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

Article type: Research Article

Authors: Rafferty, Miriam R.^{a; *} | Schmidt, Peter N.^b | Luo, Sheng T.^c | Li, Kan^d | Marras, Connie^e | Davis, Thomas L.^f | Guttman, Mark^g | Cubillos, Fernando^b | Simuni, Tanya^h | on behalf of all NPF-QII Investigatorsⁱ

Affiliations: [a] Center for Education in Health Sciences Northwestern University, Chicago, IL, USA | [b] National Parkinson Foundation, Miami, FL, USA | [c] Department of Biostatistics, University of Texas Health Science Center at Houston, Houston, TX, USA | [d] Department of Biostatistics, University of Texas Health Science Center at Houston, Houston, TX, USA | [e] Morton and Gloria Shulman Movement Disorders Centre and the Edmond J Safra Program in Parkinson’s disease, Toronto Western Hospital, University of Toronto, Toronto, Canada | [f] Thomas L. Davis, Division of Movement Disorders, Department of Neurology, Vanderbilt University, Nashville, TN, USA | [g] Division of Neurology, Department of Medicine, University of Toronto, Toronto, Canada | [h] Department of Neurology, Northwestern University, Chicago, IL, USA | [i] All National Parkinson Foundation – Quality Improvement Initiative (NPF-QII) Centers and site principal investigators are listed in the Appendix

Correspondence: [*] Correspondence to: Miriam R. Rafferty, Center for Education in Health Sciences, Northwestern University, 633N. St Clair 20th floor (2024-L), Chicago, IL 60611, USA. Tel.: +1 312 503 4288; Fax: +1 312 503 4401; E-mail: [email protected].

Abstract: Background: Research-based exercise interventions improve health-related quality of life (HRQL) and mobility in people with Parkinson’s disease (PD). Objective: To examine whether exercise habits were associated with changes in HRQL and mobility over two years. Methods: 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. Results: 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 < 0.05). Non-exercisers worsened by 1.37 points on the PDQ-39 and a 0.47 seconds on the TUG per year. Increasing exercise by 30 minutes/week was associated with slower declines in HRQL (–0.16 points) and mobility (–0.04 sec). The benefit of exercise on HRQL was greater in advanced PD (–0.41 points) than mild PD (–0.14 points; p < 0.02). Conclusions: Consistently exercising and starting regular exercise after baseline were associated with small but significant positive effects on HRQL and mobility changes over two years. The greater association of exercise with HRQL in advanced PD supports improving encouragement and facilitation of exercise in advanced PD.

Keywords: Parkinson disease, exercise, quality of life, mobility limitations, rehabilitation

DOI: 10.3233/JPD-160912

Journal: Journal of Parkinson's Disease, vol. 7, no. 1, pp. 193-202, 2017