Effectiveness of Live-Streaming Tele-Exercise Intervention in Patients With Parkinson's Disease: A Pilot Study

Abstract

Objective: Exercise can improve both motor and nonmotor symptoms in people with Parkinson's disease (PwP), but there is an unmet need for accessible and sustainable exercise options. This study aimed to evaluate the effect, feasibility, and safety of a regularly performed live-streaming tele-exercise intervention for PwP.

Methods: A live-streaming exercise intervention for PwP was implemented twice a week for 12 weeks. We measured the motor and nonmotor symptom scores of the included patients before and after the intervention. Changes in clinical scores from baseline to postintervention were analyzed using paired t-tests. Factors associated with improvements in clinical scores and compliance were analyzed using Pearson's correlation analysis.

Results: Fifty-six participants were enrolled in the study. There were significant improvements in Hospital Anxiety and Depression Scale (HADS)-anxiety (p = 0.007), HADS-depression (p < 0.001), Unified Parkinson's Disease Rating Scale (UPDRS) part III (p < 0.001), UPDRS total (p = 0.015), Hoehn and Yahr stage (p = 0.027), and Parkinson's Disease Fatigue Scale-16 (p = 0.026) scores after the intervention. Improvements in motor symptoms were associated with improvements in mood symptoms and fatigue. Higher motor impairment at baseline was associated with a greater compliance rate and better postintervention composite motor and nonmotor outcomes (ΔUPDRS total score). Overall, the 12-week tele-exercise program was feasible and safe for PwP. No adverse events were reported. The overall adherence rate was 60.0% in our cohort, and 83.4% of the participants were able to participate in more than half of the exercise routines.

Conclusion: The live-streaming tele-exercise intervention is a safe, feasible, and effective nonpharmacological treatment option that can alleviate fatigue and improve mood and motor symptoms in PwP.

Keywords: Motor symptoms; Nonmotor symptoms; Parkinson’s disease; Tele-exercise; Telehealth.

Figure 1.

Study flow at-a-glance. A: Flow diagram. B: Assessment protocol. HADS-A, Hospital Anxiety and Depression Scale-anxiety; HADSD, Hospital Anxiety and Depression Scale-depression; PFS-16, Parkinson’s Disease Fatigue Scale; NMSS, Nonmotor Symptom Scale; PDSS, Parkinson’s Disease Sleep Scale; PDQ-39, Parkinson’s Disease Questionnaire; SCOPA-AUT, Scales for Outcomes in Parkinson’s Disease-Autonomic; MoCA, Montreal Cognitive Assessment; UPDRS, Unified Parkinson’s Disease Rating Scale; H&Y, Hoehn and Yahr.

Figure 2.

Comparison of clinical scale scores before and after the live-streaming tele-exercise intervention. The boxplots show the medians (interquartile ranges). The red crossbar represents the mean value. The boxplots in blue represent the preexercise intervention scores, and the red boxplots represent the postintervention scores. The significance level is based on the analysis using the mean value. A: HADS-anxiety. B: HADS-depression. C: PFS-16. D: UPDRS Part III. E: UPDRS total score. F: H&Y stage. *p < 0.05; **p < 0.01; ***p < 0.001. HADS, Hospital Anxiety and Depression Scale; PFS-16, Parkinson’s Disease Fatigue Scale; UPDRS, Unified Parkinson’s Disease Rating Scale; H&Y, Hoehn and Yahr.

Figure 3.

Correlation matrix of relevant clinical scale scores at baseline and delta clinical scale scores. Lower negative delta clinical scale scores indicate greater improvement. *p < 0.05; **p < 0.01; ***p < 0.001. HY, Hoehn and Yahr; UPDRS; Unified Parkinson’s Disease Rating Scale; HADS_D, Hospital Anxiety and Depression Scale-depression; HADS_A, Hospital Anxiety and Depression Scale-anxiety; PFS16, Parkinson’s Disease Fatigue Scale; NMSS, Nonmotor Symptom Scale; PDQ39, Parkinson’s Disease Questionnaire.