should have been used as primary endpoints to obtain more significant conclusions but for this study the focus was overall fitness.

Contribution to Literature A meta-analysis of various studies that evaluated the effects of physical therapy on patients with Parkinsons disease found that there was a benefit in mobility but less of an effect in

neurological aspects. Goede and his associates concluded that further research with set parameters that studied participants within an isolated group would be needed to completely determine the overall effect of physical therapy. A systematic review and meta-analysis done by the Primary Care Research Group and other organizations comes to a similar conclusion that physical therapy is beneficiary to people with PD. Once again weaknesses of the study included the wide range of studies compared which used varying methods of exercise and the follow up length. Dereli and the School of Physical Therapy and Rehabilitation conducted research that compared the effects of a physiotherapist- supervised program to a home program on quality of life. Limitations were that it included on 30 and lasted 10 weeks but did extensive follow up and found that compared to home supervised an exercise program under physiotherapist was more effective on overall quality of life. Another study done by J. L Tillerson and colleagues found that exercise in PD patients is successful at improving motor related symptoms in rodent models of PD. Victoria A. Goodwin and colleagues also conducted a systematic review and metaanalysis of the effect of exercise on overall health in people with PD and they came to support pervious research that overall health was improved. Marlies van Nimwegen and colleagues conducted said research along the lines of what Goede and others were proposing by studying and apply the ParkFit program and control intervention to a baseline of Parkinsons disease participants. This study came to a very different conclusion than various other studies in the field as it did not support that exercise ameliorates the motor symptoms of patients with PD. This could be due to the study only focusing on duration of activity rather than specific aspects like balance, depression, and strength. This research can be used as a model and incorporated with methods to test different aspects of physical fitness to provide a more comprehensive understanding of the effect of exercise in patients with PD.

Recommendation The article provides a different look on exercise and its effects on patients with Parkinsons. Although it did not come to the same conclusion as other studies it focused on sedentary people with PD and could be particularly beneficial to said people who are looking for treatment. The research methods if modified a bit could provide comprehensive results. But as of at the moment the results prove too important in amplifying what parameters should be set during such a study and what primary endpoints to avoid for other researchers looking to base their studies off of this
one.