Telemedicine Intervention to Improve Physical Function

Background/Rationale:

Parkinson's disease (PD) is the second most common neurodegenerative disease, affecting over
one million Americans. The cardinal clinical manifestations of PD are motoric, which limit
functional mobility leading to difficulty working, caring for family members, managing a
household, and overall decreased independence and quality of life (QOL). A wealth of growing
data indicates tremendous benefits of exercise for patients with PD. Not only have exercise
programs been shown to improve motor function and reduce the risk of falls, but also improve
overall QOL and possibly the very course of disease pathology. However, programs that
involve supervision in the home of people with PD are expensive to roll out widely, and
programs that involve people with PD traveling to a central site not only result in
non-compliance over time because of difficulty getting to the site, but also rule out the
involvement of a large number of people with PD who simply live too far from larger centers
where such programs are typically established.

Objective:

The investigators hypothesize that a one-year in-home exercise program, centered around
remote, real-time instruction and supervision, will reduce the rate of falls and improve
strength and QOL in patients with PD.

Methods:

The proposed study is a randomized controlled trial of a structured exercise program,
evaluating effects on fall rate, physical functioning, and QOL. Community-dwelling people
with PD will be randomized either to a group who receives structured and remote exercise
instruction and supervision in real-time or a group who is taught a lifestyle exercise
program. Subjects will be male and female Veterans with a physician diagnosis of idiopathic,
typical PD, with at least 2 of 3 cardinal signs of PD, and response to dopaminergic
medication. The interventions will last one year.

Inclusion Criteria:

- Physician diagnosis of idiopathic, typical Parkinson's disease (PD)

- At least 2 of 3 cardinal signs of PD

- Response to dopaminergic medication

Exclusion Criteria:

- Angina pectoris

- History of myocardial infarction within 6 months

- History of ventricular dysrhythmia requiring current therapy