Exercise and Rehabilitation to Move and Live Well
The Parkinson’s disease rehabilitation research group at the University of Sydney led by Dr Natalie Allen and Dr Serene Paul aims to develop, evaluate and implement effective physical activity and exercise interventions for people with Parkinson’s disease, in order to improve their physical function and quality of life. Our focus is on developing sustainable, cost-effective and accessible interventions that are easily translated into clinical practice and taken up by people with Parkinson’s disease, across the disease spectrum.
We recently completed two studies to better understand how to help people with Parkinson’s disease sustain exercise. The first study examined the preferences of people with Parkinson’s disease for performing evidence-based exercise programs (Paul et al 2021, J Physiother). We used a discrete choice experiment to determine which attributes of exercise programs were driving people’s preferences and the trade-offs between exercise attributes that people were willing to accept. We found that it was important to provide people with Parkinson’s disease the opportunity to undertake evidence-based exercise at low cost, preferably involving a variety of exercise types (eg, balance, strength and aerobic exercise) and at a location easily accessible to the individual. Equipping clinicians and exercise providers with sufficient expertise about Parkinson’s disease is also important in order to gain participants’ trust. The second study investigated the impact of an education and exercise program focused on people with early stage Parkinson’s disease on exercise behaviour one year following program participation (Li et al 2021, Neurodegener Dis Manag). We found that the program resulted in >25% of people increasing their exercise one year later. This reiterates the importance of equipping people with Parkinson’s disease with the skills and strategies to maintain positive health behaviours right from diagnosis.
We have also explored the use of telehealth to help people with Parkinson’s disease to maintain home-based exercise programs – an area that has proved very topical during the Covid-19 pandemic (Flynn 2021, Clin Rehabil). We found that home-based exercise monitored with telehealth was feasible and acceptable, with people regularly and safely performing their prescribed exercise. This model of care could improve the accessibility of ongoing physiotherapy services, as people can receive support to exercise at home in a format that requires less therapist time than ongoing centre-based programs. Further work exploring the use of telehealth for people with Parkinson’s during the pandemic is ongoing.
Chronic pain has a large impact on the quality of life of many people with Parkinson’s, and our work is also investigating whether exercise can assist in the management of this pain. Our studies have shown that exercise is likely to reduce pain sensitivity in the short term (Nguy 2019, EJP) but that there is likely to be a complex relationship between physical activity and pain (Nguy 2020, JPD). We are now conducting a survey to investigate if people with different factors driving their pain have different responses to physical activity. We hope the information we learn from this will help us to develop effective pain management strategies for individuals with Parkinson’s.
We are also investigating a combined behavioural and exercise program aimed at helping people with moderate to advanced Parkinson’s disease who have cognitive impairment and/or freezing of gait to move safely (ACTRN12619000415101). Even though this group is at high risk of falls, they are often excluded from research studies. The results of this study will enable physical and occupational therapists to provide evidence-based and personalised intervention that can effectively help these individuals improve their mobility and reduce falls.
Natalie Allen, PhD and Serene Paul, PhD are Senior Lecturers, Physiotherapy at the University of Sydney. Dr. Paul is a member of the WPC 2022 Comprehensive Care Subcommittee.
Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not necessarily reflect the opinions of the World Parkinson Coalition®