Novel Tools for the Delivery and Assessment of Exercise Programs Adapted to Individuals With Parkinson's Disease

The specific aims of this project are: a) to determine whether a technology-based personalized home exercise program delivered asynchronously and supervised remotely by a kinesiologist is more effective in improving gait than a traditional home-based exercise program, b) to assess the system acceptability and satisfaction, c) to examine and compare the impact of both approaches on several secondary outcome measures related to mobility, PD symptom, and quality of life. This study is a prospective randomized controlled single-blinded clinical trial of efficacy of a technology asynchronous assisted supervised tele-exercise program compared to an a traditional home-based exercise program with a booklet.

Interventions:

Control group (CONT): The participants (n=21) included in control group will follow a non-supervised home-based exercise program (booklet format). The exercise program will include 3 physical activity sessions per week for 12 consecutive weeks. This exercise regimen has been shown to be adequate to improve functional capacities in elderly and feasible. Each exercise session will last 40-45 minutes and includes: 1) 5 minutes of warm-up exercises; 2) 15-18 minutes of mobility and balance exercises (e.g. high knees, lateral launches, side steps); 3) 15-18 minutes of strengthening and coordination exercises (e.g. weight transfer and squats, leg extension and balance, lateral shifting, horizontal flexion and extension) and; 4) 5 minutes for cool down/stretching. This exercise protocol was developed based on general guidelines for the prescription of exercises to older adults and, validated in a previous study. The exercise booklet will be introduced and supervised for the first sessions by a trained kinesiologist. Follow-ups by phone will happen at sessions 6, 12 and 18. During these follow-up calls, if the answers are "yes" to the 3 following questions (1. Did the participant perform during the last weeks all the exercise sessions? 2. Did the participant feel safe when performing exercises? 3. Did the participant find easier to perform the exercises compared to the last contact?), then the participant will be invited, but not obligated, to increase the level of difficulty using the option indicated in the booklet.

JIN Group (n=21): The JIN group (n=21) will receive an individualized asynchronous supervised home-base exercise program using the Jintronix System, 3 times/week for 12 weeks (36 sessions). This exercise regimen has shown to be adequate to improve functional capacities in elderly. Briefly, the Jintronix Rehabilitation System (JRS) uses Microsoft Kinect cameras to track patient's movements in 3D during exercises. They are programmed as games that are visualized on a television and for which performance feedback is provided to the participant. Developed by Jintronix system designers in partnership with researchers, the system provides an interactive exergame environment to execute, specialized exercises through specific instructions and real-time feedback. The Jintronix system which includes a computer, the software and a motion capture device will be installed at participants' homes on their own television. A trained kinesiologist will install the system and supervise the exercise program. Participants will be trained to use the system with help of the kinesiologist during the visits. Each exercise session will last 40-45 minutes and includes: 1) 5 minutes of warm-up exercises; 2) 15-18 minutes of mobility and balance exercises (e.g. high knees, lateral launches, side steps); 3) 15-18 minutes of strengthening and coordination exercises (e.g. weight transfer and squats, leg extension and balance, lateral shifting, horizontal flexion and extension) and; 4) 5 minutes for cool down/stretching. Based on the Web-portal daily reports on the performance of the exercise program, the kinesiologist will do online adjustment of the degree of difficulty of the individualized exercises by increasing the number of repetitions, number of series, intensity and range of motion and provide feedback to the participant. This will ensure individualized adaptations and progress throughout the 12-week intervention.

The JIN group will use the Jintronix rehabilitation software to exercise at home whereas the CONT group will use an exercise booklet. Both groups will be free to exercise on the 3 days and times that best suit their schedule, with a mandatory minimum of one day off between sessions. In addition, to counteract human interaction bias, both exercise groups will have the same number and type of contact. The first weeks following the baseline evaluation, 3 to 4 in-person home visits are required to ensure proper and safe execution of exercise protocol (both groups) and the capacity to use the technology (JIN group only). In addition to these visits, 3 follow-up phone calls will be given to allow the kinesiologist to ensure safety and adherence. An emergency contact number will be given to participants for any questions regarding the exercise regimen during the 12-week intervention.