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Feasibility of a Virtual Exercise Coach to Promote Walking in Community-Dwelling Persons with Parkinson Disease

Ellis, Terry PT, PhD, NCS; Latham, Nancy K. PT, PhD; DeAngelis, Tamara R. DPT, GCS; Thomas, Cathi A. RN; Saint-Hilaire, Marie MD; Bickmore, Timothy W. PhD

American Journal of Physical Medicine & Rehabilitation: June 2013 - Volume 92 - Issue 6 - p 472–485
doi: 10.1097/PHM.0b013e31828cd466
CME Article . 2013 Series . Number 5

Objective The short-term benefits of exercise for persons with Parkinson disease (PD) are well established, but long-term adherence is limited. The aim of this study was to explore the feasibility, acceptability, and preliminary evidence of the effectiveness of a virtual exercise coach to promote daily walking in community-dwelling persons with Parkinson disease.

Design Twenty subjects with Parkinson disease participated in this phase 1, single-group, nonrandomized clinical trial. The subjects were instructed to interact with the virtual exercise coach for 5 mins, wear a pedometer, and walk daily for 1 mo. Retention rate, satisfaction, and interaction history were assessed at 1 mo. Six-minute walk and gait speed were assessed at baseline and after the intervention.

Results Fifty-five percent of the participants were women, and the mean age was 65.6 yrs. At the study completion, there was 100% retention rate. The subjects had a mean satisfaction score of 5.6/7 (with 7 indicating maximal satisfaction) with the virtual exercise coach. Interaction history revealed that the participants logged in for a mean (SD) of 25.4 (7) days of the recommended 30 days. The mean adherence to daily walking was 85%. Both gait speed and the 6-min walk test significantly improved (P < 0.05). No adverse events were reported.

Conclusions Sedentary persons with Parkinson disease successfully used a computer and interacted with a virtual exercise coach. Retention, satisfaction, and adherence to daily walking were high for 1 mo, and significant improvements were seen in mobility.

Supplemental digital content is available in the text.

From the College of Health & Rehabilitation Sciences: Sargent, Center for Neurorehabilitation (TE, TRD) and School of Public Health, Health & Disability Research Institute (NKL), Boston University, Massachusetts; Parkinson’s Disease and Movement Disorders Center, Department of Neurology, Boston University Medical Campus, Massachusetts (CAT, MS-H); and College of Computer and Information Science, Northeastern University, Boston, Massachusetts (TWB).

All correspondence and requests for reprints should be addressed to: Terry Ellis, PT, PhD, NCS, College of Health & Rehabilitation Sciences: Sargent, Boston University, 635 Commonwealth Ave, Boston, MA 02215.

Supported by the American Parkinson Disease Association, Inc; Boston Claude D. Pepper Older Americans Independence Center; Boston University Building Interdisciplinary Research Careers in Women’s Health–K12 HD043444; ProjectSpark; and Boston University School of Public Health Pilot Project Fund. The virtual exercise coach system was developed, in part, under grant R01AG028668 from the National Institute on Aging.

CME Objectives: Upon completion of the article the reader should be able to: (1) Understand the potential role of exercise in reducing disability in persons with Parkinson disease and the factors that limit long-term adherence to exercise, (2) Explain the important and unique attributes of the computer-based Virtual Exercise Coach used to promote behavioral change, and (3) Discuss the feasibility of persons with Parkinson disease using the Virtual Exercise Coach in the home environment to increase adherence to walking.

Level: Advanced

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The Association of Academic Physiatrists designates this activity for a maximum of 1.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Presented in abstract form as Ellis TD, Latham NK, DeAngelis TR, et al: Feasibility of virtual exercise coach to promote walking in community-dwelling persons with Parkinson’s disease. Mov Disord 2012;27(suppl 1):809. Presented in poster form at the Movement Disorder Society’s International Congress of Parkinson’s Disease and Movement Disorders, Dublin, Ireland, June 19, 2012.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

Editor’s Note: Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (

© 2013 by Lippincott Williams & Wilkins