Home-Based Exergaming Shows Efficacy for Treat Gait and Balance Disorders in Parkinson Disease

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A phase 2 trial showed the effectiveness of a home-based, full-body movement exergaming program for Parkinson disease compared with control.

Marie-Laure Welter, MD, PhD, HDR, neurologist at Institut National de la Santé et de la Recherche Médicale, in Paris, France

Marie-Laure Welter, MD, PhD, HDR

The findings from a phase 2 randomized controlled trial newly published in the European Journal of Neurology demonstrated efficacy of a home-based, full-body movement, active training using tailored exergaming designed for patients with Parkinson disease (PD) who had medically refractory gait and balance disorders. These findings suggest home-based training using a tailored exergame can be performed safely by patients with PD and could improve gait and balance disorders in this population.1

Following 18 training sessions, investigators did not observe significant difference in Stand-Walk-Sit Test (SWST) score change between the active group (n = 25) and control group (n = 25) (active group, –3.71 s [SD, 18.06]; control group, –0.71s [SD, 3.41]; P = .61). Some 32% of patients in the active and 8% in the control group were considered responders to the training program, defined as a SWST duration change at least 2 s (P = .03). Notably, the clinical severity of gait and balance disorders also significantly decreased following active training, with a between-group difference in favor of the active training (P = .0082).

Top Clinical Takeaways

  • Home-based, full-body movement exergaming shows promise in improving clinical gait and balance disorders in patients with PD, despite no significant changes in functional mobility observed.
  • The study's limitations—including participant dropouts and the inability to compare exergaming with no training or usual care—highlight challenges and areas for future research in PD rehabilitation.
  • Although not conclusive, the findings contribute valuable insights into the potential effectiveness of exergaming in enhancing patients' adherence and efficacy in rehabilitation programs for PD.

“We observed no significant difference in functional mobility (the SWST duration) between active full-body movement training and control gaming. However, active exergaming training did improve clinical gait and balance disorders scores and postural gait kinetics,” senior author Marie-Laure Welter, MD, PhD, HDR, a neurologist at Institut National de la Santé et de la Recherche Médicale, in Paris, France, and colleagues wrote.1 “The control group showed no changes in motor signs, but improvement in quality of life and anxiety. The exergaming training was well received and tolerated.”

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Investigators recruited 50 patients with PD who had dopa-resistant gait and/or balance disorders. Patients were randomly assigned in a 1:1 ratio to receive training sessions at home by playing a tailored exergame with full-body movements using a motion capture system for the active group or by playing the same game with the computer's keyboard for the control group. The researchers assessed the difference between-group difference in the SWST duration change after training as the primary end point, and the secondary outcomes assessed included parkinsonian clinical scales, gait recordings, and safety.

Overall, investigators did not observe any serious adverse events (AEs) induced by the home-based training program. Despite this, 9 AEs occurred overall in 8 patients with 4 in the active and 4 in the control group. During the open-label period, 3 serious AEs were reported unrelated to the intervention and consisted of recurrent falls, or hospitalization for antiparkinsonian medication adjustment. In addition, 5 nonserious AEs were reported during the randomization and open-label periods in 5 patients.

All told, a notable limitation of the study included 2 patients who dropped out in the active group who were not replaced because of the COVID-19 pandemic, which may have resulted in an underpowering the results. Another limitation is that both patient groups received intervention programs, which prevented the investigators from examining the effects of active exergaming training compared with no training or usual care programs. Additionally, authors noted the study design did not allow for a comprehensive assessment of retention effects as all patients were given the option to engage in active training after the randomized period.

“While our findings do not definitively conclude on the effectiveness of our exergaming approach, they do contribute valuable insights into the development of rehabilitation programs incorporating exergaming to improve patients' adherence and efficacy,” Welter et al noted.1 “Further research is needed to explore the impact of exergaming on disease progression in patients with less severe forms of PD, assess the healthcare implications, and gain deeper insights into its effects on brain function.

REFERENCES
1. Nuic D, van de Weijer S, Cherif S, et al. Home-based exergaming to treat gait and balance disorders in patients with Parkinson's disease: A phase II randomized controlled trial. Eur J Neurol. 2024;31(1):e16055. doi:10.1111/ene.16055
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