Combined Cognitive and Exercise Enrichment to Improve Outcomes in Patients with Parkinson's Disease.

The study uses a “randomized controlled trial” design, with people in the treatment condition (active enrichment group) compared to those in the non-treatment condition. (passive enrichment group). The enrichment programme is for a period of 8 months. Those allocated to the active enrichment programme will complete various physical exercise activities, on a weekly basis, done in small groups, tailored to ability and preference (See #1 below). These will be supervised by a registered physiotherapist. These physical exercise sessions will be 40-50 mins long and will normally take place at the same time each week in the same place. The physiotherapist will assess movement skills and monitor progress. Participants will also complete a set of thinking and memory exercises (see #2 below). These thinking exercises will be given to participants fortnightly by members of the research team from the New Zealand Brain Research Institute. Progress on these exercises will be monitored by the researchers and new cognitive exercises will be provided as the previous ones are completed.. These thinking and memory exercises will be completed with a caregiver/spouse or research staff member in the participants own home. We anticipate the cognitive exercises will take around 40-60 minutes on a weekly basis.. Cognitive tasks will include different types of pencil and paper exercises or tasks that require a verbal response. The level of difficulty of each cognitive task will be tailored to maximise improvements on each of them. A research team member will also talk with participants about common events in the past (e.g. family life and weddings). With permission, they will also record these descriptions of the events (a copy will be available to participants). #1 Physical Activities: Participants physical abilities were assessed by a qualified physiotherapist. On that basis they engaged in a suitably tailored circuit of activities consisting of aerobic, balance and strengthening exercises after a warm-up. Examples of each of these exercises include a exercise bike (aerobic), use of hand weights (strength) and walking a beam for balance. The participants are encouraged to work at an intensity that is “Somewhat hard” using the Borg “Rating of Perceived Exertion” Emoticon Chart.” #2 Cognitive Activities: Examples included elaborating vivid memories of personal events using personal prompts and reminders; envisioning a future event; visual-spatial puzzles; selective attention, mental rotation. Adherence to the programme was assessed by records of attendance at the physiotherapy sessions (physiotherapists) and by return of completed cognitive activities folders. (Psychology PhD students and Research Coordinator).