title: Enhanced Exercise Therapy in Parkinson's disease: A comparative effectiveness trial.
abstract: OBJECTIVE
  Exercise can improve motor function in people with Parkinson's disease but depression reduces the motivation to participate in regular exercise. The aim of this study was to develop a novel Enhanced Exercise Therapy program that uses manual-driven guided exercise and peer-facilitated psychoeducation for individuals with Parkinson's disease and depression.
  
  
  METHODS
  24 week randomized controlled design.
  
  
  METHODS
  Thirty individuals were randomized to Enhanced Exercise Therapy or self-guided therapy, and evaluated at baseline, 12-weeks and at 24-weeks. Enhanced Exercise Therapy included group exercise and group psychoeducation for 12 weeks. Between 13 and 24 weeks, individuals had access to the fitness facility but group sessions were not held. Self-guided therapy included written guidelines for a self-paced exercise program and psychoeducation. Primary outcome measures included the number of exercise sessions and International Physical Activity Questionnaire score. Secondary measures included resting heart rate, supine blood pressure, estimated VO2max and incidence of orthostatic hypotension.
  
  
  RESULTS
  Twenty four individuals completed the study (80% retention) and both groups attended similar number of exercise sessions. There were no significant changes in cardiovascular fitness measures but there was a significant increase in the amount of physical activity in the Enhanced Exercise Therapy group and a decrease in the self-guided therapy group during the post-intervention period.
  
  
  CONCLUSIONS
  Enhanced Exercise Therapy appears to promote engagement in an exercise program and more physical activity, even after group sessions were concluded in individuals with Parkinson's disease and depression.
authors.affiliation: Department of Exercise Physiology, Kent State University, USA. Electronic address: aridgel@kent.edu.
authors.forename: Angela L
authors.initials: AL
authors.lastname: Ridgel
authors.affiliation: Case Western Reserve University School of Medicine, USA; Movement Disorder Center, University Hospitals, USA.
authors.forename: Benjamin L
authors.initials: BL
authors.lastname: Walter
authors.affiliation: Case Western Reserve University School of Medicine, USA; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, USA.
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
authors.affiliation: Case Western Reserve University School of Medicine, USA; Movement Disorder Center, University Hospitals, USA.
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Walter
authors.affiliation: Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, USA.
authors.forename: Kari
authors.initials: K
authors.lastname: Colón-Zimmermann
authors.affiliation: Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, USA.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Welter
authors.affiliation: Case Western Reserve University School of Medicine, USA; Neurological and Behavioral Outcomes Center, University Hospitals Case Medical Center, USA.
authors.forename: Martha
authors.initials: M
authors.lastname: Sajatovic
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000628:therapy*
keywords: Motivation; Movement disorders; Outcome assessment (health care); Physical activity; Physical therapy modalities; Psychoeducation