Home-based high-intensity interval training for people with Parkinson’s : The HIIT-Home4Parkinson’s Study
Background Exercise, particularly of high intensity, is considered to be important for people with Parkinson’s (PwP). However, PwP are less active than healthy individuals, and face disease specific and logistical barriers to exercise participation such as lack of outcome expectation, symptom exacerbation, travel logistics due to motor symptoms, expense and perceived lack of time. High-intensity interval training (HIIT) is a low volume exercise modality, evinced to be beneficial and time efficient for people within various healthy and clinical populations. HIIT therefore, particularly undertaken in the home could be apposite for PwP, although evidence is currently limited. Therefore, this study aimed to evaluate the practicality and utility of home-based HIIT for PwP, which could potentially constitute a useful long-term exercise strategy. Methods Following a systematic review of HIIT for PwP, a new, home-based HIIT programme for PwP was developed through an iterative, co-creative process of focus groups and exercise testing. The new programme was then implemented as a 12-week randomised, controlled feasibility study incorporating process evaluation, to assess feasibility, acceptability and safety, identify potential primary and secondary outcomes, and clarify key methodological considerations for a definitive trial. Assessments included programme completion, adherence and adverse events, while potential primary outcomes included brain-derived neurotrophic factor, maximal oxygen uptake and the Unified Parkinson’s Disease Rating Scale motor symptom assessment. Results A systematic review of literature indicated supervised HIIT in clinical settings to be feasible, safe and useful for some PwP of mild-to-moderate disease severity, although extended adherence appeared to be problematic. Co-creators then developed HIIT-Home4Parkinson’s (HH4P), a 12-week home-based HIIT programme, based on individualisation, adaptability and appropriate remote supervision. Following programme development, 13 PwP of Hoehn and Yahr stages 1-3 undertook the HH4P randomised controlled feasibility study, with seven allocated to the exercise group, and six to usual care. On completion, adverse effects were minor and uncommon, while high levels of programme completion and adherence along with qualitative data indicated the programme to be practical and acceptable. However, the required exercise intensity was not uniformly achieved, and participants did not experience improvements in any of the potential primary outcomes. Conclusions Home-based HIIT appears to be practical, acceptable and safe for some PwP of mild to moderate disease severity, although the potential benefits of this exercise modality, and the suitability for generating the required exercise intensity remain uncertain. Continuation to a full trial is not recommended with the current HH4P programme format, as results suggest that several aspects regarding intervention and study procedures, such as exercise type, model of support, eligibility criteria and outcome measures require further evaluation. Results of these evaluations could provide a potential rationale for the implementation of a full trial with long-term follow-up, providing further evidence regarding the suitability of home-based HIIT as a long-term exercise strategy for PwP.
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