Promotion of Physical Activity in Parkinson’s Disease; The ParkFit study

The health benefits of regular physical activity are widely appreciated. However, many persons over 50 years of age lead a sedentary life. Apparently, simply knowing about the importance of physical activity is not enough to initiate and maintain an adequate physical activity level on a regular basis. To tackle this problem, programs aimed to promote an active lifestyle have been developed based on behavioural change theories. Evidence shows that such physical activity promotions are effective, resulting in increased physical activity among participants. Unfortunately, most of these programs were developed for healthy subjects, while almost 90% of elderly adults have at least one chronic condition. It is therefore important to develop physical activity promotion strategies specifically aimed at preventing physical inactivity in patients with chronic diseases. These strategies should not only address the disease-specific content of a physical activity program, but also provide an adequate infrastructure to implement the program. Here, we propose to develop, implement and evaluate a disease-specific program (‘ParkFit’) to promote physical activity for patients with Parkinson’s disease (PD). PD represents an excellent model to evaluate the promotion of an active lifestyle for patients with chronic diseases because: a) PD patients are heavily inclined towards physical inactivity, due to increasing physical impairments (e.g. walking problems), fear of falling, apathy and depression. b) There is convincing evidence showing the health benefits of exercise in PD. Maintaining physical activity is particularly important for PD patients who are extra prone to develop complications of immobility, including osteoporosis, constipation and insomnia. Furthermore, animal studies suggest that physical activity might slow the progression of PD (neuroprotection). c) An optimal infrastructure to implement the ParkFit program is in place. Specifically, we have recently installed ‘ParkNet’ networks in 16 regions in the Netherlands (see figure). Each ParkNet is a regional network of motivated physiotherapists with specific expertise in PD and who work within the community. We aim to use these 16 ParkNet networks to ascertain a successful implementation of the ParkFit program. d) Parkinsonism is common, affecting almost 70.000 persons in the Netherlands. This number is expected to double by the year 2030. Specific aims: 1. To DEVELOP a treatment protocol for ParkFit: a disease-specific and individually tailored program to promote physical activity in PD. For this purpose, we will collaborate with UMC Utrecht, NISB, KNGF, NebasNsg, NOC*NSF and TNO. Specific features of the ParkFit program include: - individually tailored activity counselling, adjusted to personal wishes, lifestyle, social context and physical capabilities - long-term (2 years) professional support by specifically trained ParkNet physiotherapists (‘personal activity coach’) - program based on cognitive-behavioural theories concerning the promotion of behavioural change - use of a pedometer with feedback device to motivate participants and promote continued participation - opportunity to participate during the first 3 months in a ParkFit Exercise Group 2. To IMPLEMENT the ParkFit program into 16 ParkNet networks. Specifically, within each ParkNet region, we will train 2 ParkNet physiotherapists (already trained in treating PD patients) to become a ParkFit therapist. Training includes e.g. motivational interviewing, information about sports and physical activities suitable for PD patients. 3. To EVALUATE the effectiveness of ParkFit compared to regular physical therapy in a Randomised Controlled Trial (ParkFit Study). Primary research question: do patients allocated to the ParkFit program increase and maintain their level of physical activity during two years, compared to patients receiving only regular physical therapy? Secondary question: what are the health benefits for patients participating in the ParkFit program? Design In a Randomised Controlled Trial (‘ParkFit Study), 160 PD patients will be randomly assigned to an experimental group (basic physiotherapy plus ParkFit program) or a control group (basic physiotherapy without ParkFit). Patients Patients will be selected from consecutive outpatients in the 16 ParkNet regions. Key inclusion criteria are: “idiopathic PD” and “insufficiently physically active according to the ‘Dutch Norms for Physical Activity’. Evaluation a. Outcome measures: The primary outcome measurement is the estimated caloric expenditure per week. This caloric expenditure will be estimated using a questionnaire (LAPAQ) combined with a structured interview (seven-day recall) and an ambulatory activity monitor (ActiGraph). Secondary outcome measurements concern physical fitness, daily functioning, mobility and quality of life. b. Assessments: Before randomisation and after 6, 12 and 24 months. c. Blinding: All patients will be evaluated by an assessor who is blinded with respect to group allocation.