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Regular Exercise, Quality of Life, and Mobility in Parkinson's Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data.

ABSTRACT: Research-based exercise interventions improve health-related quality of life (HRQL) and mobility in people with Parkinson's disease (PD).To examine whether exercise habits were associated with changes in HRQL and mobility over two years.We identified a cohort of National Parkinson Foundation Quality Improvement Initiative (NPF-QII) participants with three visits. HRQL and mobility were measured with the Parkinson's Disease Questionnaire (PDQ-39) and Timed Up and Go (TUG). We compared self-reported regular exercisers (?2.5 hours/week) with people who did not exercise 2.5 hours/week. Then we quantified changes in HRQL and mobility associated with 30-minute increases in exercise, across PD severity, using mixed effects regression models.Participants with three observational study visits (n?=?3408) were younger, with milder PD, than participants with fewer visits. After 2 years, consistent exercisers and people who started to exercise regularly after their baseline visit had smaller declines in HRQL and mobility than non-exercisers (p?

SUBMITTER: Rafferty MR

PROVIDER: S-EPMC5482526 | biostudies-literature | 2017

REPOSITORIES: biostudies-literature

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Regular Exercise, Quality of Life, and Mobility in Parkinson's Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data.

Rafferty Miriam R MR Schmidt Peter N PN Luo Sheng T ST Li Kan K Marras Connie C Davis Thomas L TL Guttman Mark M Cubillos Fernando F Simuni Tanya T

Journal of Parkinson's disease 20170101 1

<h4>Background</h4>Research-based exercise interventions improve health-related quality of life (HRQL) and mobility in people with Parkinson's disease (PD).<h4>Objective</h4>To examine whether exercise habits were associated with changes in HRQL and mobility over two years.<h4>Methods</h4>We identified a cohort of National Parkinson Foundation Quality Improvement Initiative (NPF-QII) participants with three visits. HRQL and mobility were measured with the Parkinson's Disease Questionnaire (PDQ-3 ...[more]

PMID: 27858719

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Project description:Background and objectivesOwing to the lack of long-term observations or comprehensive adjustment for confounding factors, reliable conclusions regarding long-term effects of exercise and regular physical activity in Parkinson disease (PD) have yet to be drawn. Here, using data from the Parkinson's Progression Markers Initiative study that includes longitudinal and comprehensive evaluations of many clinical parameters, we examined the long-term effects of regular physical activity and exercise habits on the course of PD.MethodsIn this retrospective, observational cohort study, we primarily used the multivariate linear mixed-effects models to analyze the interaction effects of their regular physical activity and moderate to vigorous exercise levels, measured with the Physical Activity Scale for the Elderly questionnaire, on the progression of clinical parameters, after adjusting for age, sex, levodopa equivalent dose, and disease duration. We also calculated bootstrapping 95% confidence intervals (CIs) and conducted sensitivity analyses using the multiple imputation method and subgroup analyses using propensity score matching to match for all baseline background factors.ResultsTwo hundred thirty-seven patients with early PD (median [interquartile range] age, 63.0 [56.0-70.0] years, male 69.2%, follow-up duration 5.0 [4.0-6.0] years) were included. Regular physical activity and moderate to vigorous exercise levels at baseline did not significantly affect the subsequent clinical progression of PD. However, average regular overall physical activity levels over time were significantly associated with slower deterioration of postural and gait stability (standardized fixed-effects coefficients of the interaction term [βinteraction] = -0.10 [95% CI -0.14 to -0.06]), activities of daily living (βinteraction = 0.08 [95% CI 0.04-0.12]), and processing speed (βinteraction = 0.05 [95% CI 0.03-0.08]) in patients with PD. Moderate to vigorous exercise levels were preferentially associated with slower decline of postural and gait stability (βinteraction = -0.09 [95% CI -0.13 to -0.05]), and work-related activity levels were primarily associated with slower deterioration of processing speed (βinteraction = 0.07 [95% CI 0.04-0.09]). Multiple imputation and propensity score matching confirmed the robustness of our results.DiscussionIn the long term, the maintenance of high regular physical activity levels and exercise habits was robustly associated with better clinical course of PD, with each type of physical activity having different effects.Trial registration informationClinicalTrials.gov Identifier: NCT01176565.Classification of evidenceThis study provides Class II evidence that sustained increase in overall regular physical activity levels in patients with early PD was associated with slower decline of several clinical parameters.

Project description:Background/objectivesTo describe the Mobility Action Group (MACT), an innovative process to enhance implementation of hospital mobility programs and create a culture of mobility in acute care.DesignContinuous quality improvement intervention with episodic data review.SettingInpatient units including medical, surgical, and intensive care settings.ParticipantsA total of 42 hospitals of varying sizes across the United States.InterventionsThe MACT and Change Package were developed to provide a conceptual framework, road map, and step-by-step guide to enable mobility teams to implement mobility programs successfully and meet their mobilization goals. Participants were encouraged to select two to three change tactics to pursue during the first action cycle and select and implement additional tactics in subsequent cycles. Nine learning sessions were held via webinar from April 27, 2017, to October 5, 2017, during which faculty provided brief presentations, facilitation, and group discussion.MeasurementsImplementation of programs, walks per day, use of bed and chair alarms, and participant satisfaction.ResultsSuccessful implementation of mobility programs was achieved at most (76%) sites. The proportion of patients who received at least three walks per day increased from 9% to 19%. The proportion of patients who were placed on a bed or chair alarm decreased from 36% to 20%. On average, 69% of participants reported they were "strongly satisfied" with the learning sessions. Most participants found the Change Package (58%) and Toolkit (63%) "very helpful." Since the conclusion of the active initiative, the Change Package has been downloaded 1,200 times. Of those who downloaded it, 48% utilized it to establish a mobility program, and 58% used it at their organization at least once a month.ConclusionThe MACT and Change Package provides an innovative approach emphasizing systemwide change that can help catalyze a culture of mobility in hospitals across the nation, improving the quality of care for hospitalized older adults. J Am Geriatr Soc 68:2373-2381, 2020.

Dataset Information

Regular Exercise, Quality of Life, and Mobility in Parkinson's Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data.

Publications

Regular Exercise, Quality of Life, and Mobility in Parkinson's Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data.

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