Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
JMIR Mhealth Uhealth. 2021 Aug 31;9(8):e27662. doi: 10.2196/27662.
Patients with parkinsonism have higher inactivity levels than the general population, and this results in increased comorbidities. Although exercise has benefits for motor function and quality of life (QOL) in patients with parkinsonism, these patients face many barriers to exercise participation, such as lack of motivation, fatigue, depression, and time constraints. Recently, the use of mobile apps has been highlighted as a remote exercise management strategy for patients with chronic diseases.
This study aimed to evaluate the effects of home-based exercise management with a customized mobile app on the exercise amount, physical activity, and QOL of patients with parkinsonism.
This was a prospective, open-label, single-arm pilot study. The therapist installed the app in the smartphones of the participants and educated them on how to use the app. The therapist developed an individualized multimodal exercise program that consisted of stretching, strengthening, aerobic, balance and coordination, and oral-motor and vocal exercises. Participants were encouraged to engage in an 8-week home-based exercise program delivered through a customized app. The alarm notifications of the app provided reminders to exercise regularly at home. The primary outcome was the exercise amount. The secondary outcomes were assessed using the International Physical Activity Questionnaire (IPAQ), Parkinson's Disease Questionnaire-39 (PDQ-39), and Geriatric Depression Scale (GDS). The usability of the customized app was assessed using a self-report questionnaire.
A total of 21 participants with parkinsonism completed the intervention and assessment between September and December 2020 (mean age: 72 years; women: 17/21, 81%; men: 4/21, 19%). The participants reported a significant increase in the total amount of exercise (baseline: mean 343.33, SD 206.70 min/week; 8-week follow-up: mean 693.10, SD 373.45 min/week; P<.001) and in the amount of each exercise component, including stretching, strengthening, balance and coordination, and oral-motor and vocal exercise after 8 weeks. Analysis of the secondary outcomes revealed significant improvements in the IPAQ (P=.006), PDQ-39 (P=.02), and GDS (P=.04) scores. The usability of the program with the mobile app was verified based on the positive responses such as "intention to use" and "role expectation for rehabilitation."
Exercise management with a customized mobile app may be beneficial for improving exercise adherence, physical activity levels, depression management, and QOL in patients with parkinsonism. This remotely supervised technology-based, reinforcing, and multimodal exercise management strategy is recommended for use in patients with parkinsonism. In addition, this program proved useful as an alternative exercise management strategy during the COVID-19 pandemic when patients with Parkinson disease were less physically active than before and showed aggravation of symptoms. However, additional clinical trials are needed to evaluate the efficacy of this exercise program in a large population and to confirm its disease-modifying effects.
帕金森病患者的活动水平高于一般人群，这导致合并症增加。尽管运动对帕金森病患者的运动功能和生活质量（QOL）有益，但这些患者在参与运动方面面临许多障碍，例如缺乏动力、疲劳、抑郁和时间限制。最近，使用移动应用程序已被强调为慢性病患者远程运动管理策略。
本研究旨在评估基于家庭的运动管理与定制移动应用程序对帕金森病患者运动量、身体活动和生活质量的影响。
这是一项前瞻性、开放标签、单臂试点研究。治疗师在参与者的智能手机上安装了该应用程序，并对他们进行了如何使用该应用程序的教育。治疗师制定了一个个体化的多模式运动方案，包括伸展、强化、有氧运动、平衡和协调以及口腔运动和发声练习。鼓励参与者参与为期 8 周的基于家庭的运动计划，通过定制应用程序进行。该应用程序的警报通知提供了定期在家锻炼的提醒。主要结局是运动量。次要结局使用国际体力活动问卷（IPAQ）、帕金森病问卷-39（PDQ-39）和老年抑郁量表（GDS）进行评估。使用自我报告问卷评估定制应用程序的可用性。
共有 21 名帕金森病患者在 2020 年 9 月至 12 月期间完成了干预和评估（平均年龄：72 岁；女性：21 人，81%；男性：4 人，19%）。参与者报告称，他们的总运动量（基线：平均 343.33，SD 206.70 分钟/周；8 周随访：平均 693.10，SD 373.45 分钟/周；P<.001）和每个运动组成部分（包括伸展、强化、平衡和协调以及口腔运动和发声练习）的运动量均显著增加。对次要结局的分析显示，IPAQ（P=.006）、PDQ-39（P=.02）和 GDS（P=.04）评分均有显著改善。基于“使用意向”和“康复角色期望”等积极反馈，验证了该移动应用程序的程序可用性。
使用定制移动应用程序进行运动管理可能有助于提高帕金森病患者的运动依从性、身体活动水平、抑郁管理和生活质量。建议在帕金森病患者中使用这种远程监督、强化和多模式的运动管理策略。此外，在 COVID-19 大流行期间，当帕金森病患者的身体活动量低于以往水平且症状加重时，该计划作为替代运动管理策略非常有用。然而，需要更多的临床试验来评估该运动计划在更大人群中的疗效，并确认其对疾病的改善作用。
