Home-based prescribed exercise improves balance-related activities in people with Parkinson's disease and has benefits similar to centre-based exercise: a systematic review

Allyson Flynn; Natalie E Allen; Sarah Dennis; Colleen G Canning; Elisabeth Preston

doi:10.1016/j.jphys.2019.08.003

Home-based prescribed exercise improves balance-related activities in people with Parkinson's disease and has benefits similar to centre-based exercise: a systematic review

J Physiother. 2019 Oct;65(4):189-199. doi: 10.1016/j.jphys.2019.08.003. Epub 2019 Sep 11.

Authors

Allyson Flynn¹, Natalie E Allen², Sarah Dennis³, Colleen G Canning², Elisabeth Preston⁴

Affiliations

¹ Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Australia; Discipline of Physiotherapy, Faculty of Health, University of Canberra, Australia. Electronic address: Allyson.Flynn@canberra.edu.au.
² Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Australia.
³ Discipline of Physiotherapy, Faculty of Health Sciences, The University of Sydney, Australia; South Western Sydney Local Health District, Australia.
⁴ Discipline of Physiotherapy, Faculty of Health, University of Canberra, Australia.

PMID: 31521554
DOI: 10.1016/j.jphys.2019.08.003

Abstract

Questions: In people with Parkinson's disease, does home-based prescribed exercise improve balance-related activities and quality of life compared with no intervention? Are the effects of home-based exercise similar to those of equivalent centre-based exercise?

Design: Systematic review and meta-analysis of randomised and quasi-randomised controlled trials.

Participants: Adults diagnosed with idiopathic Parkinson's disease.

Intervention: Predominantly home-based prescribed exercise (defined as a minimum of two-thirds of the exercise being completed at home). The intervention had to primarily involve physical practice of exercises targeting gait and/or standing balance compared with either control (ie, usual care only, a sham intervention or no physiotherapy) or equivalent predominantly centre-based exercise.

Outcome measures: The primary outcome was balance-related activities and the secondary outcomes were gait speed, Berg Balance Scale, Functional Reach test, and quality of life.

Results: Sixteen trials met the inclusion criteria and all contributed to the meta-analyses. Twelve trials compared home-based prescribed exercise with control, and four trials compared home-based prescribed exercise with equivalent centre-based exercise. Home-based prescribed exercise improved balance-related activities (SMD 0.21, 95% CI 0.10 to 0.32) and gait speed (SMD 0.30, 95% CI 0.12 to 0.49), but not quality of life (SMD 0.11, 95% CI -0.01 to 0.23) compared with control. Home-based and centre-based exercise had similar effects on balance-related activities (SMD -0.04, 95% CI -0.36 to 0.27) and quality of life (SMD -0.08, 95% CI -0.41 to 0.24).

Conclusion: Home-based prescribed exercise improves balance-related activities and gait speed in people with Parkinson's disease, and these improvements are similar to improvements with equivalent centre-based exercise.

Registration: PROSPERO CRD 42018107331.

Keywords: Exercise; Home based; Parkinson disease; Rehabilitation; Systematic review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Exercise Therapy / methods*
Humans
Parkinson Disease / physiopathology
Parkinson Disease / rehabilitation*
Postural Balance*
Quality of Life
Randomized Controlled Trials as Topic