Date of Award

2018

Document Type

Scholarly Project

Degree Name

Doctor of Physical Therapy (DPT)

Department

Physical Therapy

First Advisor

Kristin Johnson Thomanschefsky

Abstract

Purpose/Hypothesis: High-intensity physical exercise has been shown to be beneficial in managing motor and nonmotor symptoms of Parkinson's Disease (PD). Exercise may also have global effects on factors that influence brain health and cognition. Programs that incorporate goal-based motor skill learning have shown promise in being more effective than aerobic exercise alone. People with PD have a need for ongoing, continuous, community-based exercise programs that are engaging and accessible. The purpose of this study was to examine the effect of a community-based exercise program, Rock Steady Boxing, on improving quality of life and physical mobility skills in people with PD.

Methods: Ten participants, five females and five males, mean age 69.6 years old (± 12 SD), clinically diagnosed with PD with a mean disease duration of 12.1 years (± 10 years) were recruited. Physical Therapist and Physical Therapy students collaborated with a local YMCA® to offer a Rock Steady boxing program (non-contact) to promote mobility, high intensity exercise, cognitive engagement, and transitional movements. Pre- and post-assessment at three months included gait speed, Parkinson's Disease Questionnaire-39 (PDQ-39) for quality of life change, Mini BESTest to measure balance/mobility, Five Times Sit to Stand to measure strength, Four Square Step Test for agility, and the Six Minute Walk Test to measure endurance.

Results: Five of the 10 participants reported an improvement in overall PDQ-39 scores. Of the 10 participants, 30% showed minimally clinically important change in cognition (MCID -1.8) and mobility (MCID -3.2), and 20% reported improvement in bodily discomfort (MCID -2.1). Post-test results of other measures were not statistically significant. Eight of the 10 participants attended the class, with a mean attendance of 6.7 visits (range 0-11), and indicated a plan to continue the exercise class. Statements from participants included: "more confidence with walking and moving", "more alert", and "enjoy the social aspect." Three of the 10 also reported a reduction in falls, and one reported an increase in falls during the three-month timeframe.

Conclusions: The outcomes of this pilot study show promise in improving quality of life and mobility in older adults with PD. Despite the progressive nature of PD, 30-50% of the participants in this study reported meaningful change in quality of life subscales while attending a three-month exercise program. More research is warranted to determine long-term benefits.

Clinical Relevance: Community-based exercise programs tailored to people with PD appear beneficial in improving functional mobility and quality of life. Programs that incorporate a combination of high intensity exercise, skill-based training, cognitive engagement and social interaction are recommended. People with PD will benefit from consistent attendance at classes that are designed to be both physically and financially accessible, to minimize barriers and encourage long-term exercise participation.

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