At-Home Aerobic Exercise Program Lessens Symptoms in Patients With Parkinson

A recent study aimed to evaluate the effectiveness of at-home aerobic exercise—enhanced with virtual reality and gamification techniques to encourage adherence—to relieve motor symptoms in patients with mild Parkinson disease severity.

It is believed that high-intensity aerobic exercise might lessen the symptoms of Parkinson, but high-quality evidence is lacking, and long-term adherence remains challenging.

The single-center, double-blind, randomized controlled trial from the Netherlands involved sedentary patients with Parkinson. Patients aged 30 to 75 years who were on stable dopaminergic medication were included and randomly assigned (in a 1:1 ratio) to either aerobic exercise preformed on a stationary cycle or stretching (active control group).

The cycles were enhanced with virtual reality software and real-life videos, providing a so-called “exergaming” experience. Both groups received a motivational app and remote supervision; the app provided the rewards for exercising.

The control group only performed stretching exercises, while the aerobic exercise group was instructed to exercise for 30 to 45 minutes on a stationary bicycle at home, at least 3 times a week, for 6 months. The primary outcome was the between-group difference in the Movement Disorders Society—Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor section at 6 months, tested during the off state, defined as 12 or more hours after the last dopaminergic medication.

In total, 139 patients were assessed for eligibility in person, of whom 130 were randomly assigned to either the aerobic intervention group (n = 65) or the control group (n = 65). Data from 125 (96%) patients were available for the primary analysis; 5 patients were lost to follow-up and 20 patients did not complete their program.

The off-state MDS-UPDRS motor score was 4.2 points lower (95% CI, 1.6-6.9; P = .0020) in the aerobic exercise, or intervention, group (mean 1.3 points vs mean 5.6 points for the control group). This is a large effect, similar to that of several conventional Parkinson drugs, according to a statement from the researchers. In addition, the cycling patients had significantly better cardiovascular fitness.

The games on the bikes made the program more entertaining and challenging, the researchers said. Participants could race against their own previous performance or against a group of other cyclists. The system adjusted the difficulty of the game to the patient’s heartbeat, making the challenge precise; in addition, the programs increased in intensity as the participants’ fitness levels increased.

The fact that this cycling exercise can take place entirely at home is a major advantage for patients, as this greatly enhances the feasibility of the treatment.

“This study is very important. We can now start researching whether much more long-term cycling can also slow the disease progression. Also, this new ‘exergaming’ approach that we have developed is very suitable to achieve long-term improvements in exercise behavior for patients with a range of other disorders that could also benefit from regular exercise,” said Bastiaan R. Bloem, MD, principal investigator.

Eleven patients had potentially related adverse events (7 in the intervention group and 4 in the control group) and 7 had unrelated serious adverse events. Future studies should establish long-term effectiveness and possible disease-modifying effects, the researchers said.

Reference

van der Volk 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 [published online September 11, 2019]. Lancet Neurol. doi: 10.1016/S1474-4422(19)30285-6.