Sajatovic Martha, Ridgel Angela L, Walter Ellen M, Tatsuoka Curtis M, Colón-Zimmermann Kari, Ramsey Riane K, Welter Elisabeth, Gunzler Steven A, Whitney Christina M, Walter Benjamin L
Department of Neurology, Case Western Reserve University School of Medicine.
Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center, Cleveland.
Patient Prefer Adherence. 2017 May 19;11:965-973. doi: 10.2147/PPA.S135551. eCollection 2017.
Depression is common in people with Parkinson's disease (PD), and exercise is known to improve depression and PD. However, lack of motivation and low self-efficacy can make exercise difficult for people with PD and comorbid depression (PD-Dep). A combined group exercise and chronic disease self-management (CDSM) program may improve the likeli-hood that individuals will engage in exercise and will show a reduction in depression symptoms. The purpose of this study was to compare changes in depression in PD-Dep between individual versus group exercise plus CDSM and to examine participant adherence and perception of the interventions.
Participants (N=30) were randomized to either Enhanced EXerCisE thErapy for PD (EXCEED; group CDSM and exercise) or self-guided CDSM plus exercise. Outcomes were change in depression assessed with the Montgomery-Asberg Depression Rating Scale (MADRS), cognition, apathy, anxiety, sleep, quality of life, motor function, self-efficacy, and patient satisfaction.
Both groups showed significant improvement in MADRS (<0.001) with no significant group difference. Individuals in EXCEED group enjoyed the group dynamics but noted difficulty with the fixed-time sessions.
Both group CDSM plus exercise and self-guided CDSM plus exercise can improve depression in PD-Dep. These findings suggest that development of a remotely delivered group-based CDSM format plus manualized exercise program could be useful for this population.
抑郁症在帕金森病（PD）患者中很常见，已知运动可改善抑郁症和帕金森病。然而，缺乏动力和自我效能感低会使PD合并抑郁症（PD-Dep）患者难以进行运动。综合的团体运动和慢性病自我管理（CDSM）项目可能会提高个体参与运动的可能性，并减轻抑郁症状。本研究的目的是比较PD-Dep患者在个体运动与团体运动加CDSM之间抑郁症状的变化，并检查参与者对干预措施的依从性和看法。
参与者（N = 30）被随机分为帕金森病强化运动疗法（EXCEED；团体CDSM和运动）组或自我指导的CDSM加运动组。结果指标包括用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）评估的抑郁变化、认知、冷漠、焦虑、睡眠、生活质量、运动功能、自我效能感和患者满意度。
两组的MADRS评分均有显著改善（<0.001），组间无显著差异。EXCEED组的个体喜欢团体氛围，但指出固定时间的课程有困难。
团体CDSM加运动和自我指导的CDSM加运动均可改善PD-Dep患者的抑郁症状。这些发现表明，开发一种远程提供的基于团体的CDSM形式加标准化运动项目可能对该人群有用。
