Patients in Italy Largely Able to Remain Fit in COVID-19 Lockdown, Survey Finds

Although the COVID-19 pandemic has limited outdoor and other physical activity for people with Parkinson’s disease, many have successfully used technology, social media, and other means to find ways to stay active.

Most patients in a survey of 74  people at the Neurology Unit of Tor Vergata University Hospital in Rome “continued sports activities,” especially those “with shorter disease duration,” its researchers wrote. The email survey covered April 20 through May 2, when Italy was in a period of lockdown to prevent the virus’ spread.

The study, “Physical activity changes and correlate effects in patients with Parkinson’s disease during COVID‐19 lockdown,” was published in the journal Movement Disorders Clinical Practice.

The global pandemic has profoundly changed daily routines for many people in a very short period of time. Those living with Parkinson’s have been especially affected, through missed follow-up visits and a loss or reduction of such regular activities as physiotherapy, sports training, and other exercise regimes.

For patients, the loss of exercise is significant, as exercise has been shown to help with key symptoms of the disorder, improving  gait and balance, flexibility, grip strength, and motor coordination, and lessening tremor.

Because this coronavirus is highly infectious, many people were obliged to adopt self-management strategies to stay active, which include home-based and technology-assisted techniques.

Researchers at Tor Vergata University surveyed of Parkinson’s patients with two goals in mind. First, they wanted to better understand the relationship between changes in physical activity and patients’ own perception of their health; second, they explored how technology-based tools influenced physical exercise during the pandemic.

Complete survey responses came from 74 people with Parkinson’s at this center. None of them had been diagnosed with COVID-19, and they were divided evenly by gender.

Of them, 59 reported exercising regularly at the pandemic’s outset, and 60 reported doing so at the time of the survey.

Of the 32 patients who were undergoing physiotherapy before the April lockdown, only seven remained in therapy at the time of the survey, a 78% drop. This interruption in physiotherapy, however, did not appear to significantly impact the number of these patients who reported still regularly exercising (20 from an initial 22).

Those with shorter disease duration were most likely to engage in regular physical activity, the researchers wrote.

Nearly 60% of respondents said that they felt that their condition had worsened over the course of the pandemic. This group did not differ in terms of age, age at Parkinson’s onset, and disease duration from those who reported remaining stable.

But patients who felt a worsening also had poorer motor and non-motor symptoms, as assessed by the Parkinson’s Well-Being Map (PWBM), and showed more signs of depression, as measured using the Beck Depression Inventory (BDI). They also reported less physical activity than did other respondents.

“Although the reasons of such decline could not be directly determined,” the researchers wrote, they suggested that the main identified risk factor associated with perceived worsening was the reduction of physical activity.

Thirty-seven patients (63% of those who exercised regularly, and 50% of the whole study population) used technology-based tools to help maintain a physical training program. Of these patients, 65% were female and 45.5% of them were using these technologies for the first time. No other differences emerged in terms of age, age at disease onset, or other measures.

About one-third of them made use of freely available web videos. Only about 10% of respondents used video games or smartphone apps, possibly because of the greater need for expensive devices or due to apps requiring fees.

Although a small study that lacked objective clinical measures, its results support past findings on how exercise benefits the well-being of Parkinson’s patients. It also points to a resilience among these patients to the challenges of COVID-19, in their willingness to seek alternative ways of remaining active at home.

The researchers noted that physical exercise and home-based training are increasingly seen as promising therapeutic strategies in Parkinson’s management.

“An adequate level of physical activity,” they concluded, “is critical to ensure patients’ well-being even during [the] COVID-19 emergency. [To this end], it is necessary either to promote communication and education among patients, especially through media, networks and organizations, or to increase availability and accessibility [of technology-based tools] and telemedicine.”