Home-based exercise for Parkinson’s disease

...does it improve balance and quality of life?

Parkinson’s disease is a chronic, progressive, neurodegenerative disorder. It is the fastest growing neurological disorder in the world; the number of people with Parkinson’s disease is projected to double from 6 million in 2015 to 12 million in 2040.

Physiotherapy interventions such as balance exercises, treadmill training, cueing and strength exercise have become an integral part of the management of Parkinson’s disease. High-quality systematic reviews and randomised controlled trials have shown that exercise improves mobility (gait speed, step length and walking capacity), balance and quality of life, while reducing falls.

Despite this wealth of evidence, questions remain about the optimal location, amount of supervision, mode of delivery (individual, group or both), intensity, duration and type of exercise required to maximise these benefits. Home-based prescribed exercise is of particular interest because the lower resourcing required might allow it to become one way that the healthcare system can cope with the growing population of people with Parkinson's disease.

Four trials compared home-based prescribed exercise with equivalent centre-based exercise. 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).

Overall, the authors concluded that home-based prescribed exercise improves balance and gait speed in people with Parkinson’s disease. Home-based and centre-based exercise were found to have similar effects on balance-related activities and quality of life. This suggests that home-based prescribed exercise may be an effective strategy for delivering high-quality exercise to people with Parkinson’s disease in health services where resources are limited.

> From: Flynn et al., J Physiother 65 (2019) (Epub ahead of print). All rights reserved to Australian Physiotherapy Association. Click here for the online summary.

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