Home-based exercise training by using a smartphone app in patients with Parkinson’s disease: a feasibility study

Background Parkinson’s disease (PD) patients experience deterioration in mobility with consequent inactivity and worsened health and social status. Physical activity and physiotherapy can improve motor impairments, but several barriers dishearten PD patients to exercise regularly. Home-based approaches (e.g., via mobile apps) and remote monitoring, could help in facing this issue. Objective This study aimed at testing the feasibility, usability and training effects of a home-based exercise program using a customized version of Parkinson Rehab® application. Methods Twenty PD subjects participated in a two-month minimally supervised home-based training. Daily session consisted in performing PD-specific exercises plus a walking training. We measured: (i) feasibility (training adherence), usability and satisfaction (via an online survey); (ii) safety; (iii) training effects on PD severity, mobility, cognition, and mood. Evaluations were performed at: baseline, after 1-month of training, at the end of training (T2), and at 1-month follow-up (T3). Results Eighteen out of twenty participants completed the study without important adverse events. Participants’ adherence was 91% ± 11.8 for exercise and 105.9% ± 30.6 for walking training. Usability and satisfaction survey scored 70.9 ± 7.7 out of 80. Improvements in PD severity, mobility and cognition were found at T2 and maintained at follow-up. Conclusion The home-based training was feasible, safe and seems to positively act on PD-related symptoms, mobility, and cognition in patients with mild to moderate stage of PD disease. Additionally, the results suggest that the use of a mobile app might increase the amount of daily physical activity in our study population. Remote monitoring and tailored exercise programs appear to be key elements for promoting exercise. Future studies in a large cohort of PD participants at different stages of disease are needed to confirm these findings.

[1]  Jiping Wang,et al.  Wearable Intelligent Machine Learning Rehabilitation Assessment for Stroke Patients Compared with Clinician Assessment , 2022, Journal of clinical medicine.

[2]  B. Shia,et al.  Identifying the Predictors of Patient-Centered Communication by Machine Learning Methods , 2022, Processes.

[3]  S. Fioretti,et al.  Identification of Neurodegenerative Diseases From Gait Rhythm Through Time Domain and Time-Dependent Spectral Descriptors , 2022, IEEE Journal of Biomedical and Health Informatics.

[4]  S. Chung,et al.  Effect of mobile health intervention for self-management on self-efficacy, motor and non-motor symptoms, self-management, and quality of life in people with Parkinson's disease: Randomized controlled trial. , 2022, Geriatric nursing.

[5]  A. Nieuwboer,et al.  A systematic review on exercise and training-based interventions for freezing of gait in Parkinson’s disease , 2021, NPJ Parkinson's disease.

[6]  Seo Jung Yun,et al.  Exercise Management Using a Mobile App in Patients With Parkinsonism: Prospective, Open-Label, Single-Arm Pilot Study , 2021, JMIR mHealth and uHealth.

[7]  M. Filippi,et al.  Action Observation and Motor Imagery Improve Dual Task in Parkinson's Disease: A Clinical/fMRI Study , 2021, Movement disorders : official journal of the Movement Disorder Society.

[8]  Mark T Elliott,et al.  Can a ‘rewards-for-exercise app’ increase physical activity, subjective well-being and sleep quality? An open-label single-arm trial among university staff with low to moderate physical activity levels , 2021, BMC Public Health.

[9]  T. Ellis,et al.  Digital Therapeutics in Parkinson’s Disease: Practical Applications and Future Potential , 2021, Journal of Parkinson's disease.

[10]  C. Canning,et al.  Home-based exercise monitored with telehealth is feasible and acceptable compared to centre-based exercise in Parkinson’s disease: A randomised pilot study , 2020, Clinical rehabilitation.

[11]  M. Landers,et al.  A Mobile App Specifically Designed to Facilitate Exercise in Parkinson Disease: Single-Cohort Pilot Study on Feasibility, Safety, and Signal of Efficacy , 2020, JMIR mHealth and uHealth.

[12]  B. Bloem,et al.  Personalized Care Management for Persons with Parkinson’s Disease , 2020, Journal of Parkinson's disease.

[13]  A. Mirelman,et al.  Barriers and Motivators to Engage in Exercise for Persons with Parkinson’s Disease , 2020, Journal of Parkinson's disease.

[14]  C. Ballinger,et al.  Participant expectations and experiences of a tailored physiotherapy intervention for people with Parkinson’s and a history of falls , 2020, Disability and rehabilitation.

[15]  B. Bloem,et al.  Integrated and patient-centred management of Parkinson's disease: a network model for reshaping chronic neurological care , 2020, The Lancet Neurology.

[16]  B. Bloem,et al.  Proactive and Integrated Management and Empowerment in Parkinson's Disease: Designing a New Model of Care , 2020, Parkinson's disease.

[17]  Sidong Yang,et al.  The benefits and mechanisms of exercise training for Parkinson's disease. , 2020, Life sciences.

[18]  L. Avanzino,et al.  Effectiveness of Physiotherapy on Freezing of Gait in Parkinson's Disease: A Systematic Review and Meta‐Analyses , 2019, Movement disorders : official journal of the Movement Disorder Society.

[19]  Lisbeth Fagerström,et al.  Person-centered home-based rehabilitation for persons with Parkinson's disease: A scoping review. , 2019, International journal of nursing studies.

[20]  B. Fisher,et al.  Eight Weeks of Aerobic Interval Training Improves Psychomotor Function in Patients with Parkinson’s Disease—Randomized Controlled Trial , 2019, International journal of environmental research and public health.

[21]  Cathi A Thomas,et al.  Comparative Effectiveness of mHealth-Supported Exercise Compared With Exercise Alone for People With Parkinson Disease: Randomized Controlled Pilot Study , 2019, Physical therapy.

[22]  L. Rochester,et al.  Mobilizing Parkinson’s Disease: The Future of Exercise , 2018, Journal of Parkinson's disease.

[23]  Mark T. Elliott,et al.  Physical Activity Behavior Change Driven by Engagement With an Incentive-Based App: Evaluating the Impact of Sweatcoin , 2018, JMIR mHealth and uHealth.

[24]  Nir Giladi,et al.  Basal ganglia and beyond: The interplay between motor and cognitive aspects in Parkinson’s disease rehabilitation , 2018, Neuroscience & Biobehavioral Reviews.

[25]  L. Avanzino,et al.  Effect of Group-Based Rehabilitation Combining Action Observation with Physiotherapy on Freezing of Gait in Parkinson's Disease , 2018, Neural plasticity.

[26]  M. Neto,et al.  The Effects of Functional Training, Bicycle Exercise, and Exergaming on Walking Capacity of Elderly Patients With Parkinson Disease: A Pilot Randomized Controlled Single-blinded Trial. , 2018, Archives of physical medicine and rehabilitation.

[27]  N. Latham,et al.  Peer Coaching Through mHealth Targeting Physical Activity in People With Parkinson Disease: Feasibility Study , 2018, JMIR mHealth and uHealth.

[28]  P. Bernardis,et al.  Action Observation Plus Sonification. A Novel Therapeutic Protocol for Parkinson’s Patient with Freezing of Gait , 2018, Front. Neurol..

[29]  N. Smania,et al.  Virtual Reality Telerehabilitation for Postural Instability in Parkinson's Disease: A Multicenter, Single-Blind, Randomized, Controlled Trial , 2017, BioMed research international.

[30]  Eyal Oren,et al.  Global, regional, and national burden of neurological disorders, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016 , 2017, The Lancet. Neurology.

[31]  Xia Shen,et al.  Long-term effects of exercise and physical therapy in people with Parkinson disease , 2017, Nature Reviews Neurology.

[32]  E. Atterbury,et al.  Balance training in individuals with Parkinson's disease: Therapist-supervised vs. home-based exercise programme. , 2017, Gait & posture.

[33]  G. Lancioni,et al.  Italians do it worse. Montreal Cognitive Assessment (MoCA) optimal cut-off scores for people with probable Alzheimer’s disease and with probable cognitive impairment , 2017, Aging Clinical and Experimental Research.

[34]  L. Quinn,et al.  A pilot study of a minimally supervised home exercise and walking program for people with Parkinson's disease in Jordan. , 2017, Neurodegenerative disease management.

[35]  J. Daneault,et al.  The Effects of Physical Activity in Parkinson’s Disease: A Review , 2016, Journal of Parkinson's disease.

[36]  T. Khoo,et al.  The Impact of Physical Activity on Non-Motor Symptoms in Parkinson’s Disease: A Systematic Review , 2016, Front. Med..

[37]  L. Avanzino,et al.  Action Observation and Motor Imagery: Innovative Cognitive Tools in the Rehabilitation of Parkinson's Disease , 2015, Parkinson's disease.

[38]  Rebecca Stowe,et al.  Physiotherapy for Parkinson's disease: a comparison of techniques. , 2014, The Cochrane database of systematic reviews.

[39]  A. Albanese,et al.  Validation of the Italian version of the Movement Disorder Society—Unified Parkinson’s Disease Rating Scale , 2013, Neurological Sciences.

[40]  Natalie E. Allen,et al.  Recurrent Falls in Parkinson's Disease: A Systematic Review , 2013, Parkinson's disease.

[41]  M. Hallett,et al.  Freezing of gait: moving forward on a mysterious clinical phenomenon , 2011, The Lancet Neurology.

[42]  A. Nieuwboer,et al.  Motor learning in Parkinson's disease: limitations and potential for rehabilitation. , 2009, Parkinsonism & related disorders.

[43]  Talia Herman,et al.  Reliability of the new freezing of gait questionnaire: agreement between patients with Parkinson's disease and their carers. , 2009, Gait & posture.

[44]  F. Horak,et al.  The Balance Evaluation Systems Test (BESTest) to Differentiate Balance Deficits , 2009, Physical Therapy.

[45]  Wayne Dite,et al.  A clinical test of stepping and change of direction to identify multiple falling older adults. , 2002, Archives of physical medicine and rehabilitation.

[46]  M. Hoehn,et al.  Parkinsonism , 1998, Neurology.

[47]  L. Ferrucci,et al.  A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. , 1994, Journal of gerontology.

[48]  J. Hughes,et al.  Accuracy of clinical diagnosis of idiopathic Parkinson's disease: a clinico-pathological study of 100 cases. , 1992, Journal of neurology, neurosurgery, and psychiatry.

[49]  M. Hamilton.  A RATING SCALE FOR DEPRESSION , 1960, Journal of neurology, neurosurgery, and psychiatry.

[50]  D. Bilowit.  Establishing physical objectives in the rehabilitation of patients with Parkinson's disease; gymnasium activities. , 1956, The Physical therapy review.

[51]  A. Amara,et al.  Effects of Exercise on Non-motor Symptoms in Parkinson's Disease. , 2018, Clinical therapeutics.

[52]  S. Mezzarobba,et al.  [Estimate of the prevalence of Parkinson's disease by using electronic health archives]. , 2015, Recenti progressi in medicina.

[53]  C. Winstein,et al.  Translating the science into practice: shaping rehabilitation practice to enhance recovery after brain damage. , 2015, Progress in brain research.

[54]  I. Heuser,et al.  The Hamilton Anxiety Scale: reliability, validity and sensitivity to change in anxiety and depressive disorders. , 1988, Journal of affective disorders.