Abstract
BackgroundPatients with parkinsonism have higher inactivity levels than the general population, and this results in increased comorbidities. Although exercise has benefits for motor function and quality of life (QOL) in patients with parkinsonism, these patients face many barriers to exercise participation, such as lack of motivation, fatigue, depression, and time constraints. Recently, the use of mobile apps has been highlighted as a remote exercise management strategy for patients with chronic diseases.ObjectiveThis study aimed to evaluate the effects of home-based exercise management with a customized mobile app on the exercise amount, physical activity, and QOL of patients with parkinsonism.MethodsThis was a prospective, open-label, single-arm pilot study. The therapist installed the app in the smartphones of the participants and educated them on how to use the app. The therapist developed an individualized multimodal exercise program that consisted of stretching, strengthening, aerobic, balance and coordination, and oral-motor and vocal exercises. Participants were encouraged to engage in an 8-week home-based exercise program delivered through a customized app. The alarm notifications of the app provided reminders to exercise regularly at home. The primary outcome was the exercise amount. The secondary outcomes were assessed using the International Physical Activity Questionnaire (IPAQ), Parkinson’s Disease Questionnaire-39 (PDQ-39), and Geriatric Depression Scale (GDS). The usability of the customized app was assessed using a self-report questionnaire.ResultsA total of 21 participants with parkinsonism completed the intervention and assessment between September and December 2020 (mean age: 72 years; women: 17/21, 81%; men: 4/21, 19%). The participants reported a significant increase in the total amount of exercise (baseline: mean 343.33, SD 206.70 min/week; 8-week follow-up: mean 693.10, SD 373.45 min/week; P<.001) and in the amount of each exercise component, including stretching, strengthening, balance and coordination, and oral-motor and vocal exercise after 8 weeks. Analysis of the secondary outcomes revealed significant improvements in the IPAQ (P=.006), PDQ-39 (P=.02), and GDS (P=.04) scores. The usability of the program with the mobile app was verified based on the positive responses such as “intention to use” and “role expectation for rehabilitation.”ConclusionsExercise management with a customized mobile app may be beneficial for improving exercise adherence, physical activity levels, depression management, and QOL in patients with parkinsonism. This remotely supervised technology-based, reinforcing, and multimodal exercise management strategy is recommended for use in patients with parkinsonism. In addition, this program proved useful as an alternative exercise management strategy during the COVID-19 pandemic when patients with Parkinson disease were less physically active than before and showed aggravation of symptoms. However, additional clinical trials are needed to evaluate the efficacy of this exercise program in a large population and to confirm its disease-modifying effects.
Highlights
Parkinson disease (PD) is a progressive neurodegenerative disease characterized by motor symptoms including tremors, rigidity, and bradykinesia, and nonmotor symptoms such as depression and cognitive impairment [1]
Exercise management with a customized mobile app may be beneficial for improving exercise adherence, physical activity levels, depression management, and quality of life (QOL) in patients with parkinsonism
This remotely supervised technology-based, reinforcing, and multimodal exercise management strategy is recommended for use in patients with parkinsonism
Summary
Parkinson disease (PD) is a progressive neurodegenerative disease characterized by motor symptoms including tremors, rigidity, and bradykinesia, and nonmotor symptoms such as depression and cognitive impairment [1]. Physical inactivity results in increased comorbidities such as cardiovascular events, diabetes mellitus, cancer, and osteoporosis [3]. This is probably true in patients with atypical parkinsonism, such as multiple system atrophy (MSA), progressive supranuclear palsy (PSP), and corticobasal degeneration (CBD), which show clinical symptoms similar to those of PD and whose differential diagnosis can be challenging in the early disease stages [4]. Tomlinson et al [9] reviewed the short-term benefits of a physical intervention program on gait, balance, and disability outcomes, and Mak et al [10] reviewed the long-term benefits of exercise on motor symptoms and physical function parameters such as muscle strength, aerobic capacity, gait impairment, balance, and fall risk. The use of mobile apps has been highlighted as a remote exercise management strategy for patients with chronic diseases
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