Exercise is important for helping people with Parkinson disease achieve better balance and mobility, but it can be hard to keep it up. A Dutch study has yielded positive results with a novel home exercise computer gaming program.

For people with Parkinson disease, exercise is key to good health.

The Parkinson's Outcomes Project, which is a 10 year study of 12,000 people in five countries, found that starting exercise as early as possible following diagnosis and doing at least 2.5 hours per week can slow the condition's progress.

However, which exercise is best?

Access, cost, commitment, and self-consciousness can all prove challenging to the nearly 1 million people with Parkinson in the United States.

The Parkinson's Foundation advise stretching, along with exercises that are aerobic, strengthening, and enjoyable.

Enter the Park-in-Shape study in bicycle loving Holland. This large study, which now appears in The Lancet Neurology, used motivational apps to get people with Parkinson's moving.

One control group did stretching exercises, while the other used stationary bikes at home. The latter group showed a significant improvement in motor ability—comparable with that achieved by several conventional Parkinson's drugs.

"We conducted the study for several reasons," Nicolien van der Kolk—a PhD student at Radboud University Medical Center in Nijmegen, the Netherlands—explained to Medical News Today.

"Previous exercise research in people showed the beneficial effect of targeted training on improving skills, for example, walking training improved walking speed, however, it was unknown whether it could also improve symptoms that were not directly trained.

"Animal research suggested an important role for aerobic exercise in influencing [Parkinson]. We, therefore, wanted to see what the effect of aerobic exercise was on [Parkinson] symptoms that were not directly trained with the exercise."

The bike group, who had to cycle for 30–45 minutes three times per week for 6 months, received exercise bikes with screens and games designed to rouse their enthusiasm and motivate them to improve.

For example, they could race themselves, battling to the finish against the "ghost rider" of their previous effort, or they could take on a group of other riders—all in the comfort of their own homes.

The system, which monitored the participants' heart rate and upped the ante accordingly, became tougher as they got fitter.

'Exergame' matches medication's benefits

The study—which the Department of Neurology at the Donders Institute for Brain, Cognition, and Behaviour at Radboud University Medical Center ran—showed that those with bikes had significantly improved their motor ability compared with those who simply stretched.

In fact, the participants with bikes scored 4.2 points lower, on average, on the MDS-UPDRS score. This is a unified rating scale that measures the course of the condition.

The cyclists also showed better cardiovascular fitness:

"This study shows that by performing intensive aerobic exercise, [people with Parkinson] can improve their cardiovascular fitness, which obviously has many health benefits and can limit comorbidity in the future."

—Nicolien van der Kolk

"In addition, it shows that aerobic exercise has effects on [Parkinson] motor signs that are similar to levodopa [a drug that aids muscle control], however with the main difference that exercise stabilizes and levodopa improves signs."

The researchers conclude that the gains to motor ability were clinically significant and showed the benefit of exercise in a treatment regimen.

Not only that, they say, but the convenience of exercising at home in a fun way—with an "exergame"—proved motivating. The participants surprised the researchers with their commitment.

A review of seven studies on the benefits of exergaming for Parkinson, which appears in the Journal of Neuroengineering, showed that "exergaming" improved balance and motor symptoms and helped with walking. It also showed the potential of exergaming as a means to boost motor skills in people with Parkinson's.

It also helped overcome the challenges of deciding where to exercise, the cost, and commitment issues.

Van der Kolk said that most participants were happy with the motivating elements of the game.

"Some were very pleased with the support function that their family could fulfil, whereas others were mainly stimulated by the visualization of the goal on the bike's computer screen."

The researchers say that they can now start looking at the potential of an extended cycling program to slow the condition down, as well as its effectiveness for other disorders.

"Whether the brain is compensating the neurodegenerative process better, or whether it reduces or slows down the neurodegenerative process, is so far unknown. Additional research is necessary to study the effect in the brain, as well as on [Parkinson] symptoms over a longer period of time," said van der Kolk.