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Exercise for People in Early- or Mid-Stage Parkinson Disease: A 16-Month Randomized Controlled Trial
Open accessAbstract
BACKGROUND: Exercise confers short-term benefits for individuals with Parkinson disease (PD). OBJECTIVE: 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. DESIGN: 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). SETTING: This study was conducted in outpatient clinics. PATIENTS: The participants were 121 individuals with PD (Hoehn & Yahr stages 1-3). INTERVENTIONS: 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 Fitness Counts program, with 1 supervised, clinic-based group session per month. MEASUREMENTS: 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]). RESULTS: 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). LIMITATIONS: Absence of a non-exercise control group was a limitation of the study. CONCLUSIONS: Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy (up to 16 months) in the AE group.
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“Prior research has shown significant improvements in aerobic capacity (Schenkman et al., 2012) and muscle strength (Goodwin et al., 2008; Mehrholz et al., 2010), in persons with PD following exercise training.”
From Perception of Physical Demand, Mental Demand, and Performance: A Comparison of Two Voice Interventions for Parkinson's Disease (2022) · cites this paper as Schenkman et al., 2012
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“Only a few studies have examined the effects of aerobic training alone that incorporate limited or no aspects of skill learning 13, 22, 49.”
From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [13]
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“While preliminary, these studies appear to demonstrate only modest gains in motor skill performance.”
From Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson's disease (2013) · cites this paper as [13]
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Metadata
- Authors
- Schenkman, M., Hall, D. A., Barón, A. E., Schwartz, R. S., Mettler, P., & Kohrt, W. M.
- Affiliations
- University of Colorado Anschutz (US)
- Rush University Medical Center (US)
- Colorado School of Public Health (US)
- Corresponding author
- Schenkman, Margaret
- Venue
- Physical Therapy
- Publisher
- Oxford University Press (OUP)
- Published
- 2012-11-01
- Volume
- 92
- Issue
- 11
- Pages
- 1395-1410
- ISSN
- 0031-9023 (ISSN-L)
- 1538-6724
- PMC
- PMC3488266
- OpenAlex
- W2129106050
- Cited by
- 224
- References
- 72
- Citations by year
- 2026: 8 · 2025: 14 · 2024: 21 · 2023: 15 · 2022: 16 · 2021: 13 · 2020: 14 · 2019: 14 · 2018: 19 · 2017: 16 · 2016: 17 · 2015: 23 · 2014: 17 · 2013: 14 · 2012: 2
- FWCI
- 44.60
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Physical Therapy (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (TL1TR001081)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK048520)
- National Institute of Neurological Disorders and Stroke (K23NS052487, NS052487)
- National Center for Research Resources (TL1RR025778)
- National Center for Advancing Translational Sciences
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD043770)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Keywords
- Parkinson's disease, exercise intervention, aerobic exercise, home-based exercise, supervised exercise, physical function, balance, walking economy, oxygen consumption, motor symptoms, activities of daily living, quality of life, Unified Parkinson's Disease Rating Scale, PDQ-39, functional reach test
- MeSH terms
- Activities of Daily Living, Disability Evaluation, Postural Balance, Exercise Therapy, Female, Humans, Male, Parkinson Disease, Quality of Life, Severity of Illness Index, Walking, Treatment Outcome, Physical Therapy Modalities
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