Objective/Rationale:
Parkinson's patients are inclined toward a sedentary lifestyle. This is due to a combination of both physical handicaps (e.g. walking difficulties) and mential impairments (e.g. depression). Improving the amount of physical activity in PD is probably beneficial for many reasons. First, this would reduce the number of disease complications, such as cardiovascular disease or diabetes mellitus. Second, this might reduce specific PD problems such as bone fractures due to osteoporosis, depression or sleep disturbances. Exercise may also postpone cognitive deterioration and might even slow down disease progression in PD. We have developed the ParkFit program: an innovative approach to promote physical activity in patients with PD. Our research project concerns the scientific evaluation of this unique promotion program for an active lifestyle.
Project Description:
The ParkFit program features several complementary tools to assist patients in increasing their level of physical activity. For example, each patient receives a dedicated personal coach (‘ParkFit Therapist’) who develops an individually based activity program and who supervises the patient during two years. We intend to scientifically evaluate the merits of this ParkFit program. 700 patients will be randomly assigned to either a group receiving the ParkFit program or to a control group not receiving the program. All patients will be carefully followed for 2 years. We will evaluate whether the ParkFit program, when offered to PD patients with a sedentary lifestyle, affords a meaningful improvement in physical activity levels during at least 2 years. We will also determine the health benefits of these improved physical activity levels.
Relevance to Diagnosis/Treatment of Parkinson’s Disease:
We expect to demonstrate that the ParkFit program is a pragmatic way to help patients in improving their levels of physical activity, and that such an increase in physical activity is associated with considerable health benefits for patients with PD. If proven to be effective, the ParkFit program can easily be implemented into clinical practices around the world. In addition, our study may clarify if exercise could be used to slow down the progression of PD. This would obviously have an enormous impact for PD patients worldwide.
Anticipated Outcome:
Simply advertising the benefits of more physical activity is clearly not enough to actually make people move more, and this is particularly true for patients with a chronic disease such as PD. We hope to learn more about the critical determinants that are required to increase physical activity levels in PD patients. In addition, we expect to establish the specific health benefits for patients who manage to increase their physical activity levels. Finally, this is the first study to address whether physical activity in everyday life might be used to slow down the progression of PD.
Progress Report
Many patients with Parkinson’s disease (PD) lead a sedentary lifestyle. Promotion of physical activities may beneficially affect the clinical presentation of PD, and perhaps even modify the course of PD. However, because of physical and cognitive impairments, patients with PD require specific support to increase their level of physical activity. For this purpose, we have developed the ParkFit Program: a PD?specific and multifaceted behavioral program to promote physical activity. The emphasis is on creating a behavioral change, using a combination of accepted behavioral motivation techniques. In addition, we designed a multicentre randomized clinical trial (The ParkFit trial) to investigate whether this ParkFit Program increases physical activity levels over two years in sedentary PD patients. A total of 586 patients – with a mean (SD) age of 64.1 (7.6) years and disease duration of 5.3 (4.5) years – has entered the study. The ParkFit trial is expected to yield important new evidence about behavioral interventions to promote physical activity in sedentary patients with PD. The results of the trial are expected in the year 2012.
Final Outcome
The ParkFit study is a large multifaceted behavioral change program to increase physical activity in sedentary patients with Parkinson disease (PD) over a period of two-years. Recruitment ran from September 2008 to January 2010, every patient is followed for two years. After baseline assessment, 586 PD patients were randomly assigned either to the ParkFit program or a matched general physiotherapy intervention. The ParkFit program was based on theories and models of behavioural change and widely used behavioural change techniques with proven effectiveness. The ParkFit program and the control intervention were exclusively delivered by experienced physiotherapists who participate in the Dutch ParkinsonNet (n=154). During the study period we have organized 190 ‘assessment days’ in 26 ParkinsonNet regions until December 2011. The study is now finished and the results of the study will be published soon.
Presentations & Publications
Presentations:
o Munneke; Physical Activity®: Just like a drug, Movement Disorders Congress 2009 (Paris)
o Speelman; The ParkFit study, Exercise Conference 2009 (London)
o Munneke; Exercise in Parkinson’s Disease, 21st Puijo symposium “physical exercise, aging and disability – current evidence” 2011 (Kuopio, Finland)
o Speelman; The ParkFit study. Ralph S. Paffenbarger Jr. poster award 2011, 21st Puijo symposium “physical exercise, aging and disability – current evidence” 2011 (Kuopio, Finland)
o Bloem; The Dutch experience of rehabilitation trials in Parkinson’s disease. Trials Collaborators’ Meeting, Birmingham (27 June 2011).
o Bloem. The ParkFit trial: design and 6-month results. Parkinonism and Related disorders, 2011 (Shanghai).
o van Nimwegen, Dag van het sportonderzoek 2011, (The Hague, the Netherlands
o van Nimwegen, VSG congres 2011, (Kaatsheuvel, the Netherlands)
Coming in 2012
o Invited lectures Bloem and Munneke, Movement Disorders Congress (Dublin)
o Invited lecture Munneke, Neurorehabilitation Congress (Melbourne)
o Invited lecture Munneke and abstract presentation Speelman, Congress American College of Sports Medicine (San Francisco)
Publications:
Van Nimwegen M, Speelman AD, Smulders K, Overeem S, Borm GF, Bloem BR, Munneke M; on behalf of the ParkFit Study Group. Design and baseline characteristics of the ParkFit study: a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patients. BMC Neurology, 2010 (published)
Speelman AD, van de Warrenburg BP, van Nimwegen M, Petzinger GM, Munneke M, Bloem BR; How might physical activity benefit patients with Parkinson disease?. Nat. Rev. Neurol., 2011 (published)
Van Nimwegen M, Speelman AD, Hofman-van Rossum EJM, Overeem S, Deeg DJH, Borm GF, van der Horst MHL, Bloem BR, Munneke M; Physical inactivity in Parkinson’s disease, J Neurol, 2011 (published)
Speelman AD, van Nimwegen M, Borm GF, Bloem BR, Munneke M; Monitoring of walking in Parkinson’s disease: Validation of an ambulatory monitor, Parkinsonism and related disorders, 2011 (published)
Speelman AD, Groothuis JT, van Nimwegen M, van der Scheer ES, Borm GF, Bloem BR, Hopman MTE, Munneke M; Cardiovascular responses during a submaximal exercise test in patients with Parkinson’s disease, Neurology (submitted)