Promoting physical activity in patients with Parkinson’s disease

What do Mohammad Ali, Michael J. Fox, Bob Hoskins, Salvador Dali, Francisco Franco and Adolf Hitler all have in common?

That was question 3 in our Woodland quiz last night. Almost all the elves got it right and the title of this blog no doubt gives it away but yes, they did indeed all suffer from Parkinson’s disease. It’s a tough neurogenerative condition where sufferers have to cope with both motor and non-motor symptoms. The latter include depression, apathy, insominia and constipation. Quality of life can be severely affected, so there is great interest in the development of successful interventions to treat the symptoms of Parkinson’s.

Increasing physical activity has been a focus of research in recent years due to its obvious cardiovascular benefits, positive effects on the non-motor symptoms and possible neuroprotective qualities. On this note, a study from the Netherlands has addressed how to change the behaviour of people with Parkinson’s disease who lead sedentary lifestyles. The multicentre randomised controlled trial involved 586 sedentary people with mild to moderate idiopathic Parkinson’s disease (aged between 40 and 75 years). The team developed a multifaceted behavioural change programme (ParkFit), to bring about an increase in activity among the participants, which was delivered over 2 years. To evaluate ParkFit they compared outcomes with a matched control intervention. Outcomes measured were the level of physical activity, quality of life and fitness.

ParkFit had several key elements:

  • Physiotherapy and physical activity coaching delivered by physiotherapists
  • Participants informed about the benefits of exercise
  • Elements informed by social cognitive theory were incorporated into the programme e.g. identifying potential barriers and means to overcome them, systematic goal setting with a health contract and log book, encouragement to do group exercise, an ambulatory monitor with automated feedback, use of a website where data could be loaded, website accessible by patient and coach
  • Physiotherapy and coaching sessions occurred regularly (19 and 14 times, respectively over 2 years)

This is what they found:

  • ParkFit behavioural change programme did not increase the overall volume of all physical activities
  • Analysis of secondary outcomes indicated increased physical activity in ParkFit patients as shown by the activity diary, the ambulatory activity monitor and the six minute walk test
  • Quality of life and the number of falls did not differ between the two groups

But:

  • The choice of control intervention might have obscured greater differences on the questionnaire that was used to measure the level of physical activity

The authors concluded:

Our study also highlights the challenges of selecting the appropriate outcomes for a complex intervention such as a behavioural change programme. Physical activity is a complex behaviour: it includes sports as well as non-sports activities, and it can be characterised by purpose (occupational or leisure), type (cycling, fitness or soccer), intensity (light, moderate or vigorous) and duration. Further research should focus on comprehensive, valid and reliable instruments to accurately measure all these aspects of physical activity behaviour.

Further well-designed research is clearly needed to understand how to achieve behaviour change in this difficult area. In the meantime, maybe the authors should take a look at a potentially inspiring way for Parkinson’s sufferers to increase their daily exercise.  It’s physical and mental therapy all rolled into one. Take a look here on the BBC website ‘En pointe to tackle Parkinson’s disease’.

Links:

van Nimwegen M ,Speelman AD ,Overeem S ,van de Warrenburg BP ,Smulders K ,Dontje ML ,et al. Promotion of physical activity and fitness in sedentary patients with Parkinson’s disease: randomised controlled trial. BMJ 2013;346:f576

Playford ED. Increasing activity in patients with Parkinson’s disease. BMJ 2013;346:f1429

Stewart L En pointe to tackle Parkinson’s disease, 2013, Health Check, BBC World Service