Exercise may help patients with Parkinson’s disease improve their balance, ability to move around, and quality of life, even if it does not reduce their risk of falling, according to a new study published online ahead of print December 31, 2014, in Neurology.
Falling is common among people with Parkinson’s disease. Approximately 60% of patients fall each year, and two-thirds of these individuals fall repeatedly. “The resulting injuries, pain, limitations of activity, and fear of falling again can really affect people’s health and well-being,” said study author Colleen G. Canning, PhD, Associate Professor of Physiotherapy at the University of Sydney.
Evidence from systematic reviews shows that exercise programs are effective in preventing falls in the general older population, so Dr. Canning and colleagues sought to determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors, including poor balance, reduced leg muscle strength, and freezing of gait, in patients with Parkinson’s disease.
For the study, 231 patients with Parkinson’s disease received their usual care or took part in an exercise program three times per week for six months. Each session consisted of 40 to 60 minutes of balance and leg-strengthening exercises. This minimally supervised exercise program was prescribed and monitored by a physical therapist, and participants performed most of the exercise at home. On average, 13% of the exercise sessions were supervised by a physical therapist.
Six months of falls data were available for 225 study participants, and one or more months of falls data were available for the remaining six participants. During the intervention period, 467 falls (4.1 per person) were reported in the exercise group, and 810 falls (7.0 per person) were reported in the control group. This difference in fall rate was not statistically significant.
Prespecified subgroup analysis, however, did reveal a significant interaction effect for disease severity. The number of falls by participants who exercised was reduced among people with less severe Parkinson’s disease, but not in those with more severe disease, compared with the number of falls for the control group. For participants with less severe disease, a 69% reduction in falls was reported in people who exercised, compared with those who did not.
“These results suggest that minimally supervised exercise programs aimed at reducing falls in people with Parkinson’s disease should be started early in the disease process,” Dr. Canning said. Because the progression of disease affects both motor and nonmotor systems, patients with more severe disease may derive more benefit from a multifactorial, closely supervised intervention, the researchers suggested. Overall, patients who took part in the exercise program performed better on tests of ability to move around and balance, had a lower fear of falls, and reported better overall mood and quality of life.