Effects Of Traditional Chinese Medical Exercise On Mobility,Psychology And Quality Of Life In Patients With Parkinson's Disease:Homebased Vs Community-based Training

Background and purposes:China is the country with the largest number of patients with Parkinson's Disease(PD)in the world.Clinically relevant motor symptoms and non-motor symptoms of PD severely reduce the quality of life of patients.Studies have shown that Traditional Chinese Medical exercises can effectively improve the motor and non-motor symptoms and quality of life of patients with PD,but different training modes(homebased or community-based modes)of Traditional Chinese exercises on improving symptoms of PD patients need to be further clarified.The purpose of the present study is to explore whether homebased and community-based practice of traditional Chinese Exercises could improve symptoms of patients with PD;and to compare the differences of effect between homebased and community-based practice on patients with PD.Methods:Calculated the needed sample size by G*power is 28 and we enrolled thirty-four patients(12 males)considering the loss of sample.Those subjects were assigned to the community-based and homebased traditional Chinese exercise(Yi Tai chi,Health Qigong·Wu Qin Xi and Ba Duan Jin)groups.The patients participated in 90-minute exercise sessions twice weekly for 12 weeks.The patients in the community-based group practiced collectively under the guidance of professional coaches,and patients in the homebased group practiced at home with the video.The motor part of the Movement Disorder Society-sponsored revision of the Unified Parkinson Disease Rating Scale(UPDRSIII)was used to assess the motor symptoms,the new freezing of gait questionnaire(NFOGQ)was used to measure the freezing of gait,the Mini Balance Evaluation System Test(Mini-BEST)was used to assess balance,Timed Up and Go Test(TUGT)was used to assess mobility,TUGT-Cognitive Dual Task Test(cog-TUGT)was used to assess mobility when it is disturbed by cognitive task,10m Walk Test(10MWT)was used to measure velocity and step length,30 Seconds Sit to stand test(30s-STS)was used to measure strength of lower limbs,Hamilton Rating Scale of Depression(HRSD)was used to measure depression,Happiness Index was used to measure the subjective well-being,and The Parkinson's Disease-specific quality of life Questionnaire-39(PDQ-39)was used to measure quality of life of patients with Parkinson's Disease.Results:Thirty patients(male=11)completed the exercise training,and four patients(male=l)failed to complete the exercise.Repeated-measures analysis of variance was used to compare the intervention effects on outcome measures.1)The UPDRSIII scores of both groups were significantly reduced from baseline,from 19.7±11.8 to 12.3±7.9(p=0.002)in community-based group,and from 21.3±16 to 16.1±15.3(p=0.027)in homebased group,but no statistically significant difference between groups,p=0.556,and demonstrate that the homebased and community-based exercises shows no btween-group difference in improving motor symptoms of patients with PD.2)The Mini-BEST scores of the two groups were significantly increased from baseline,from 20.2±2.3 to 21.9±2.4(p=0.015)in community-based group,from 19.6±2.6 to 22.5±2.2(p<0.001)in homebased group,and no statistically significant difference between groups,p=1,and demonstrated that the homebased and community-based exercises shows no btween-group difference in improving balance of patients with PD.3)Homebased training performed better cog-TUGT than the community-based,F=6.297,p=0.018,between-group defference of the post was 1.8 with 95%CI of 0.5 to 3,p=0.007,indicated that the homebased exercise may show better effect on improving the ability for motor-cognitive dual task.4)There was no statistically significant change between groups for the NFOGQ scores(p=0.951),but homebased training group got significant higher scores from baseline,from 2.8±4.6 to 9.5±8.8(p=0.007).We speculate that the community-based exercise may play a maintenance effect on freezing of gait according to the chronic progression characteristic of PD.5)Both groups performed better from baseline for the subjective well-being,from 76±15.7to 85±9.5(p<0.001)in community-based group,from 71±22.9to 78±25(p<0.000)for the homebased group,but no between-group defferrence change were observed(p=0.841),showed that the homebased and community-based exercises shows no btween-group difference in improving subjective well-being of patients with PD.6)There was no statistically significant change between groups for the HRSD scores(p=0.316),but community-based training group got significant lower scores from baseline,9.7±4.8 to 6.3±4.4,(p=0.008),indicated that patients with PD would benefit from community-based training.Conclusions:Homebased training may have a better effect on improving the motor-cognitive dual task ability of individuals with PD.Community-based training appears to benefit for improved depression(HRSD)and may have a maintainnance effect on the freezing of gait(NFOGQ).And home-based training of traditional Chinese Medical exercises appears to have the same effect on improving motor symptoms(UPDRSIII),balance(Mini-BEST),and subjective well-being(happiness index)of patients with PD as the community-based training.