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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 …
Contributors NK participated in the design, enrolled patients, carried out and coordinated the study at the Nijmegen site and drafted the manuscript. NV and BP helped draft the manuscript. AP enrolled patients and coordinated the study at the Cleveland site. MN participated in the design and coordination of the study and helped draft the manuscript. MV and AM participated in the cardiopulmonary screening before physical fitness testing of the patients at the Nijmegen site. BB and JA wrote the grant application, conceived of the study and participated in its design and coordination and helped draft the manuscript. All authors read and approved the final manuscript.
Competing interests None declared.
Patient consent Obtained.
Ethics approval CMO Arnhem-Nijmegen and Cleveland Clinic Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.