Physical Therapy Program, Department of Physical Medicine and Rehabilitation, School of Medicine, University of Colorado Anschutz Medical Campus, Mailstop C-244, 13121 E 17th Ave, ED II South, Room L28-3106, Aurora, CO 80045, USA.
Phys Ther. 2012 Nov;92(11):1395-410. doi: 10.2522/ptj.20110472. Epub 2012 Jul 19.
Exercise confers short-term benefits for individuals with Parkinson disease (PD).
The purpose of the study was to compare short- and long-term responses among 2 supervised exercise programs and a home-based control exercise program.
The 16-month randomized controlled exercise intervention investigated 3 exercise approaches: flexibility/balance/function exercise (FBF), supervised aerobic exercise (AE), and home-based exercise (control).
This study was conducted in outpatient clinics.
The participants were 121 individuals with PD (Hoehn & Yahr stages 1-3).
The FBF program (individualized spinal and extremity flexibility exercises followed by group balance/functional training) was supervised by a physical therapist. The AE program (using a treadmill, bike, or elliptical trainer) was supervised by an exercise trainer. Supervision was provided 3 days per week for 4 months, and then monthly (16 months total). The control group participants exercised at home using the National Parkinson Foundation Fitness Counts program, with 1 supervised, clinic-based group session per month.
Outcomes, obtained by blinded assessors, were determined at 4, 10, and 16 months. The primary outcome measures were overall physical function (Continuous Scale-Physical Functional Performance [CS-PFP]), balance (Functional Reach Test [FRT]), and walking economy (oxygen uptake [mL/kg/min]). Secondary outcome measures were symptom severity (Unified Parkinson's Disease Rating Scale [UPDRS] activities of daily living [ADL] and motor subscales) and quality of life (39-item Parkinson's Disease Quality of Life Scale [PDQ-39]).
Of the 121 participants, 86.8%, 82.6%, and 79.3% completed 4, 10, and 16 months, respectively, of the intervention. At 4 months, improvement in CS-PFP scores was greater in the FBF group than in the control group (mean difference=4.3, 95% confidence interval [CI]=1.2 to 7.3) and the AE group (mean difference=3.1, 95% CI=0.0 to 6.2). Balance was not different among groups at any time point. Walking economy improved in the AE group compared with the FBF group at 4 months (mean difference=-1.2, 95% CI=-1.9 to -0.5), 10 months (mean difference=-1.2, 95% CI=-1.9 to -0.5), and 16 months (mean difference=-1.7, 95% CI=-2.5 to -1.0). The only secondary outcome that showed significant differences was UPDRS ADL subscale scores: the FBF group performed better than the control group at 4 months (mean difference=-1.47, 95% CI=-2.79 to -0.15) and 16 months (mean difference=-1.95, 95% CI=-3.84 to -0.08).
Absence of a non-exercise control group was a limitation of the study.
Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy (up to 16 months) in the AE group.
运动对帕金森病（PD）患者有短期益处。
本研究旨在比较 2 种监督下的运动方案与家庭为基础的对照运动方案之间的短期和长期反应。
这项为期 16 个月的随机对照运动干预研究调查了 3 种运动方法：灵活性/平衡/功能锻炼（FBF）、监督有氧运动（AE）和家庭为基础的锻炼（对照组）。
本研究在门诊诊所进行。
121 名 PD 患者（Hoehn & Yahr 分期 1-3）参加了研究。
FBF 方案（个体化脊柱和肢体柔韧性锻炼，随后进行小组平衡/功能训练）由物理治疗师监督。AE 方案（使用跑步机、自行车或椭圆训练器）由运动训练师监督。监督在 4 个月内每周进行 3 天，然后每月进行（共 16 个月）。对照组的参与者在家中使用国家帕金森基金会健身计数方案进行锻炼，每月参加 1 次监督的小组课程。
由盲法评估者获得的结果在 4、10 和 16 个月时进行评估。主要结局指标是整体身体功能（连续量表-身体功能表现[CS-PFP]）、平衡（功能伸展测试[FRT]）和步行经济性（耗氧量[mL/kg/min]）。次要结局指标是症状严重程度（统一帕金森病评定量表[UPDRS]日常生活活动[ADL]和运动子量表）和生活质量（39 项帕金森病生活质量量表[PDQ-39]）。
在 121 名参与者中，分别有 86.8%、82.6%和 79.3%完成了干预的 4、10 和 16 个月。在 4 个月时，FBF 组的 CS-PFP 评分改善大于对照组（平均差异=4.3，95%置信区间[CI]为 1.2 至 7.3）和 AE 组（平均差异=3.1，95%CI 为 0.0 至 6.2）。在任何时间点，各组之间的平衡都没有差异。与 FBF 组相比，AE 组在 4 个月（平均差异=-1.2，95%CI=-1.9 至-0.5）、10 个月（平均差异=-1.2，95%CI=-1.9 至-0.5）和 16 个月（平均差异=-1.7，95%CI=-2.5 至-1.0）时的步行经济性均有改善。仅在次要结局中出现显著差异，即 UPDRS ADL 子量表评分：4 个月时，FBF 组的表现优于对照组（平均差异=-1.47，95%CI=-2.79 至-0.15）和 16 个月时（平均差异=-1.95，95%CI=-3.84 至-0.08）。
缺乏非运动对照组是研究的一个局限性。
研究结果表明，FBF 组在 4 个月时具有整体功能益处，AE 组在 16 个月时改善了步行经济性。
