COPE-Co-morbidities, Parkinson's Disease and Exercise
COPE-Co-morbidities, Parkinson's Disease and Exercise
Problems with balance and walking that affect mobility are an inevitable cause of decreased
 quality of life in older people with chronic neurologic conditions such as Parkinson's
 disease (PD). Although there is evidence that exercise can improve mobility in the elderly,
 the investigators don't know: 1) What is the best mode of exercise intervention delivery
 (i.e. individual therapy in a clinic, home exercise program, or a group class)? and 2) how do
 other problems common in people with PD and/or the elderly affect outcomes? Although most
 physical therapy is carried out individually, a group or home program would be most
 cost-effective so the investigators need to know if they are just as effective. Since most
 older people with chronic neurologic diseases also have other problems affecting mental
 function, muscles and joints and/or pain, it is important to understand how these other
 problem affect the success of their therapy. The purpose of this study is to investigate how
 PT intervention should be delivered to patients with chronic neurologic disease who also have
 other problems. The investigators will using elderly people with PD who have one or more
 co-morbidities associated with PD and/or aging. Sixty people PD and co-morbidities will be
 randomized into 1of 3 groups; home program, individual PT or group exercise class. Each of
 the 3 groups will be led by the same PT providing a novel sensory-motor agility program
 developed by our laboratory. All groups will perform the same type of exercises 3 X/week for
 4 weeks. Improvement in the Physical Performance Test of disability will be used to determine
 the success of therapy. To determine how and why mobility was improved by therapy, changes in
 gait, balance, and quality of life will be measured. Gait and balance will be measured with
 new, wearable motion sensors (iPOD size) while standing up from a chair, walking, turning
 around and sitting back down. The findings from this study will help guide rehabilitation
 treatment for complex , chronic problems affecting mobility in older people.
Specific Aims Effectiveness of Physical Therapy in chronic neurologic disease; the role of
 co-morbidities and delivery of PT services.

 Despite frequent referrals of people with chronic neurologic disease to outpatient physical
 therapy (PT) services, the relative effectiveness of various types of PT delivery for this
 population is uncertain. The investigators have encouraging data to support the effectiveness
 of a customized, evidence-based agility exercise program for patient's with Parkinson's
 disease but wonder whether less expensive modes of delivery of this PT service, a group
 program or independent, home exercise program could be as effective as individualized,
 one-on-one treatment by a physical therapist. Traditional studies of exercise in patients
 with chronic neurologic disease also tend to exclude subjects with co-morbidities, so common
 in complex, degenerative diseases, especially in the elderly so the extent to which the
 presence of co-morbidities determine success of PT services is also unknown. This proposal
 will use a randomized, intervention study to evaluate three modes of PT delivery of an
 agility exercise program to improve mobility of people with longstanding PD who also have at
 least one other significant co-morbidities. This study will help determine the optimal
 referral patterns for PT services in patients with complex, chronic problems affecting
 mobility.

 Aim 1. To determine the effects of differing modes of delivery for PT services on mobility
 disability, gait and balance in people with chronic neurologic disease. The investigators
 will examine the changes in disability as well as gait and balance performance measures
 before and after 4 weeks of exercise performed 3 times per week for a 1) home exercise
 program provided by a PT, 2) group PT-led exercise program, and 3) individual program. The
 primary outcome will be the Physical Performance Test of disability. Secondary outcome
 measures will provide information about the processes underlying effectiveness: an
 instrumented Timed up and go test and PDQ-39 for perceived mobility, mood, and cognitive
 deficits. The investigators will also compare adverse events and the number of exercise
 sessions that subjects miss because of complications from the exercise program as well as
 compliance, the number of PD subjects that drop out and do not maintain the 12-session,
 exercise programs.

 Aim 2. To determine how specific PD-related and age-related co-morbidities influence
 effectiveness of different types of PT delivery. The investigators will categorize the
 co-morbidities into those directly related to PD, including mental (depression, cognition),
 balance (falls and fractures) and autonomic (orthostatic hypotension) and those related to
 aging (peripheral neuropathy, pain and muscle weakness). The investigators will determine if
 the number and type of such co-morbidities influence the outcome of each exercise program.

 This project has great clinical significance for rehabilitation of elderly people with
 chronic, complex neurologic disease. The information from this study will influence how to
 best approach physical therapy services to improve mobility in patient with complex problems
 affecting their balance and gait.
Inclusion Criteria:

 -  Diagnosis of Idiopathic Parkinson's disease

 Exclusion Criteria:

 -  Outside of the age range