Promotion of physical activity and fitness in sedentary patients with Parkinson's disease: randomised controlled trial

Marlies van Nimwegen, Arlène D Speelman, Sebastiaan Overeem, Bart P van de Warrenburg, Katrijn Smulders, Manon L Dontje, George F Borm, Frank J G Backx, Bastiaan R Bloem, Marten Munneke, ParkFit Study Group, A Winogrodzka, J C M Zijlmans, G J Tissingh, K Keizer, H J M M Lohmann, R van Koningsveld, A J W Boon, E van Wensen, F E Strijks, G A van Meer, A Mosch, J P ter Bruggen, M F Roesdi, E Berger, A G G C Korten, M Westerink, M Aramideh, R Rundervoort, F A Rooyer, D J Kamphuis, G J de Jong, L van Hooff, K Lemmen, J M Breuer, J M J Krul, P M Laboyrie, F J W Opstelten, A M G Sas, P J Nederveen, J Lion, C Jansen, Marlies van Nimwegen, Arlène D Speelman, Sebastiaan Overeem, Bart P van de Warrenburg, Katrijn Smulders, Manon L Dontje, George F Borm, Frank J G Backx, Bastiaan R Bloem, Marten Munneke, ParkFit Study Group, A Winogrodzka, J C M Zijlmans, G J Tissingh, K Keizer, H J M M Lohmann, R van Koningsveld, A J W Boon, E van Wensen, F E Strijks, G A van Meer, A Mosch, J P ter Bruggen, M F Roesdi, E Berger, A G G C Korten, M Westerink, M Aramideh, R Rundervoort, F A Rooyer, D J Kamphuis, G J de Jong, L van Hooff, K Lemmen, J M Breuer, J M J Krul, P M Laboyrie, F J W Opstelten, A M G Sas, P J Nederveen, J Lion, C Jansen

Abstract

Objective: To evaluate whether a multifaceted behavioural change programme increases physical activities in patients with Parkinson's disease.

Design: Multicentre randomised controlled trial.

Setting: 32 community hospitals in the Netherlands, collaborating in a nationwide network (ParkinsonNet).

Participants: 586 sedentary patients with idiopathic Parkinson's disease aged between 40 and 75 years with mild to moderate disease severity (Hoehn and Yahr stage ≤ 3).

Intervention: Patients were randomly assigned to the ParkFit programme or a matched general physiotherapy intervention. ParkFit is a multifaceted behavioural change programme, designed specifically to achieve an enduring increase in the level of physical activity (coaches using motivational strategies; ambulatory feedback).

Main outcome measures: The primary endpoint was the level of physical activity, measured every six months with a standardised seven day recall (LASA physical activity questionnaire-LAPAQ). Secondary endpoints included two other measures of physical activity (activity diary and ambulatory activity monitor), quality of life (Parkinson's disease questionnaire-PDQ-39), and fitness (six minute walk test).

Results: 540 (92.2%) patients completed the primary outcome. During follow-up, overall time spent on physical activities (LAPAQ) was comparable between the groups (adjusted group difference 7%, 95% confidence interval -3 to 17%; P=0.19). Analyses of three secondary outcomes indicated increased physical activity in ParkFit patients, as suggested by the activity diary (difference 30%; P<0.001), the activity monitor (difference 12%; P<0.001), and the six minute walk test (difference 4.8 m; P=0.05). PDQ-39 did not differ between ParkFit patients and controls (difference -0.9 points; P=0.14). The number of fallers was comparable between ParkFit patients (184/299; 62%) and controls (191/287; 67%).

Conclusions: The ParkFit behavioural change programme did not increase overall physical activity, as measured with the LAPAQ. The analysis of the secondary endpoints justifies further work into the possible merits of behavioural change programmes to increase physical activities in daily life in Parkinson's disease.

Trial registration: Clinical trials NCT00748488.

Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work (other than those listed under funding); SO is supported by a VIDI grant from the Netherlands Organization for Scientific Research (016.116.371) and has received honorariums for serving on scientific advisory boards for Boehringer Ingelheim, UCB Pharma, and Novartis; GFB received a grant from ZonMw and is a consultant for the pharmaceutical companies Synthon and Panta Rhei; BPW has received research support from the European Union, the Prinses Beatrix Fonds, the Dutch Brain Foundation, Ipsen Pharmaceuticals, the Gossweiler Foundation, and the Royal Dutch Society for Physiotherapy; FJGB has received grants from ZonMw and the Dutch Diabetes Fund; BRB has served as an editorial board member for Movement Disorders, currently serves as an editorial board member for Physiotherapy Canada, is associate editor for the Journal of Parkinson’s Disease, and has received honorariums for serving on scientific advisory boards for Boehringer Ingelheim, Teva, GlaxoSmithKline, and Novartis and research support from the Netherlands Organization for Scientific Research (016.076.352), the Michael J Fox Foundation, the Prinses Beatrix Foundation, the Stichting Internationaal Parkinson Fonds, and the Alkemade Keuls fonds; MM has received grants from ZonMw, the Michael J Fox Foundation, the National Parkinson Foundation, the Dutch Parkinson’s Disease Society, and the Prinses Beatrix Fonds.

Figures

https://www.ncbi.nlm.nih.gov/pmc/articles/instance/4790789/bin/vanm006637.f1_default.jpg
Screening, randomisation, and completion of primary outcome measure. *Vigorous intensity physical activity >3 times/week and >60 minutes/week or moderate intensity physical activity >3 times/week and >150 minutes/week. †Hoehn and Yahr stage >3, mini-mental state examination

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