November 27, 2019
Patients with Parkinson disease (PD) with mild disease severity can attenuate off-state motor signs by performing at-home aerobic exercise, according to results of the Park-in-Shape trial.
To conduct the double-blind trial, the researchers recruited 139 sedentary patients with PD from an outpatient clinic in the Netherlands between February 2, 2015, and October 27, 2017. These participants were aged 30 to 75 years, had a Hoehn and Yahr stage of 2 or lower, and were on stable dopaminergic medication.
In all, 130 participants were randomly assigned 1:1 to either aerobic exercise on a stationary home-trainer (aerobic intervention group) or stretching (active control group). The 2 home-based interventions required 30 to 45 minutes of training 3 times a week for 6 months.
Participants in both groups used a motivational app and were remotely supervised. To promote adherence, the training was also gamified, meaning home trainers were enhanced with virtual reality software and real-life videos.
At 6 months, the researchers compared the motor section of the Movement Disorder Society—Unified Parkinson's Disease Rating Scale (MDS-UPDRS) between the 2 groups during the off state (12 hours or more after the last dopaminergic medication). Four of the participants in the intervention group and 1 in the control group were not included in the analysis.
The researchers determined that a between-group difference of 3.5 points or more in the off-state MDS-UPDRS motor score would be considered a priori clinically relevant.
Among the 125 participants who were included in the primary analysis, there was a between-group difference of 4.2 points in favor of aerobic exercise (mean 1.3 points in the intervention group vs mean 5.6 points in the control group).
In all, 7 participants in the intervention group and 4 in the control group had potentially related adverse events.
“Aerobic exercise can be done at home by patients with Parkinson's disease with mild disease severity, and it attenuates off-state motor signs,” the researchers concluded. “Future studies should establish long-term effectiveness and possible disease-modifying effects.”
van der Kolk NM, de Vries NM, Kessels RPC, et al. Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson's disease: a double-blind, randomised controlled trial. Lancet Neurol. 2019;18(11):998-1008. doi: https://doi.org/10.1016/S1474-4422(19)30285-6