Home-based exercise training by using a smartphone app in patients with Parkinson's disease: a feasibility study

Abstract

Background: Parkinson's disease (PD) patients experience deterioration in mobility with consequent inactivity and worsened health and social status. Physical activity and physiotherapy can improve motor impairments, but several barriers dishearten PD patients to exercise regularly. Home-based approaches (e.g., via mobile apps) and remote monitoring, could help in facing this issue.

Objective: This study aimed at testing the feasibility, usability and training effects of a home-based exercise program using a customized version of Parkinson Rehab® application.

Methods: Twenty PD subjects participated in a two-month minimally supervised home-based training. Daily session consisted in performing PD-specific exercises plus a walking training. We measured: (i) feasibility (training adherence), usability and satisfaction (via an online survey); (ii) safety; (iii) training effects on PD severity, mobility, cognition, and mood. Evaluations were performed at: baseline, after 1-month of training, at the end of training (T2), and at 1-month follow-up (T3).

Results: Eighteen out of twenty participants completed the study without important adverse events. Participants' adherence was 91% ± 11.8 for exercise and 105.9% ± 30.6 for walking training. Usability and satisfaction survey scored 70.9 ± 7.7 out of 80. Improvements in PD severity, mobility and cognition were found at T2 and maintained at follow-up.

Conclusion: The home-based training was feasible, safe and seems to positively act on PD-related symptoms, mobility, and cognition in patients with mild to moderate stage of PD disease. Additionally, the results suggest that the use of a mobile app might increase the amount of daily physical activity in our study population. Remote monitoring and tailored exercise programs appear to be key elements for promoting exercise. Future studies in a large cohort of PD participants at different stages of disease are needed to confirm these findings.

Keywords: Parkinson disease; exercise; gait; home-based training; mobile apps.

Figure 1

Graphical example of an exercise using the mobile app.

Figure 2

Project timeline. Patients underwent an eight-weeks home-based rehabilitation training with the support of the Parkinson Rehab® application downloaded on their personal smartphones (T0-T2). They participated into 4 evaluations with clinical, cognitive, mood, and motor tests: baseline (T0), one month after the training was started (T1), within 3-days after the end of the training (T2), and at 1-month follow-up (T3). Two weeks after T0 and T1, participants were contacted by phone to provide new exercises and a new number of steps to be taken daily.

Figure 3

Distribution of bi-weekly steps performed by participants throughout the total training period, clustered based on steps assigned x day (3000-4999 steps, 5000-6999 steps, ≥ 7000 steps).

Figure 4

Training-induced changes on PD symptoms. SPPB, FSST, Mini-BESTest, MDS-UPDRS (part III and total), and PD-CRS mean scores (± standard error) are represented at T0 (baseline), T1 (mid-training), T2 (end of the training), and T3 (one month follow up). Panels: (A) SPPB, Short Physical Performance Battery; (B) FSST, Four Square Step Test; (C) MINIBEST–Mini Balance Evaluation Systems Test; (D) MDS-UPDRS III, Movement Disorder Society–Unified Parkinson’s Disease Rating Scale part III; (E) MDS-UPDRS TOT, Movement Disorder Society–Unified Parkinson’s Disease Rating Scale total score; (F) PD-CRS TOT, Parkinson’s Disease-Cognitive Rating Scale total score. Asterisks indicate statistically significant differences emerged at post hoc analysis of RM-ANOVA or Friedmann test (∗p < 0.05; ∗∗p < 0.01).