The 'PD Warrior' exercise programme improves motor outcomes and quality of life in patients with early Parkinson disease: results of a pilot study.

BACKGROUND: 'PD Warrior' (PDW) is a popular exercise programme for Parkinson disease; however, there are no published studies on the outcomes of the programme. AIMS: To investigate short-term functional and quality of life (QoL) outcomes after the PDW 10-week programme in a pilot study of individuals with early Parkinson Disease (PD). METHODS: Twenty individuals with PD (Hoehn & Yahr 1-3) attending a hospital outpatient clinic were recruited into the PDW 10-week programme, comprising a weekly 1-h supervised class complemented by an individualised daily home exercise programme. Participants had the following assessments at baseline and after completion of the programme: Movement Disorder Society Unified Parkinson Disease Rating Scale (MDS-UPDRS) Part III, timed up-and-go (TUG), 10-m walk test (10mWT), 6-min walking test (6MWT), balance tests, fine motor skills, 7-day Parkinson KinetiGraph (PKG) and PDQ-39 QoL scale. RESULTS: Seventeen individuals completed the programme. Significant improvements were observed in MDS-UPDRS motor score (P = 0.019, d = 0.68, MCID 7); 6MWT distance (P < 0.001, d = 1.16); walking time during motor or cognitive dual tasking (P = 0.006, d = 0.77; P = 0.005, d = 0.79, respectively); and the PDQ-39 emotional well-being subdomain (P = 0.009; MCID 4.2); as well as improvements trending to significance in bradykinesia (P = 0.025, d = 0.73), 10mWT walking time (P = 0.023, d = 0.61) and borderline improvement in balance (P = 0.056, d = 0.50). CONCLUSIONS: The outcomes of this study support the efficacy of the PDW programme in individuals with early PD and provide justification for future trials and investigation of its effects.

Investigation of the implementation of a Communication Enhanced Environment model on an acute/slow stream rehabilitation and a rehabilitation ward: A before-and-after pilot study.

OBJECTIVES: Develop and implement a Communication Enhanced Environment model and explore its effect on language activities for patients early after stroke. METHOD AND DESIGN: Before-and-after pilot study. SETTING: An acute/slow stream rehabilitation and a rehabilitation ward in a private hospital in Perth, Western Australia. PARTICIPANTS: Fourteen patients recruited within 21 days of stroke. Seven recruited during the before-phase (control group: patients with aphasia = 3, patients without aphasia = 4) and seven recruited in the after-phase (intervention group: patients with aphasia = 4, patients without aphasia = 3). INTERVENTION: The intervention group exposed to a Communication Enhanced Environment model had access to equipment, resources, planned social activities and trained communication partners. Both groups received usual stroke care. DATA COLLECTION: Hospital site champions monitored the availability of the intervention. Behavioural mapping completed during the first minute of each 5-minute interval over 12 hours (between 7 am and 7 pm) determined patient engagement in language activities. RESULTS: Seventy-one percent of the Communication Enhanced Environment model was available to the intervention group who engaged in higher, but not significant (95% CI), levels of language activities (600 of 816 observation time points, 73%) than the control group (551 of 835 observation time points, 66%). Unforeseen reorganisation of the acute ward occurred during the study. CONCLUSIONS: Implementation of a Communication Enhanced Environment model was feasible in this specific setting and may potentially influence patients' engagement in language activities. The unforeseen contextual challenges that occurred during the study period demonstrate the challenging nature of the hospital environment and will be useful in future research planning.

FIGHT-PD: A feasibility study of periodized boxing training for Parkinson disease.

BACKGROUND: Boxing training has become a popular form of exercise for people with Parkinson disease (PD). There is a dearth of high-quality feasibility, safety, and efficacy data on boxing training for PD. Feasibility of Instituting Graduated High-intensity Training (FIGHT-PD) aimed to examine these features in a periodized boxing training program featuring high-intensity physical and cognitive demands. OBJECTIVE: To conduct a feasibility study, aiming to address deficiencies in the current knowledge base and to provide data for future studies. DESIGN: Single-arm, open-label feasibility. SETTING: University department and medical research institute. PARTICIPANTS: Ten people with early stage PD without contraindications to intense exercise, identified from a database of participants interested in boxing training. INTERVENTIONS: A 15-week exercise program with three 1-hour sessions per week, with each session including warmup and then rounds of noncontact boxing using a training device. Three distinct blocks of 5 weeks including active rest. Boxers Development: focus on training technique Boxers Cardio: increasing intensity, including high-intensity interval training Boxers Brain: focus on cognitively challenging dual task training MAIN OUTCOME MEASURES: Process, resource, and management measures including recruitment and retention rates, timelines and costs, and compliance with prescribed exercise targets. Clinical outcomes were safety (adverse events), training intensity (using heart rate and perceived exertion monitoring), tolerability (pain, fatigue, and sleep scores), and pre- and postprogram Unified Parkinson Disease Rating Scale (UPDRS-III). RESULTS: Among 10 participants from a pool of 82 (recruitment rate = 12%), there were no withdrawals; 348/360 workouts were completed (adherence = 97.7%); 4/348 (1.1%) workouts were missed due to minor injury. Nine of 10 participants showed improvement in UPDRS motor score. CONCLUSIONS: FIGHT-PD provides a depth of feasibility and safety data, methodological detail, and preliminary results that is not described elsewhere and could provide a useful basis for future studies of boxing training for PD.

Physical activity and sedentary behaviors in people with stroke living in the community: a systematic review.

BACKGROUND: Regular physical activity is vital for cardiovascular health. Time spent in sedentary behaviors (eg, sitting, lying down) also is an independent risk factor for cardiovascular disease. The pattern in which sedentary time is accumulated is important-with prolonged periods of sitting time being particularly deleterious. People with stroke are at high risk for cardiovascular disease, including recurrent stroke. PURPOSE: This systematic review aimed to update current knowledge of physical activity and sedentary behaviors among people with stroke living in the community. A secondary aim was to investigate factors associated with physical activity levels. DATA SOURCES: The data sources used were MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complimentary Medicine Database (AMED), EMBASE, and the Cochrane Library. STUDY SELECTION: Studies involving people with stroke living in the community and utilizing objective measures of physical activity or sedentary behaviors were included. DATA EXTRACTION: Data were extracted by one reviewer and checked for accuracy by a second person. DATA SYNTHESIS: Twenty-six studies, involving 983 participants, were included. The most common measure of activity was steps per day (22 studies), which was consistently reported as less than half of age-matched normative values. Only 4 studies reported on sedentary time specifically. No studies described the pattern by which sedentary behaviors were accumulated across the day. Walking ability, balance, and degree of physical fitness were positively associated with higher levels of physical activity. LIMITATIONS: This review included only studies of people living in the community after stroke who were able to walk, and the majority of included participants were aged between 65 and 75 years of age. CONCLUSIONS: Little is known about the time people with stroke spend being sedentary each day or the pattern in which sedentary time is accumulated. Studies using objective, reliable, and valid measures of sedentary time are needed to further investigate the effects of sedentary time on the health of people with stroke.