Clinician Article
Home-based prescribed exercise improves balance-related activities in people with Parkinson's disease and has benefits similar to centre-based exercise: a systematic review.
PMID: 31521554
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GeriatricsRelevance - 6/7
Newsworthiness - 5/7 -
Physical Medicine and RehabilitationRelevance - 6/7
Newsworthiness - 4/7 -
Family Medicine (FM)/General Practice (GP)Relevance - 5/7
Newsworthiness - 5/7 -
General Internal Medicine-Primary Care(US)Relevance - 5/7
Newsworthiness - 5/7 -
Internal MedicineRelevance - 5/7
Newsworthiness - 5/7 -
NeurologyRelevance - 5/7
Newsworthiness - 4/7
Abstract
QUESTIONS: In people with Parkinson's disease, does home-based prescribed exercise improve balance-related activities and quality of life compared with no intervention? Are the effects of home-based exercise similar to those of equivalent centre-based exercise?
DESIGN: Systematic review and meta-analysis of randomised and quasi-randomised controlled trials.
PARTICIPANTS: Adults diagnosed with idiopathic Parkinson's disease.
INTERVENTION: Predominantly home-based prescribed exercise (defined as a minimum of two-thirds of the exercise being completed at home). The intervention had to primarily involve physical practice of exercises targeting gait and/or standing balance compared with either control (ie, usual care only, a sham intervention or no physiotherapy) or equivalent predominantly centre-based exercise.
OUTCOME MEASURES: The primary outcome was balance-related activities and the secondary outcomes were gait speed, Berg Balance Scale, Functional Reach test, and quality of life.
RESULTS: Sixteen trials met the inclusion criteria and all contributed to the meta-analyses. Twelve trials compared home-based prescribed exercise with control, and four trials compared home-based prescribed exercise with equivalent centre-based exercise. Home-based prescribed exercise improved balance-related activities (SMD 0.21, 95% CI 0.10 to 0.32) and gait speed (SMD 0.30, 95% CI 0.12 to 0.49), but not quality of life (SMD 0.11, 95% CI -0.01 to 0.23) compared with control. Home-based and centre-based exercise had similar effects on balance-related activities (SMD -0.04, 95% CI -0.36 to 0.27) and quality of life (SMD -0.08, 95% CI -0.41 to 0.24).
CONCLUSION: Home-based prescribed exercise improves balance-related activities and gait speed in people with Parkinson's disease, and these improvements are similar to improvements with equivalent centre-based exercise.
REGISTRATION: PROSPERO CRD 42018107331.
Clinical Comments
General Internal Medicine-Primary Care(US)
This makes clinical and biologic sense and would be interesting to see whether people engaged in these programs ultimately have less falls/trauma, which is a risk in PD.
Geriatrics
In this meta-analysis by Flynn et al, data demonstrate that immediately after completion of a home-based exercise program, standardized balance-related and gait-speed scores significantly improved on average and were not statistically different from center-based scores. Not surprisingly, longer and more intense exercise programs were more successful. These data reverse conventional knowledge that center-based programs are more successful and supply evidence that clinicians should emphasize ongoing prescribed mobility programs for patients with Parkinson disease. In other words, an exercise prescription should be regularly added to medication for cognitively intact patients with Parkinson disease. What is lacking in this meta-analysis is detail about programs that work and don't work, and how to create an exercise prescription. Home health PT would be helpful, but many patients with Parkinson disease do not qualify because they are not home-bound. Strategies need to be developed for clinicians or their office staff to teach patients safe and effective exercises that can done at home.
Physical Medicine and Rehabilitation
A combination of small underpowered trials.
Physical Medicine and Rehabilitation
Home-based prescribed exercise improves balance-related activities and gait speed in people with mild to moderate Parkinson’s disease without substantial cognitive deficit. This benefit only lasts during the intervention phase and is similar to the benefits seen in center based physical therapy.
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