The effects of an individualized smartphone-based exercise program on self-defined motor tasks in Parkinson's disease: a long-term feasibility study

Abstract

Background: Exercise therapy is considered effective for the treatment of motor impairment in patients with Parkinson's disease (PD). During the COVID-19 pandemic, training sessions were cancelled and the implementation of telerehabilitation concepts became a promising solution. The aim of this controlled interventional feasibility study was to evaluate the long-term acceptance and to explore initial effectiveness of a digital, home-based, high-frequency exercise program for PD patients. Training effects were assessed using patient-reported outcome measures combined with sensor-based and clinical scores.

Methods: 16 PD patients (smartphone group, SG) completed a home-based, individualized training program over 6-8 months using a smartphone app, remotely supervised by a therapist, and tailored to the patient's motor impairments and capacity. A control group (CG, n = 16) received medical treatment without participating in digital exercise training. The usability of the app was validated using System Usability Scale (SUS) and User Version of the Mobile Application Rating Scale (uMARS). Outcome measures included among others Unified Parkinson Disease Rating Scale, part III (UPDRS-III), sensor-based gait parameters derived from standardized gait tests, Parkinson's Disease Questionnaire (PDQ-39), and patient-defined motor activities of daily life (M-ADL).

Results: Exercise frequency of 74.5% demonstrated high adherence in this cohort. The application obtained 84% in SUS and more than 3.5/5 points in each subcategory of uMARS, indicating excellent usability. The individually assessed additional benefit showed at least 6 out of 10 points (Mean = 8.2 ± 1.3). From a clinical perspective, patient-defined M-ADL improved for 10 out of 16 patients by 15.5% after the training period. The results of the UPDRS-III remained stable in the SG while worsening in the CG by 3.1 points (24%). The PDQ-39 score worsened over 6-8 months by 83% (SG) and 59% (CG) but the subsection mobility showed a smaller decline in the SG (3%) compared to the CG (77%) without reaching significance level for all outcomes. Sensor-based gait parameters remained constant in both groups.

Conclusions: Long-term training over 6-8 months with the app is considered feasible and acceptable, representing a cost-effective, individualized approach to complement dopaminergic treatment. This study indicates that personalized, digital, high-frequency training leads to benefits in motor sections of ADL and Quality of Life.

Fig. 1

Radar plots of M-ADL scores. Radar plots of rated daily motor activity of all 16 patients. Black drawn through line represents T0, dashed line represents T1 and dotted line around grey area represents T2

Fig. 2

Response to training according to different subcategories. a M-ADL subcategories: Dark bars represent change of total score of each subcategory from T0 to T2 for R, light bars represent change for NR. b UPDRS-III subcategories: Dark bars represent total scores in each subcategory for all R at T0, light grey bars represent scores for all R in T2

Fig. 3

Characteristics of of R and NR. Scatter plot of R (dark) and NR (grey) according to their baseline examinations in age, stage of H&Y and maximum distance at 2MWT. Box plots present the distribution of 2MWT distance, age, and H&Y stage within the group of R and NR.