How COVID-19 will boost remote exercise-based treatment in Parkinson’s disease: a narrative review

Abstract

The lack of physical exercise during the COVID-19 pandemic-related quarantine measures is challenging, especially for patients with Parkinson’s disease (PD). Without regular exercise not only patients, but also nursing staff and physicians soon noticed a deterioration of motor and non-motor symptoms. Reduced functional mobility, increased falls, increased frailty, and decreased quality of life were identified as consequences of increased sedentary behavior. This work overviews the current literature on problems of supplying conventional physiotherapy and the potential of telerehabilitation, allied health services, and patient-initiated exercise for PD patients during the COVID-19 period. We discuss recent studies on approaches that can improve remote provision of exercise to patients, including telerehabilitation, motivational tools, apps, exergaming, and virtual reality (VR) exercise. Additionally, we provide a case report about a 69-year-old PD patient who took part in a 12-week guided climbing course for PD patients prior to the pandemic and found a solution to continue her climbing training independently with an outdoor rope ladder. This case can serve as a best practice example for non-instructed, creative, and patient-initiated exercise in the domestic environment in difficult times, as are the current. Overall, many recent studies on telemedicine, telerehabilitation, and patient-initiated exercises have been published, giving rise to optimism that facilitating remote exercise can help PD patients maintain physical mobility and emotional well-being, even in phases such as the COVID-19 pandemic. The pandemic itself may even boost the need to establish comprehensive and easy-to-do telerehabilitation programs.

Worsened Parkinson’s Disease Progression: Impact of the COVID-19 Pandemic

“…In addition, fitness centers, dancing classes, and many other team sports that are popular among PD patients but also socio-cultural institutions (e.g., restaurants, art galleries) were closed over many months. This challenge has been discussed already early during the pandemic [6,7] and has ever since been corroborated by the literature [3,[8][9][10][11]. For instance, a Dutch group found that the pandemic evokes psychological distress and lifestyle changes including reduced physical activity [12].…”

Action Imagery and Observation in Neurorehabilitation for Parkinson’s Disease (ACTION-PD): Development of a User-Informed Home Training Intervention to Improve Functional Hand Movements

“…e present findings indicate that home-based AO + MI training delivered using mobile technology is feasible in people with mild to moderate PD, although future work should explore the feasibility of the intervention in those with more severe symptoms or in different subtypes. Homebased approaches could provide widely accessible, low-cost, and scalable alternatives or supplements to existing rehabilitation programmes, and their importance is more apparent than ever in light of the COVID-19 pandemic [75,76].…”

Einfluss der COVID-19 Pandemie auf die ambulante Physiotherapie

“…Bei diesen Patient*innen wird daher ein Rückgang des Therapiefortschritts, ein Fortschreiten von degenerativen Erkrankungen und Chronifizierungen von akuten Erkrankungen, wie zum Beispiel nach einem Schlaganfall oder einer Operation am Bewegungsapparat, befürchtet. Dies wird durch aktuelle Studien unterstützt [23] , [24] , [25] . Bei Patient*innen mit Morbus Parkinson beispielsweise wurde bereits eine Verschlechterung der Erkrankung durch eingeschränkte Mobilität und pandemiebedingte psychische Belastungen, wie Ängste und Einsamkeit, sowie eine dadurch deutlich reduzierte Lebensqualität festgestellt [24] , [25] .…”

“…Dies wird durch aktuelle Studien unterstützt [23] , [24] , [25] . Bei Patient*innen mit Morbus Parkinson beispielsweise wurde bereits eine Verschlechterung der Erkrankung durch eingeschränkte Mobilität und pandemiebedingte psychische Belastungen, wie Ängste und Einsamkeit, sowie eine dadurch deutlich reduzierte Lebensqualität festgestellt [24] , [25] . Regelmäßige Physiotherapie scheint daher essentiell, um den Krankheitsverlauf und die Lebensqualität der Parkinsonpatient*innen positiv beeinflussen zu können.…”

“…Drohenden Konsequenzen für das Gesundheitssystem und die Lebensqualität der Patient*innen muss daher mit der Sicherstellung der Patientenversorgung in allen Bereichen begegnet werden. Teletherapie könnte dabei ein Teil der Lösung darstellen [24] , [26] , was auch die Befragten über die Pandemie hinaus als Chance sahen. Die Umsetzung von Videotherapie als eine Möglichkeit der Teletherapie wurde jedoch im Rahmen dieser Befragung von vielen als herausfordernd beschrieben.…”