Physiotherapy led palliative exercise programme for people with advanced Parkinson's disease (PEP-PD): a feasibility study

Introduction Parkinson’s disease (PD) is the second most common neurodegenerative condition with an estimated world prevalence of 5 million. People with PD in Ireland cannot consistently avail themselves of specialist palliative care services. A recent cross sectional study by Saleem et al, 2013 examined the palliative care needs of people with PD [1]. The study reported problems with mobility as one of the main symptoms for people with PD. Aim The main aim of this thesis was to examine the feasibility of engaging people with advanced Parkinson’s disease (Hoehn and Yahr stage 3 to 4) in a group exercise programme in a hospice setting. The secondary aim was to examine if this exercise programme impacted on measures of impairment, activity limitation and participation restrictions in people with advanced PD. Methods Two systematic reviews with meta-analysis were completed to examine the totality of evidence for aerobic and progressive resistance exercise for people with PD. The review output informed the design of a feasibility study comprising six weeks of a lower limb, progressive resistance training programme; once weekly supervised in a hospice out-patient setting and twice weekly unsupervised at home. Primary outcome measure was the SMWT. Secondary outcome measures included the p1-RM, MDS-UPDRS and PDQ-39. Assessments took place at pre, post and six month follow up points. Semi-structured interviews were also outlined and took place at the post assessment. Results A significant improvement was found in muscle strength (p < 0.05) of the lower limbs and non-significant improvement in the SMWT, MDS-UPDRS and PDQ-39. Qualitative interview results reported participants experiencing a perceived improvement in walking capacity and identified and outlined four main themes that impact exercise in people with PD. Further research is needed to examine the impact of progressive resistance training for advanced stage people with PD in a hospice setting.