Tuesday, March 28, 2017 2-Year Study: Informal Exercise Could Play a Role in Slowing QoL, Mobility Losses Associated with PD In brief: Researchers tracked individuals with PD over a 2-year period to look for correlation between self-reported informal exercise hours per week, and changes to health-related quality-of-life and TUG test scores. Participants who reported at least 2.5 hours of exercise a week showed slower losses in HRQL and TUG than participants who reported no weekly exercise. On average, for every 30 minutes of weekly exercise, annual HRQL rates slowed by 0.16, TUG score losses slowed by 0.04 seconds. Losses were slowed at an even higher rate among participants with advanced PD who exercised 2.5 hours per week or more. Authors say findings point to the need for providers to track and facilitate informal exercise patterns of PD patients, particularly for patients with more advanced PD. Plenty of research supports the idea that formal, supervised exercise interventions can slow and even improve mobility and health-related quality-of-life (HRQL) among individuals with Parkinson disease (PD), but a new study asserts that informal home-based exercise can also produce positive effects that are long-lasting, especially when individuals get in at least 2.5 hours a week—and particularly for those with more advanced stages of the disease. The study, published in the March 28 issue of the Journal of Parkinson's Disease (abstract only available for free), analyzed data from 3,408 individuals participating in the National Parkinson Foundation Quality Improvement Initiative (NPF-QII), a 3-country program that tracks functional mobility, HRQL, and lifestyle data among individuals with PD through a series of annual visits. Researchers looked at data spanning a 2-year period, hoping to see if there was any correlation between participants who reported at least 2.5 hours of exercise weekly and scores on HRQL and mobility measures over time. HQRL was measured by way of the Parkinson Disease Questionnaire; mobility was measured through the timed up-and-go test (TUG). A correlation emerged. While participants who reported at least 2.5 hours/week of exercise still recorded losses in HRQL and mobility over the 2-year study period, those losses were smaller than those recorded by participants who reported no exercise. For the nonexercise group, HRQL worsened by an average of 1.37 points over 2 years, and by 0.47 seconds in the TUG test; among those who exercised, researchers found that for every 30 minutes of activity, annual losses slowed by 0.16 on the HQRL and by 0.04 seconds on the TUG. Positive effects in HRQL were even more significant among participants with advanced PD who exercised at least 2.5 hours/week. On average, that group slowed losses to 0.41 over 2 years, compared with exercisers with mild PD, who showed a rate that was 0.14 points slower than the nonexercise group. Functional mobility improvements were the same for all PD stages. Researchers even found improvements among participants who began exercising after their first visit; however, they were unable to see significant change among participants who waited until after their second visit, about 1 year later, to begin exercise. Authors speculate that the reason improvement wasn't noted with the later adopters is that "informal, independent exercise habits may require a longer time to accrue than short-term, supervised, research-based exercise participation." Authors of the study claim that this is the first time researchers have looked at the effects of self-reported informal home (as opposed to supervised and/or clinic-based) exercise over an extended period of time. The current study has several limitations, according to the authors: participants in the study represented only 42% of the total NPF-QII patient population and tended to be younger and more likely to be in the early stages of PD; the data do not include type or intensity of exercise performed and were self-reported; and the findings cannot be assumed to establish any causal relationship between exercise and improvements in HRQL and mobility. Still, they assert, the findings do shed light on the need for clinicians to "encourage, facilitate, and monitor long-term exercise participation" among their patients with PD, and particularly among those in more advanced stages. "While the incremental difference was small this finding has significant clinical and research implications for the development of strategies to make exercise and physical activity more accessible to people with more severe disability," authors write. "Novel methods to encourage physical activity and exercise in people with advanced PD … could provide a great benefit to the PD community." APTA offers several resources on the role physical therapy can play in the treatment of PD, including MoveForwardPT.com's PT's Guide to Parkinson Disease designed for sharing with patients, and evidence-based practice research that can be accessed through PTNow. The association has also produced a 4-module education series in partnership with the Parkinson Disease Foundation (module 1, module 2, module 3, module 4). Research-related stories featured in PT in Motion News are intended to highlight a topic of interest only and do not constitute an endorsement by APTA. For synthesized research and evidence-based practice information, visit the association's PTNow website.