• Extrapyramidal & Movement Disorders
• Nursing Clinical Trials

• Neurology
• Extrapyramidal & Movement Disorders
• Nursing
• Neurology Clinical Trials

Exercise increases neuron proliferation in animal studies and improves motor function in patients with early-stage Parkinson's disease (PD). Multiple studies have demonstrated that the LSVT BIGR physical therapy exercise program is effective for improving the motor symptoms of PD. LSVT BIG is a program developed by LSVT Global that uses physical and occupational therapy in an intensive, whole-body, amplitude-based training protocol to treat individuals with PD. Khashayar Dashtipour, MD, PhD, Loma Linda University School of Medicine, Loma Linda, California, USA, presented the results of a pilot study comparing the effects of the LSVT BIG program with those of a one-on-one exercise program in patients with PD.

Nine patients with early- to middle-stage PD were randomly assigned to the LSVT BIG physical therapy exercise program (n=4) versus a one-on-one exercise program consisting of treadmill plus seated trunk and limb exercise (n=5). Both exercise programs took place in 16 1-hour supervised sessions. The goal was to compare the effects of each program on motor as well as on nonmotor symptoms in these patients with PD. The patients were assessed before and after the exercise intervention with the Unified Parkinson's Disease Rating Scale (UPDRS), UPDRS motor (UPDRS M), Beck Depression Inventory (BDI), Beck Anxiety Inventory, and Modified Fatigue Impact Scale (MFIS). The assessments were given at baseline (first evaluation) and monthly at 3 follow-up visits (second, third, and fourth evaluations). Follow-up data were compared with baseline data using Wilcoxon rank sum testing. The analysis was repeated separately for each of the assessments and for each evaluation period.

In the combined cohort of all 9 patients, all assessment results were improved from baseline at the follow-up evaluations, with statistically significant decreases in the UPDRS score at the second (p=0.0237), third (p=0.0361), and fourth (p=0.0142) evaluations. UPDRS M scores were significantly decreased from baseline at the third (p=0.0208) and fourth (p=0.0313) evaluations. BDI scores were significantly decreased at the second (p=0.0014), third (p<0.0001), and fourth (p<0.0001) evaluations. MFIS scores were significantly decreased only at the fourth evaluation (p=0.0022).

There were no significant differences between the LSVT BIG physical therapy and one-on-one exercise groups at any of the evaluations except for the MFIS score, which was significantly decreased from baseline to the fourth evaluation (–11.2 vs 0.0, p=0.0159) in the one-on-one exercise group compared with the LSVT BIG group. Changes from baseline to the fourth evaluation for the other assessments in the one-on-one exercise group compared with the LSVT BIG group are shown in Table 1.

The results of this pilot study demonstrated a positive effect of exercise and physical therapy on motor and nonmotor symptoms in patients with PD, with reductions in all scores from baseline. The only significant difference between the 2 groups was the significantly reduced MFIS score at the final evaluation in the one-on-one exercise group compared with the LSVT BIG group. The results of this pilot study suggest that one-on-one exercise could be at least as effective as the LSVT BIG physical therapy program for improving the symptoms of PD, but larger trials are needed to validate these data.

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