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A remotely supervised home-based aerobic exercise programme is feasible for patients with Parkinson’s disease: results of a small randomised feasibility trial
  1. Nicolien M van der Kolk1,
  2. Nienke M de Vries1,
  3. Amanda L Penko2,
  4. Maureen van der Vlugt3,
  5. Anton A Mulder3,
  6. Bart Post1,
  7. Jay L Alberts2,4,
  8. Bastiaan R Bloem1
  1. 1Department of Neurology, Donders Institute for Brain, Cognition, and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
  2. 2Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio, USA
  3. 3Department of Cardiology, Radboud University Medical Centre, Nijmegen, The Netherlands
  4. 4Center for Neurological Restoration, Cleveland Clinic, Cleveland, Ohio, USA
  1. Correspondence to Professor Bastiaan R Bloem, Department of Neurology (935), Radboud University Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands; bas.bloem{at}radboudumc.nl

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Introduction

Parkinson’s disease (PD) is a complex neurodegenerative disorder characterised by disabling motor and non-motor signs. Current medical therapies can partially alleviate these symptoms, but are also accompanied by dose-limiting side effects. Moreover, their therapeutic window narrows with disease progression, leaving the patient with increasing disability. Complementary non-pharmacological approaches, such as aerobic exercise, have been evaluated for over two decades. The heterogeneity of the interventions and outcomes used hinders the interpretation of the effect of exercise in PD.1 Several systematic reviews and meta-analyses have pooled the results, but their conclusions depend greatly on the diversity of the included exercise modalities. Nevertheless, a beneficial effect of exercise on motor symptoms of PD as well as a general health benefit (physical fitness) seems likely from these studies. A beneficial effect on non-motor symptoms in PD is also conceivable, but not yet proven.2 To strengthen the evidence on symptomatic benefits, we need methodologically sound randomised controlled trials (RCTs) with large sample sizes, clinically relevant outcomes for both motor and non-motor signs, long-term interventions and prolonged follow-up.3 Additionally, there is a need for pragmatic home-based or community-based studies, aiming to test the feasibility and efficacy of exercise therapies in real life. Several semi-supervised home-based studies were performed in PD before. These included low-intensity therapies that were delivered only briefly.4. Although these home-based studies reported some positive results, it appears that more intensive exercise therapies (ie, resistance …

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