How COVID-19 will boost remote exercise-based treatment in Parkinson's disease: a narrative review

Abstract

The lack of physical exercise during the COVID-19 pandemic-related quarantine measures is challenging, especially for patients with Parkinson's disease (PD). Without regular exercise not only patients, but also nursing staff and physicians soon noticed a deterioration of motor and non-motor symptoms. Reduced functional mobility, increased falls, increased frailty, and decreased quality of life were identified as consequences of increased sedentary behavior. This work overviews the current literature on problems of supplying conventional physiotherapy and the potential of telerehabilitation, allied health services, and patient-initiated exercise for PD patients during the COVID-19 period. We discuss recent studies on approaches that can improve remote provision of exercise to patients, including telerehabilitation, motivational tools, apps, exergaming, and virtual reality (VR) exercise. Additionally, we provide a case report about a 69-year-old PD patient who took part in a 12-week guided climbing course for PD patients prior to the pandemic and found a solution to continue her climbing training independently with an outdoor rope ladder. This case can serve as a best practice example for non-instructed, creative, and patient-initiated exercise in the domestic environment in difficult times, as are the current. Overall, many recent studies on telemedicine, telerehabilitation, and patient-initiated exercises have been published, giving rise to optimism that facilitating remote exercise can help PD patients maintain physical mobility and emotional well-being, even in phases such as the COVID-19 pandemic. The pandemic itself may even boost the need to establish comprehensive and easy-to-do telerehabilitation programs.

Fig. 1. Decision tree for remote exercise-based treatment options.

The figure shows the various needs of PD patients and their respective telemedical solution. White boxes: patient’s needs. Green boxes: online resources. Blue boxes: mobile applications. Virtual reality: patient-controlled avatar performs playful exercises to train balance, gait, or fine motor skills using motion sensors (either hand-held, body-mounted, or via a pressure-sensitive platform) and a headset or screen^,. Exergaming: videogames demanding physical participation designed to improve motor skills^,. 1:1 personal session: live therapeutic session with trainer or therapist via internet-based video calls^–. Self-help groups and podcasts: motivational community resources on social media^–. Exercise classes: web-based exercise options delivered by experts^–. Training plans: downloadable plans for individual use^–. Motivational apps: encouragement to stay active by donating to PD research (Charity Miles, Parkinson’s Moving Day). Traditional exercise: combination of motor, speech, and dexterity exercises (9zest Parkinson’s Therapy & Exercises, Parkinson Exercises Mobile, PD Warrior, Beats Medical Parkinsons Treat). Alternative exercise: yoga postures potentially beneficial for postural control and against rigidity (Yoga against Parkinson’s). Speech: speech exercises for correction of hypophonia (Voice analyst). Symptom-tracking: symptom tracking apps to monitor treatment response and optimize care by generating reports for discussion with physician and/ or physical therapist (Parkinson mPower 2, APDA Symptom tracker, uMotif^,). Options with scientific evidence of feasibility and/ or effectiveness are indicated by an asterisk*.