Comparing exercise in Parkinson's disease—the Berlin BIG Study

Physiotherapy is widely used in Parkinson's disease (PD), but there are few controlled studies comparing active interventions. Recently, a technique named “LSVT®BIG” has been introduced. LSVT®BIG is derived from the Lee Silverman Voice Treatment and focuses on intensive exercising of high‐amplitude movements. In the present comparative study, 60 patients with mild to moderate PD were randomly assigned to receive either one‐to‐one training (BIG), group training of Nordic Walking (WALK), or domestic nonsupervised exercises (HOME). Patients in training (BIG) and WALK received 16 hours of supervised training within 4 (BIG) or 8 (WALK) weeks. The primary efficacy measure was difference in change in Unified Parkinson's Disease Rating Scale (UPDRS) motor score from baseline to follow‐up at 16 weeks between groups. UPDRS scores were obtained by blinded video rating. ANCOVA showed significant group differences for UPDRS‐motor score at final assessment (P < 0.001). Mean improvement of UPDRS in BIG was −5.05 (SD 3.91) whereas there was a mild deterioration of 0.58 (SD 3.17) in WALK and of 1.68 (SD 5.95) in HOME. LSVT®BIG was also superior to WALK and HOME in timed‐up‐and‐go and timed 10 m walking. There were no significant group differences for quality of life (PDQ39). These results provide evidence that LSVT®BIG is an effective technique to improve motor performance in patients with PD. © 2010 Movement Disorder Society