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Background and Purpose: Exercise is beneficial for persons with Parkinson disease (PwPD). The overarching purpose of this scoping review was to provide guidance to clinicians and scientists regarding current evidence for bicycling exercise for PwPD. A scoping review was conducted to examine the heterogeneous literature on stationary bicycling for PwPD to reduce motor symptoms and body function structure impairments, improve activities and motor performance, and reduce disease severity., Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines were followed. PubMed, CINAHL, and PEDro were searched from inception to January 23, 2023. Articles reporting original data on relevant outcome measures were included. Search results were screened and articles were extracted. Data were analyzed quantitatively with percentages of significant and clinically meaningful findings and qualitatively to extract themes., Results: Bicycling was categorized using bicycle types (assisted, nonassisted) and training modes (speed, aerobic, force). A high percentage of the 34 studies showed statistical significance for reducing motor symptoms (83%), body function structure impairments (78%), disease severity (82%), and improving activities (gait 72%, balance 60%). Clinically meaningful findings were achieved in 71% of the studies for reduction in disease severity and in 50% for improving gait., Discussion and Conclusions: The literature on bicycling for PwPD has evolved from speed to aerobic studies. The terminology describing types of bicycling was simplified. Of all the outcomes reported, reduction of disease severity achieved the highest frequency of clinical meaningful improvements. Bicycling was comparable with other forms of aerobic training for walking speed and endurance. Opportunities for translation to practice and research are presented., Competing Interests: The authors declare no conflict of interest., (Copyright © 2024 Academy of Neurologic Physical Therapy, APTA.)

Objective: he purpose of the study was to determine the impact of novel coronavirus 2019 (COVID-19) restrictions on community-based exercise classes for people with Parkinson disease (PD) and their instructors., Methods: Data were collected via custom-designed electronic surveys for people with PD and class instructors who reported attending or teaching PD-specific exercise class ≥1 time/week for ≥3 months prior to pandemic restrictions (March 2020). The PD group also completed the Godin Leisure-Time Questionnaire, Self-Efficacy for Exercise scale, Schwab-England scale, and Parkinson's Disease Questionnaire 8., Results: Eighty-seven people with PD (mean = 70 [7.3] years old) and 43 instructors (51 [12.1] years old) from the United States completed surveys (October 2020 to February 2021). Mean Schwab-England (84 [16]) and Parkinson's Disease Questionnaire 8 (21 [15]) scores indicated low-to-moderate disability in the PD group. Ninety-five percent of the PD group had COVID-19 exposure concerns, and 54% reported leaving home ≤1 time/week. Although 77% of the PD group scored "active" on the Godin Leisure-Time Questionnaire, the mean Self-Efficacy for Exercise Scale score (55 [24]) indicated only moderate exercise self-efficacy, and >50% reported decreased exercise quantity/intensity compared with pre-COVID. There was decreased in-person and increased virtual class participation for both groups. The top in-person class barrier for the PD (63%) and instructor (51%) groups was fear of participant COVID-19 exposure. The top virtual class barriers were lack of socialization (20% of PD group) and technology problems (74% of instructor group)., Conclusion: During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and decreased exercise quantity and intensity. Virtual classes may not fully meet the needs of people with PD, and primary barriers include technology and lack of socialization., Impact: As COVID-19 restrictions wane, it is imperative to help people with PD increase exercise and activity. The barriers, needs, and facilitators identified in this study might help inform approaches to increase participation in exercise and activity for people with PD., Lay Summary: During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and a decrease in exercise quantity and intensity. If you have PD, virtual classes might not fully meet your needs. Primary barriers may include technology problems and lack of social interaction., (Published by Oxford University Press on behalf of American Physical Therapy Association 2021.)

Introduction: Disturbances in the visual, vestibular, and oculomotor systems have been identified in Parkinson's disease (PD). Patients' perspectives regarding these symptoms remain unexplored and may provide insights on functional implications of these symptoms and guide future interventions. The goal of this study is to elicit perceptions of individuals with PD with respect to visual, vestibular, and oculomotor deficits. Methods : Twenty-nine individuals with PD participated in focus group discussions. Participants discussed visual, vestibular, and oculomotor deficits they experience and how these deficits affect function. Discussions were recorded, transcribed, and coded. Inductive qualitative data analysis techniques were used to interpret responses. Results : Four themes emerged: 1) participants perceived visual, vestibular, and oculomotor deficits and related these deficits to their PD diagnosis; 2) participants perceive that these deficits affect function; 3) participants suggested these deficits are not recognized by healthcare providers; and 4) participants indicated they receive limited treatment for these deficits. Conclusions : Visual, vestibular, and oculomotor deficits are under-reported and under-assessed symptoms, which have a significant impact on the lives of people with PD. Healthcare providers should be aware of such deficits. The findings suggest that the healthcare team can better identify these deficits and identify important future areas of research.

Importance: Parkinson disease is a progressive neurologic disorder. Limited evidence suggests endurance exercise modifies disease severity, particularly high-intensity exercise., Objectives: To examine the feasibility and safety of high-intensity treadmill exercise in patients with de novo Parkinson disease who are not taking medication and whether the effect on motor symptoms warrants a phase 3 trial., Design, Setting, and Participants: The Study in Parkinson Disease of Exercise (SPARX) was a phase 2, multicenter randomized clinical trial with 3 groups and masked assessors. Individuals from outpatient and community-based clinics were enrolled from May 1, 2012, through November 30, 2015, with the primary end point at 6 months. Individuals with idiopathic Parkinson disease (Hoehn and Yahr stages 1 or 2) aged 40 to 80 years within 5 years of diagnosis who were not exercising at moderate intensity greater than 3 times per week and not expected to need dopaminergic medication within 6 months participated in this study. A total of 384 volunteers were screened by telephone; 128 were randomly assigned to 1 of 3 groups (high-intensity exercise, moderate-intensity exercise, or control)., Interventions: High-intensity treadmill exercise (4 days per week, 80%-85% maximum heart rate [n = 43]), moderate-intensity treadmill exercise (4 days per week, 60%-65% maximum heart rate [n = 45]), or wait-list control (n = 40) for 6 months., Main Outcomes and Measures: Feasibility measures were adherence to prescribed heart rate and exercise frequency of 3 days per week and safety. The clinical outcome was 6-month change in Unified Parkinson's Disease Rating Scale motor score., Results: A total of 128 patients were included in the study (mean [SD] age, 64 [9] years; age range, 40-80 years; 73 [57.0%] male; and 108 [84.4%] non-Hispanic white). Exercise rates were 2.8 (95% CI, 2.4-3.2) days per week at 80.2% (95% CI, 78.8%-81.7%) maximum heart rate in the high-intensity group and 3.2 (95% CI, 2.8-3.6; P = .13) days per week at 65.9% (95% CI, 64.2%-67.7%) maximum heart rate in the moderate-intensity group (P < .001). The mean change in Unified Parkinson's Disease Rating Scale motor score in the high-intensity group was 0.3 (95% CI, -1.7 to 2.3) compared with 3.2 (95% CI, 1.4 to 5.1) in the usual care group (P = .03). The high-intensity group, but not the moderate-intensity group, reached the predefined nonfutility threshold compared with the control group. Anticipated adverse musculoskeletal events were not severe., Conclusions and Relevance: High-intensity treadmill exercise may be feasible and prescribed safely for patients with Parkinson disease. An efficacy trial is warranted to determine whether high-intensity treadmill exercise produces meaningful clinical benefits in de novo Parkinson disease., Trial Registration: clinicaltrials.gov Identifier: NCT01506479.

Background and Purpose: Objective ambulatory activity during daily living has not been characterized for people with Parkinson disease prior to initiation of dopaminergic medication. Our goal was to characterize ambulatory activity based on average daily step count and examine determinants of step count in nonexercising people with de novo Parkinson disease., Methods: We analyzed baseline data from a randomized controlled trial, which excluded people performing regular endurance exercise. Of 128 eligible participants (mean ± SD = 64.3 ± 8.6 years), 113 had complete accelerometer data, which were used to determine daily step count. Multiple linear regression was used to identify factors associated with average daily step count over 10 days. Candidate explanatory variable categories were (1) demographics/anthropometrics, (2) Parkinson disease characteristics, (3) motor symptom severity, (4) nonmotor and behavioral characteristics, (5) comorbidities, and (6) cardiorespiratory fitness., Results: Average daily step count was 5362 ± 2890 steps per day. Five factors explained 24% of daily step count variability, with higher step count associated with higher cardiorespiratory fitness (10%), no fear/worry of falling (5%), lower motor severity examination score (4%), more recent time since Parkinson disease diagnosis (3%), and the presence of a cardiovascular condition (2%)., Discussion and Conclusions: Daily step count in nonexercising people recruited for this intervention trial with de novo Parkinson disease approached sedentary lifestyle levels. Further study is warranted for elucidating factors explaining ambulatory activity, particularly cardiorespiratory fitness, and fear/worry of falling. Clinicians should consider the costs and benefits of exercise and activity behavior interventions immediately after diagnosis of Parkinson disease to attenuate the health consequences of low daily step count.Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A170).

Background: Parkinson disease (PD) may lead to functional limitations through both motor and nonmotor symptoms. Although patients with advanced disease have well-documented and profound functional limitations, less is known about the determinants of function in early to mid-stage disease where interventions may be more likely to benefit and preserve function., Objective: The objective of the current study was to identify motor, cognitive, and gait determinants of physical functional performance in patients with early to mid-stage PD., Design: This was a secondary analysis of cross-sectional baseline data from a randomized clinical trial of exercise., Setting: The study was performed at a tertiary academic medical center., Participants: The study included 121 patients with early to mid-stage PD., Methods: Our functional performance outcomes included the following: the Continuous Scale Physical Functional Performance Test (CS-PFP; primary outcome); the Timed Up and Go test (TUG); and Section 2 (Activities of Daily Living) of the Unified Parkinson's Disease Rating Scale (UPDRS). Explanatory variables included measures of disease severity, motor function, cognitive function, balance, and gait. Stepwise linear regression models were used to determine correlations between explanatory variables and outcome measures., Results: In our regression models, the CS-PFP significantly correlated with walking endurance (Six-Minute Walk Test; r(2) = 0.12, P < .0001), turning ability (360° Turn Test; r(2) = 0.03, P = .002), attention (Brief Test of Attention; r(2) = 0.01, P = .03), overall cognitive status (Mini-Mental State Examination; r(2) = 0.01, P = .04), and bradykinesia (timed tapping; r(2) = 0.02, P = .02). The TUG significantly correlated with walking speed (5-Meter Walk Test; r(2) = 0.33, P < .0001), stride length (r(2) = 0.25, P < .0001), turning ability (360° turn, r(2) = 0.05, P = .0003), and attention (r(2) = 0.016, P = .03). Section 2 of the UPDRS was significantly correlated with endurance (r(2) = 0.09, P < .0001), turning ability (r(2) = 0.03, P = .001), and attention (r(2) = 0.01, P = .03)., Conclusions: Gait, motor, and cognitive function all contribute to objectively measured global functional ability in mild to moderate PD. Subjectively measured functional activity outcomes may underestimate the impact of both motor and nonmotor symptoms., (Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

A burgeoning literature suggests that exercise has a therapeutic benefit in persons with Parkinson disease (PD) and in animal models of PD, especially when animals exercise at high intensity. If exercise is to be prescribed as "first-line" or "add-on" therapy in patients with PD, we must demonstrate its efficacy and dose-response effects through testing phases similar to those used in the testing of pharmacologic agents. The SPARX Trial is a multicenter, randomized, controlled, single-blinded, Phase II study that we designed to test the feasibility of using high-intensity exercise to modify symptoms of PD and to simultaneously test the nonfutility of achieving a prespecified change in patients' motor scores on the Unified Parkinson Disease Rating Scale (UPDRS). The trial began in May 2102 and is in the process of screening, enrolling, and randomly assigning 126 patients with early-stage PD to 1 of 3 groups: usual care (wait-listed controls), moderate-intensity exercise (4 days/week at 60%-65% maximal heart rate [HRmax]), or high-intensity exercise (4 days/week at 80%-85% HRmax). At 6-month follow-up, the trial is randomly reassigning usual care participants to a moderate-intensity or high-intensity exercise group for the remaining 6 months. The goals of the Phase II trial are to determine if participants can exercise at moderate and high intensities; to determine if either exercise yields benefits consistent with meaningful clinical change (nonfutility); and to document safety and attrition. The advantage of using a non-futility approach allows us to efficiently determine if moderate- or high-intensity exercise warrants further large-scale investigation in PD., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Exercise confers short-term benefits for individuals with Parkinson disease (PD)., Objective: The purpose of the study was to compare short- and long-term responses among 2 supervised exercise programs and a home-based control exercise program., Design: The 16-month randomized controlled exercise intervention investigated 3 exercise approaches: flexibility/balance/function exercise (FBF), supervised aerobic exercise (AE), and home-based exercise (control)., Setting: This study was conducted in outpatient clinics., Patients: The participants were 121 individuals with PD (Hoehn & Yahr stages 1-3)., Interventions: The FBF program (individualized spinal and extremity flexibility exercises followed by group balance/functional training) was supervised by a physical therapist. The AE program (using a treadmill, bike, or elliptical trainer) was supervised by an exercise trainer. Supervision was provided 3 days per week for 4 months, and then monthly (16 months total). The control group participants exercised at home using the National Parkinson Foundation Fitness Counts program, with 1 supervised, clinic-based group session per month., Measurements: Outcomes, obtained by blinded assessors, were determined at 4, 10, and 16 months. The primary outcome measures were overall physical function (Continuous Scale-Physical Functional Performance [CS-PFP]), balance (Functional Reach Test [FRT]), and walking economy (oxygen uptake [mL/kg/min]). Secondary outcome measures were symptom severity (Unified Parkinson's Disease Rating Scale [UPDRS] activities of daily living [ADL] and motor subscales) and quality of life (39-item Parkinson's Disease Quality of Life Scale [PDQ-39])., Results: Of the 121 participants, 86.8%, 82.6%, and 79.3% completed 4, 10, and 16 months, respectively, of the intervention. At 4 months, improvement in CS-PFP scores was greater in the FBF group than in the control group (mean difference=4.3, 95% confidence interval [CI]=1.2 to 7.3) and the AE group (mean difference=3.1, 95% CI=0.0 to 6.2). Balance was not different among groups at any time point. Walking economy improved in the AE group compared with the FBF group at 4 months (mean difference=-1.2, 95% CI=-1.9 to -0.5), 10 months (mean difference=-1.2, 95% CI=-1.9 to -0.5), and 16 months (mean difference=-1.7, 95% CI=-2.5 to -1.0). The only secondary outcome that showed significant differences was UPDRS ADL subscale scores: the FBF group performed better than the control group at 4 months (mean difference=-1.47, 95% CI=-2.79 to -0.15) and 16 months (mean difference=-1.95, 95% CI=-3.84 to -0.08)., Limitations: Absence of a non-exercise control group was a limitation of the study., Conclusions: Findings demonstrated overall functional benefits at 4 months in the FBF group and improved walking economy (up to 16 months) in the AE group.

Background: People with Parkinson disease (PD) typically have complaints of weakness. The mechanisms underlying this deficit have not been well established, although many factors may contribute., Objective: This investigation aimed to characterize quadriceps muscle weakness and activation failure in people with PD and explore whether these deficits were related to disease severity. The authors further sought to examine quadriceps muscle fatigability., Methods: This was a cross-sectional comparison of 17 people with mild-severe PD and 17 healthy adults matched by age, sex, and body mass index (BMI). The Unified Parkinson's Disease Rating Scale motor score (UPDRS motor) ranged from 9.5 to 61.0. Participants were divided into those with low-PD motor signs (UPDRS motor < 31.7) and high-PD motor signs (UPDRS motor ≥ 31.7). Measures of quadriceps performance included isometric torque, central activation using doublet interpolation, and an isokinetic fatigue test., Results: Participants with high-PD motor signs had significantly more quadriceps weakness and central activation deficits than those with low-PD motor signs or healthy controls. Strength and activation deficits correlated strongly with UPDRS motor score. Quadriceps muscle fatigue was present in healthy controls and in those with low-PD motor signs but not in those with high-PD motor signs., Conclusions: These findings provide additional evidence for lower-extremity strength loss with PD; central activation deficits may account for some of the strength deficits, especially with increased PD motor signs. Also, muscle fatigue did not occur in individuals with a greater degree of PD motor signs, most likely because of insufficient central activation to allow for muscle overload to induce metabolic fatigue.

Background: Overall functional ability declines over time in people with Parkinson disease (PD). Established benchmarks are needed to allow clinicians and researchers to facilitate meaningful interpretation of data., Objective: The purposes of this study were: (1) to report typical values for standard measures of functional ability commonly used in intervention studies and clinical practice with individuals in the early and middle stages of PD and (2) to describe the profile of functional limitations using the Hoehn and Yahr (H&Y) stages of disease and Unified Parkinson's Disease Rating Scale (UPDRS) motor scores., Design: Cross-sectional data were obtained from 5 different studies., Methods: Three hundred thirty-nine patients were evaluated for disease severity (UPDRS motor score); functional capacity (Continuous Scale Physical Functional Performance Test [CS-PFP]); balance and gait (Functional Reach Test [FRT], Timed "Up & Go" Test [TUG], 360-degree turn, Six-Minute Walk Test [6MWT], and Two-Minute Walk Test); and basic functional activities (supine-to-stand task, stand-to-supine task, and functional axial rotation [FAR])., Results: The mean UPDRS motor score for the sample was 39.2 (SD=12.93). At each stage of PD (from least to most involved), scores on functional measures indicated a significant and progressively reduced functional status. Limitations began early in the disease for the CS-PFP and FAR. Losses in performance were consistent across all stages of disease for the CS-PFP, FRT, 6MWT, and FAR. Several measures demonstrated meaningful losses of function only in later stages of disease. Findings extend current appreciation of functional limitations that begin early in PD and can guide the choice of functional outcome measures at different stages of disease severity., Limitations: Data were obtained only from participants in H&Y stages 1 through 3 and only for some of the performance measures typically used., Conclusions: The findings demonstrate that functional loss occurs at different points in the disease process, depending on the task under consideration. The resulting profile of functional limitations provides benchmarks that clinicians and researchers can use to interpret and monitor status of patients.

Background and Purpose: Exercise intervention studies for people with Parkinson disease (PD) have been shown to result in improvement in a variety of outcome measures. However, after the supervised exercise period, these measures tend to return toward baseline values. This regression may reflect the progressive nature of PD but may also reflect a decline in activity levels. The purpose of this qualitative study was to learn more about the motivations and barriers to continued exercise among persons with PD following a 16-month exercise intervention study., Methods: Eighteen individuals with PD (12 men and 6 women) and their spouses participated in structured interviews concerning reasons for entering the exercise study, experiences during the study, activity levels after the study, and strategies to encourage ongoing activity. Of those with PD, 15 had completed the exercise study and 3 had dropped out before completion., Results: Among the 18 individuals who participated in the interviews, motivations for exercising included: hope that exercise would slow the disease or prevent a decline in function (7 individuals [39%]), feeling better with exercise (3 individuals [17%]), belief that exercise is beneficial (3 individuals [17%]), and encouragement from family members (3 individuals [17%]). After the study, all graduates and 2 of the 3 dropouts maintained some physical activity. For 14 (79%) respondents, intensity and/or frequency was reduced from maximal activity levels achieved during the intervention. To encourage ongoing activity, participants wanted evidence supporting the benefits of exercise (5 participants [28%]), greater availability of programs (4 participants [22%]), and guidance from medical providers toward exercise studies (3 participants [17%])., Discussion and Conclusions: This study provides insights into the motivations and barriers for continued exercise after an exercise study. The issues identified provide information that may assist practitioners as they design exercise programs for individuals with PD. It may be of value to explore these issues in future experimental studies.

Background and Purpose: Individuals with Parkinson disease (PD) experience a range of deficits of body systems and activities. A clinical test is needed that is reliable, valid, applicable to physical therapist practice, and appropriate for use in early and mid-stages of the disease. PROFILE PD is one such scale, consisting of 24 items that would typically be assessed during the physical therapist's examination and evaluation of individuals with PD. The purpose of this article is to report on clinimetric properties of the PROFILE PD and to make the test available for use., Methods: Interrater reliability was determined using the intraclass correlation coefficient. Construct validity was determined by comparing scores on the PROFILE PD with the gold standard (Unified Parkinson's Disease Rating Scale [UPDRS]) as well as scales of physical activity and participation. Construct validity and structure of the PROFILE PD were further examined using exploratory factor analysis using principal component analysis with Promax rotation that allows a correlated factor structure., Results: Interrater reliability of the PROFILE PD was high (ICC = 0.97). Construct validity was demonstrated with the UPDRS (r = 0.86, P < 0.0001), Schwab & England Activities of Daily Living Scale (S&E) (r = -0.83, P < 0.0001), and Continuous Scale Physical Functional Performance test (r = -0.62, P < 0.0001). Principal component analysis demonstrated that the test comprises a single scale., Conclusions: The PROFILE PD is a reliable and valid scale that can be used to quantify alterations in body systems and activity of individuals in early and mid-stages of PD. Use of the scale can provide an overall summary of the impact of PD on body systems and activities.

Although Parkinson disease (PD) is common throughout the world, the evidence for physical therapy interventions that enable long-term improvement in walking is still emerging. This article critiques the major physical therapy approaches related to gait rehabilitation in people with PD: compensatory strategies, motor skill learning, management of secondary sequelae, and education to optimize physical activity and reduce falls. The emphasis of this review is on gait specifically, although balance and falls are of direct importance to gait and are addressed in that context. Although the researchers who have provided the evidence for these approaches grounded their studies on different theoretical paradigms, each approach is argued to have a valid place in the comprehensive management of PD generally and of gait in particular. The optimal mix of interventions for each individual varies according to the stage of disease progression and the patient's preferred form of exercise, capacity for learning, and age.

Gait dysfunction is an early problem identified by patients with Parkinson's disease (PD). Alterations in gait may result in an increase in the energy cost of walking (i.e., walking economy). The purpose of this study was to determine whether walking economy is atypical in patients with PD when compared with healthy controls. A secondary purpose was to evaluate the associations of age, sex, and level of disease severity with walking economy in patients with PD. The rate of oxygen consumption (VO(2)) and other responses to treadmill walking were compared in 90 patients (64.4 +/- 10.3 years) and 44 controls (64.6 +/- 7.3 years) at several walking speeds. Pearson correlation coefficients (r) were calculated to determine relationships of age, sex, and disease state with walking economy in PD patients. Walking economy was significantly worse in PD patients than in controls at all speeds above 1.0 mph. Across all speeds, VO(2) was 6 to 10% higher in PD patients. Heart rate, minute ventilation, respiratory exchange ratio, and rating of perceived exertion were correspondingly elevated. No significant relationship of age, sex, or UPDRS score with VO(2) was found for patients with PD. The findings suggest that the physiologic stress of daily physical activities is increased in patients with early to mid-stage PD, and this may contribute to the elevated level of fatigue that is characteristic of PD., (Copyright 2009 Movement Disorder Society.)

Background and Purpose: Even early in Parkinson disease (PD), individuals have reduced economy of movement. In this case report, the effects of endurance exercise training are examined on walking economy and other measures for 3 individuals in early and middle stages of PD., Patients: The patients were 1 woman and 2 men with PD, aged 52 to 72 years, classified at Hoehn and Yahr stages 2 to 2.5., Intervention: Each patient completed 4 months of supervised endurance exercise training and 12 months of home exercise, with monthly clinic follow-up sessions. Strategies were included to enhance adherence to exercise., Outcomes: The main outcome measure was economy of movement (rate of oxygen consumption during gait) measured at 4 treadmill speeds. Secondary outcome measures included the Unified Parkinson's Disease Rating Scale (UPDRS), Continuous-Scale Physical Functional Performance Test (CS-PFP), Functional Reach Test (FRT), and Functional Axial Rotation Test (FAR). Economy of movement improved for all 3 patients after 4 months of supervised exercise and remained above baseline at 16 months. Two patients also had scores that were above baseline for UPDRS total score, CS-PFP, FRT, and FAR, even at 16 months., Discussion and Conclusion: : Evidence from these 3 individuals suggests that gains may occur with a treadmill training program that is coupled with specific strategies to enhance adherence to exercise.

Purpose: Functional measures are needed that are applicable to middle-aged adults with neurological disorders who are on the threshold of disability. One potential measure is the Continuous Scale Physical Functional Performance Test (CS-PFP), which has been normalized and validated to older adults but performance is unknown for adults younger than the age of 65 years with and without neurological disorders. The purposes of this investigation were (1) to compare scores on the CS-PFP of nondisabled adults in three age groups from 35 to 64 years with two groups of individuals older than the age of 65; (2) to determine whether there is a ceiling effect for nondisabled middle-aged adults; and (3) to determine whether performance of individuals in early stages of Parkinson's disease (PD) age 45 to 64 years differ significantly from performance of similarly aged nondisabled adults., Methods: Data were obtained from three samples: (1) 37 adults with PD (45-54 and 55-64 years; 57% female), (2) 70 nondisabled adults (35-44, 45-54, and 55-64 years; 69% female); (3) 72 nondisabled older adults (65-74 and 75-85 years; 79% female). The CS-PFP was administered in a single test session for each subject. Analysis of variance was performed for group differences with adjustment of sex as a covariate followed by a Student-Newman-Keuls post hoc analysis., Results: For nondisabled individuals, the CS-PFP total and domain scores were significantly lower in the oldest group (75-85 years) compared to all other age groups and significantly higher in the younger two groups (35-44 and 45-54 years) compared to the older groups. There was no ceiling effect for any domain score or total score for the adults younger than 65 years. For individuals with PD, both age groups had significantly lower scores on the CS-PFP than did the nondisabled counterparts., Conclusions: Results from the nondisabled middle-aged individuals provide comparison data to be used clinically or in investigations of middle-aged adults with neurological dysfunction. Comparison of middle-aged individuals with PD to middle-aged nondisabled adults illustrates the true extent of functional difficulty experienced by individuals with PD and demonstrates the importance of using age appropriate comparison data. The CS-PFP is particularly applicable to middle-aged adults with compromised functional performance for their age but is too high to be effectively quantified with other assessment measures.

Purpose: Parkinson's disease (PD) is a chronic progressive neurological disorder that frequently results in nearly total disability. This study examined changes over 3 years in patients' experiences living with PD, and explored how participants' health perceptions and predicted mortality at baseline related to their actual death by Year 3., Design and Methods: Data were obtained from a local sample of 109 participants by in-home interviews., Results: The collected results (1) suggested a disconnection between the participants' responses to open-ended questions about the disorder, compared with their responses to questions structured by the investigators; (2) demonstrated changes in responses to structured and open-ended questions; and (3) demonstrated that respondents who declined to predict whether they would be living in 10 years were three times more likely to die by Year 3 than those who answered the question., Implications: Results demonstrate the importance of identifying the most important issues for the individual with PD and suggest that these issues may change over time. Results also raise issues surrounding how patients' perceptions influence the course of their disease.

Background and Purpose: Initiation of gait requires transitions from relatively stationary positions to stability with movement and from double- to single-limb stances. These are deliberately destabilizing activities that may be difficult for people with early Parkinson disease (PD), even when they have no problems with level walking. We studied differences in postural stability during gait initiation between participants with early and middle stages of PD (characterized by Hoehn and Yahr as stages 1-3) and 2 other groups of participants without PD--older and younger adults., Subjects: The mean ages of the 3 groups of participants were as follows: subjects with PD, 69.3 years (SD=5.7, range=59-78); older subjects without PD, 69.0 years (SD=3.9, range=65-79); and younger subjects without PD, 27.5 (SD=3.9, range=22-35)., Methods: A 3-dimensional motion analysis system was used with 2 force platforms to obtain data for center of mass (COM) and center of pressure (COP). The distance between the vertical projections of the COM and the COP (COM-COP distance) was used to reflect postural control during 5 events in gait initiation., Results: By use of multivariate analysis of variance, differences in COM-COP distance were found among the 3 groups. An analysis of variance indicated differences for 4 of the 5 events in gait initiation. A Scheffe post hoc analysis demonstrated differences in gait initiation between the subjects with PD and both groups of subjects without PD (2 events) and between the subjects with PD and the younger subjects without PD (2 events)., Discussion and Conclusion: The COM-COP distance relationship was used to measure postural control during the transition from quiet standing to steady-state gait. Differences between groups indicated that individuals with impaired postural control allow less COM-COP distance than do individuals with no known neurologic problems. The method used could prove useful in the development and assessment of interventions to improve ambulation safety and enhance the independence of people with impaired postural control.

Objective: he purpose of the study was to determine the impact of novel coronavirus 2019 (COVID-19) restrictions on community-based exercise classes for people with Parkinson disease (PD) and their instructors. Methods: Data were collected via custom-designed electronic surveys for people with PD and class instructors who reported attending or teaching PD-specific exercise class ≥1 time/week for ≥3 months prior to pandemic restrictions (March 2020). The PD group also completed the Godin Leisure-Time Questionnaire, Self-Efficacy for Exercise scale, Schwab-England scale, and Parkinson's Disease Questionnaire 8. Results: Eighty-seven people with PD (mean = 70 [7.3] years old) and 43 instructors (51 [12.1] years old) from the United States completed surveys (October 2020 to February 2021). Mean Schwab-England (84 [16]) and Parkinson's Disease Questionnaire 8 (21 [15]) scores indicated low-to-moderate disability in the PD group. Ninety-five percent of the PD group had COVID-19 exposure concerns, and 54% reported leaving home ≤1 time/week. Although 77% of the PD group scored "active" on the Godin Leisure-Time Questionnaire, the mean Self-Efficacy for Exercise Scale score (55 [24]) indicated only moderate exercise self-efficacy, and >50% reported decreased exercise quantity/intensity compared with pre-COVID. There was decreased in-person and increased virtual class participation for both groups. The top in-person class barrier for the PD (63%) and instructor (51%) groups was fear of participant COVID-19 exposure. The top virtual class barriers were lack of socialization (20% of PD group) and technology problems (74% of instructor group). Conclusion: During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and decreased exercise quantity and intensity. Virtual classes may not fully meet the needs of people with PD, and primary barriers include technology and lack of socialization. Impact: As COVID-19 restrictions wane, it is imperative to help people with PD increase exercise and activity. The barriers, needs, and facilitators identified in this study might help inform approaches to increase participation in exercise and activity for people with PD. Lay Summary: During COVID-19, there has been less in-person and more virtual exercise class participation in people with PD and a decrease in exercise quantity and intensity. If you have PD, virtual classes might not fully meet your needs. Primary barriers may include technology problems and lack of social interaction. [ABSTRACT FROM AUTHOR]

Purpose of this study was to characterize side-to-side differences in quadriceps, hamstrings strength, and quadriceps activation in individuals with Parkinson disease (PD). Participants were individuals with PD (n = 17) with Unified Parkinson's Disease Rating Scale motor scores ranging from 9.5 to 61.0. Paired t tests compared strength and muscle activation between limbs for all individuals. The stronger quadriceps was 15.2% stronger (P < .001) and the stronger hamstring was 12.9% stronger (P = .001). Side-to-side differences in quadriceps activation was 18.9%, but insignificant (P = .072). No pattern explained side-to-side differences. Muscle strength asymmetry is variable, but present across a range of PD disease severity, which emphasizes the importance of a detailed clinical examination. [ABSTRACT FROM AUTHOR]

Background and Purpose: Individuals with Parkinson disease (PD) experience a range of deficits of body systems and activities. A clinical test is needed that is reliable, valid, applicable to physical therapist practice, and appropriate for use in early and mid-stages of the disease. PROFILE PD is one such scale, consisting of 24 items that would typically be assessed during the physical therapist's examination and evaluation of individuals with PD. The purpose of this article is to report on clinimetric properties of the PROFILE PD and to make the test available for use. Methods: Interrater reliability was determined using the intraclass correlation coefficient. Construct validity was determined by comparing scores on the PROFILE PD with the gold standard (Unified Parkinson's Disease Rating Scale [UPDRS]) as well as scales of physical activity and participation. Construct validity and structure of the PROFILE PD were further examined using exploratory factor analysis using principal component analysis with Promax rotation that allows a correlated factor structure. Results: Interrater reliability of the PROFILE PD was high (ICC = 0.97). Construct validity was demonstrated with the UPDRS (r - 0.86, P < 0.0001), Schwab & England Activities of Daily Living Scale (S&E) (r --0.S3,P< 0.0001 ), and Continuous Scale Physical Functional Performance test (/¦ = -0.62, P < 0.0001). Principal component analysis demonstrated that the test comprises a single scale. Conclusions: The PROFILE PD is a reliable and valid scale that can be used to quantify alterations in body systems and activity of individuals in early and mid-stages of PD. Use of the scale can provide an overall summary of the impact of PD on body systems and activities. [ABSTRACT FROM AUTHOR]