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In people with Parkinson disease, home-based exercise helps with balance-related activities and walking speed by a small amount compared with usual care and may be similar to centre-based exercise

Flynn A, Allen NE, Dennis S, et al. Home-based prescribed exercise improves balance-related activities in people with Parkinson's disease and has benefits similar to centre-based exercise: a systematic review. J Physiother. 2019;65:189-99.

Review questions

In people with Parkinson disease, does organized exercise done mainly at home improve their balance and quality of life? Is it as good as similar types of exercise done mainly at a central location?

Background

Parkinson disease affects the nervous system. It causes problems with movement, posture, and balance that get worse over time. People with the disease may have tremors (shaking), rigid muscles, and changes in their ability to speak or write. Parkinson disease cannot be cured, but exercise may help reduce some of its symptoms. This review looks at the effects of organized exercise programs that are done mainly at home (home-based exercise) or at a central location (centre-based exercise).

How the review was done

The researchers did a systematic review of studies available up to April 2019. They found 16 studies that included 1700 people with an average age of 60 to 74 years. 14 studies were randomized controlled trials.

The key features of the studies were:

• people had mild to severe Parkinson disease for an average of 5 to 9 years and did not have cognitive problems;
• exercise was prescribed by a physiotherapist or other qualified health professional and aimed to improve people’s walking ability and their balance when standing;
• most studies compared home-based exercise programs with usual care;
• some studies compared home-based exercise programs with similar types of supervised centre-based exercise programs done in community or medical centres, private practices, or hospital outpatient departments;
• exercise was done in 2 to 7 sessions per week for 15 to 60 minutes per session; home-based programs included at least 1 exercise session that was supervised; and
• most exercise programs lasted for 6 to 10 weeks (minimum 4 sessions over 2 weeks).

Most studies were rated as good quality.

What the researchers found

Compared with usual care, home-based exercise programs:

• improved performance on balance-related activities and walking speed by a small amount at the end of the exercise program;
• improved quality of life by a small amount at 6 to 46 weeks after the end of the exercise program;
• did not improve performance of balance-related activities at 4 to 26 weeks after the end of the exercise program; and
• did not improve quality of life at the end of the exercise program.

In studies with small numbers of people, home-based and centre-based exercise programs had similar effects for performance of balance-related activities and quality of life at the end of the exercise programs.

Conclusions

In people with Parkinson disease, home-based exercise programs help with balance-related activities and walking speed by a small amount at the end of the program compared with usual care. The effects on balance outcomes only lasted a short time after finishing the exercise program, which suggests the exercises need to be continued to provide benefit. Home-based and centre-based exercise programs may have similar effects.

Effects of home-based exercise programs in people with Parkinson disease

*Amount of improvement of home-based exercise programs compared with usual care or centre-based exercise programs is based on standardized mean differences (SMDs), where SMD < 0.50 = small improvement; SMD 0.50 to 0.79 = moderate improvement; SMD ≥ 0.80 = large improvement.

†Most studies compared home-based exercise programs with usual care. 1 study compared home-based exercise with a life skills program and 1 with no physiotherapy.