Study: SMARTfit May Outperform Traditional Physiotherapy

Margarida Maia, PhD avatar

by Margarida Maia, PhD |

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SMARTfit gym equipment, which combines movement with cognitive tasks in a playful way, may lead to better motor and cognitive functions than  conventional physiotherapy, according to a small study in people with Parkinson’s disease.

The equipment can be used easily and safely by anyone, researchers say, and the training program can be tailored in real time to meet the unique, evolving needs of Parkinson’s patients in particular.

“Our SMARTfit technology is focused on the entire spectrum of human health and brain-body fitness,” Cathi Lamberti, CEO of SMARTfit, the equipment’s developer, said in a press release.

“This … study provides initial evidence that SMARTfit-based dual-task therapy may be better for Parkinson’s disease patients compared with traditional single-task [physical therapy] delivered by excellent therapists. Furthermore, we provide a solution that is both economical and scalable,” Lamberti added.

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The study, “Gamified dual-task training for individuals with Parkinson disease: An exploratory study on feasibility, safety, and efficacy,” was published in the International Journal of Environmental Research and Public Health.

The team was led by Charles Liu, MD, PhD, who directs the University of Southern California (USC) Neurorestoration Center, and Beth Fisher, PhD, a professor at the USC Division of Biokinesiology and Physical Therapy.

“Many researchers have established the immense value of physical therapy for Parkinson’s disease, including the coauthors of this paper,” said Liu. “However, good physical therapy is often not available to large numbers of [Parkinson’s disease] patients, and this has been exacerbated by the COVID-19 global pandemic.”

Physical therapy, also called physiotherapy, often is used to manage the symptoms of Parkinson’s. It can help build muscle strength, increase mobility, and regain independence in daily tasks.

While exercises typically focus on motor skills, there also is a so-called dual-task program that combines movement with cognitive tasks. This is because some patients with Parkinson’s experience mild cognitive impairment, and cognitive impairment can affect how well someone plans, focuses attention, remembers instructions, and juggles multiple tasks while moving. 

Now, the team led by Liu and Fisher also thought of adding elements of game playing to a dual-task program. This approach, called gamification, is expected to further improve motor and cognitive function by making training more playful and engaging.

One piece of equipment delivering this type of gamified training is SMARTfit. 

“In this study, we wanted to explore the feasibility of using a novel device called SMARTfit as a tool for therapists to use dual-task cognitively engaged training in treating [Parkinson’s disease] patients,” said Liu, adding that “although the study included only a small cohort of patients, the results were quite promising, showing that dual-task training using SMARTfit may be better than [single-task] standard [physical therapy]. Furthermore, SMARTfit dual-task training can be delivered by the therapist in a physical distancing way.”

The study (NCT03921359) included eight patients with mild-to-moderate idiopathic (of unknown cause) Parkinson’s who completed a minimum of 24 hours for each of two training conditions, two to three times per week over a mean of 8.8 weeks. One condition used the SMARTfit equipment and the other was a conventional single-task physical therapy program. The patients started on either one or the other, and there was a mean “washout” period of 11.5 weeks between programs.

While the conventional program developed around functional tasks only, the SMARTfit equipment added a variety of interactive cognitive tasks. Both were optimized over the course of the programs to ensure the tasks remained challenging.

A moderate exercise intensity was reached during all sessions of both program.

“The average heart rate that was reached across all training sessions was equivalent to a moderate exercise intensity,” the researchers wrote.

When the researchers watched for changes in the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale Motor Examination (MDS-UPDRS) score before and after each program, they found that more patients had an improvement of at least five points in motor symptoms after the SMARTfit program.

More patients also had an improvement of at least three points in perceived disability after the SMARTfit program. The MDS-UPDRS is a measure of the severity and progression of Parkinson’s. However, the changes were not significant between the two conditions.

Similar findings were observed for the Parkinson’s Disease-Cognitive Rating Scale (PD-CRS), a test battery that covers the full spectrum of cognitive changes associated with Parkinson’s.

The researchers are working on additional studies to further explore the benefits of SMARTfit for a variety of other indications that may benefit from physical therapy.

“SMARTfit is currently working with and supporting an estimated 600 sites in 14 countries where early adopters have tested many aspects of the technology,” said Lamberti.