Exercise Interventions in Parkinson's Disease

National Institute for Health Research, United Kingdom, Royal Berkshire NHS Foundation Trust (participant identification centre), Nuffield Orthopaedic Centre NHS Trust (participant identification centre)

This study sets out to determine the effect of exercise performed over a longer period of time (6 months), delivered using community facilities, on motor and non motor symptoms, health and well being in people with Parkinson's Disease.

Participation in exercise is beneficial for health and well being, but the effect over a longer period of time in people with Parkinson's disease (PD) has not been established. People with PD currently only receive short-term support for exercise therapy interventions funded from the National Health Service; it is therefore unsurprising that people with PD are observed to have low levels of physical activity that decrease over time. Using mixed methodology the investigators will explore the effect of exercise delivered over a longer period of time (six months) in people with PD. The investigators will examine the views of people participating in the program. Aims Using a randomized controlled trial with one intervention arm and an active comparator control group with blinded assessments and semi-structured interview techniques the investigators will determine in people with PD: The effect of longer-term exercise participation on motor symptoms The effect of longer-term exercise participation on non motor symptoms, fitness, health and well being. Participants views of the process and sustainability of community provision of exercise over a longer period of time.

6 months 2 x a week aerobic and anaerobic exercise delivered in community facilities by an exercise professional and supported by a physiotherapist.

6 months 2 x a week hand writing practice. Performed in the home supported by a physiotherapist (5 support sessions)

6 months 2 x a week aerobic and anaerobic exercise delivered in community facilities by an exercise professional and supported by a physiotherapist

6 months 2 x a week hand writing practice. Performed in the home supported by a physiotherapist (5 support sessions)

Time taken to sit to stand from a chair , walk 3 meters, turn and return to sitting in the chair. At normal speed

An incremental cycle ergometer exercise test. (Heart rate, blood pressure, rating of perception of effort, rate of oxygen consumption (metabolism) from measures of expired air will be measured at the beginning, each increment and at the end of the test

Self reported retrospective physical activity in social, work and home domains. Measured by the Physical Activity Scale for the Elderly questionnaire

participant interviews on the perceived results and experiences/process. Interviews will be digitally audio-recorded. An interview schedule will be used to guide content. A standard thematic analysis technique will be used. The transcripts will be examined to identify themes and categories.

Exercise Programme: Attendance at exercise sessions and session content (Heart Rate, Rating of perceived Exertion and duration, speed and repetition of exercises)(6 months 2 x a week). Hand writing Programme: Diary of hand writing practice (6 months 2 x a week)

Particpants will be followed at each scheduled session for the duration of the intervention (6 months 2 x a week)

Time taken to sit to stand from a chair , walk 3 meters, turn and return to sitting in the chair. At normal speed

Time taken to sit to stand from a chair , walk 3 meters, turn and return to sitting in the chair. At normal speed

An incremental cycle ergometer exercise test. (Heart rate, blood pressure, rating of perception of effort, rate of oxygen consumption (metabolism) from measures of expired air will be measured at the beginning, each increment and at the end of the test

Self reported retrospective physical activity in social, work and home domains. Measured by the Physical Activity Scale for the Elderly questionnaire

Self reported retrospective physical activity in social, work and home domains. Measured by the Physical Activity Scale for the Elderly questionnaire

Inclusion Criteria: Parkinson's disease diagnosed by neurological examination; idiopathic PD defined by the UK Parkinson's Disease Society Brain Bank Criteria Able to walk ≥ 100m maintained a stable medical regime for 12 weeks prior to initiation of the study, and anticipated to maintain a stable regime for the course of study (as determined by the referring clinician). Exclusion Criteria: Dementia History of additional prior neurological condition Severe depression or psychosis or a mental state that would preclude consistent active involvement with the study over its duration Cardiac precautions that would prevent the subject from completing the exercise program or the full battery of outcome measures Any known contraindication to exercise Reduced cognition of any cause [Minimental state examination [(MMSE) < 23] An orthopaedic condition that independently limits walking;

Collett J, Franssen M, Meaney A, Wade D, Izadi H, Tims M, Winward C, Bogdanovic M, Farmer A, Dawes H. Phase II randomised controlled trial of a 6-month self-managed community exercise programme for people with Parkinson's disease. J Neurol Neurosurg Psychiatry. 2017 Mar;88(3):204-211. doi: 10.1136/jnnp-2016-314508. Epub 2016 Nov 11.