Speech and Exercise Therapy for Parkinson's Disease

Overseen by David William Sparrow, DSc

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: VA Office of Research and Development

No Placebo Group

Trial Summary

What is the purpose of this trial?

Nearly 90% of people with Parkinson's disease have speech and voice disorders that negatively impact their ability to communicate effectively in daily life. This study will test the hypothesis that a combined speech and exercise intervention will improve speech intelligibility in people with Parkinson's disease and speech impairment. This approach would offer an affordable way to continue to both instruct and encourage training by Veterans virtually indefinitely through the remote access technology. These findings may help VA clinicians provide optimal care for the many Veterans with Parkinson's disease and speech impairment.

Do I have to stop taking my current medications for the trial?

The protocol does not specify if you need to stop taking your current medications. However, since participants must respond to dopaminergic medication, it seems likely you will continue taking it.

What data supports the idea that Speech and Exercise Therapy for Parkinson's Disease is an effective treatment?

The available research shows that while exercise programs and rehabilitation are not always essential when motor disorders are controlled by medication, they become necessary when motor decline occurs. Exercise therapy, especially goal-based task-specific training, has been found effective in improving motor symptoms. Studies indicate that physical exercise, including speech therapy, can improve mobility, balance, and speech problems in Parkinson's patients. However, the effects on reducing daily life disability are more significant than on specific symptoms like tremor. New studies highlight improvements in movement and balance through strength training and rhythmic exercises, suggesting that these therapies can help patients manage their condition better. ^{1 2 3 4 5}

What safety data exists for speech and exercise therapy in Parkinson's disease?

The available research indicates that exercise and motor training are beneficial for people with Parkinson's disease, but there is limited reporting on adverse events in clinical trials. A systematic review found that 72% of trials did not report adverse events, which poses challenges for assessing safety. However, the Lee Silverman Voice Treatment, a specific speech therapy, has been shown to relieve speech problems in Parkinson's patients. Overall, while the benefits of exercise and speech therapy are recognized, more consistent reporting on safety and adverse events is needed. ^{3 5 6 7 8}

Is the combined speech and exercise treatment a promising treatment for Parkinson's disease?

Yes, the combined speech and exercise treatment is promising for Parkinson's disease. Exercise therapy helps improve movement and balance, and speech therapy can relieve speech problems. Together, they can enhance overall quality of life for people with Parkinson's disease. ^{3 4 5 8 9}

Research Team

David William Sparrow, DSc

Principal Investigator

VA Boston Healthcare System Jamaica Plain Campus, Jamaica Plain, MA

Eligibility Criteria

This trial is for people with Parkinson's disease who have speech and voice disorders known as hypokinetic dysarthria. Participants must have a diagnosis of idiopathic PD, show at least two key symptoms (resting tremor, rigidity, bradykinesia), and respond to medication for PD. Those with recent heart issues or requiring therapy for irregular heartbeat cannot join.

Inclusion Criteria

I have a speech disorder due to muscle weakness.

My condition improves with dopamine medication.

I have been diagnosed with Parkinson's disease by a doctor.

Exclusion Criteria

I have had a heart attack in the last 6 months.

I am currently being treated for irregular heartbeats.

I have chest pain due to heart problems.

Treatment Details

Interventions

• Combined speech and exercise intervention (Behavioral Intervention)
• Health education (Behavioral Intervention)

Trial Overview The study is testing if a combined speech and exercise program can help improve how well people with Parkinson's can speak and be understood. It compares this approach to standard health education. The intervention will be delivered through telemedicine, which could make long-term care more accessible.

Participant Groups

Group I: Combined speech and exercise intervention Experimental Treatment 1 Intervention

Home-based exercise intervention with interactive automated speech response features that encourage a higher level of speech performance.

Group II: Control group Active Control 1 Intervention

Health education

Who Is Running the Clinical Trial?

VA Office of Research and Development

Lead Sponsor

Trials

1,691

Recruited

3,759,000+

Findings from Research

Exercise and rehabilitation programs become essential for Parkinson's disease patients when motor decline occurs despite DOPAtherapy, as they can help reduce daily life disability rather than directly improving core symptoms like bradykinesia or tremor.

Only a few well-designed studies exist on the effectiveness of rehabilitation in Parkinson's disease, but they suggest that early intervention with physiotherapy focusing on postural control and fall prevention can significantly benefit patients' independence.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[Exercices program and rehabilitation of motor disorders in Parkinson's disease]. Pélissier, J., Pérennou, D.[2006]

In a randomized controlled trial involving Parkinson's disease patients at Hoehn Yahr stage II, physiotherapy (PT) significantly improved functional outcomes, as indicated by a 3-point increase in FIM scores and better performance on the TUG test compared to general exercise (GE).

The UPDRS scores also showed a notable improvement in the PT group, with a 6.5-point difference at the end of treatment and an 11-point difference at follow-up, suggesting that physiotherapy is more effective than general exercise for managing symptoms in these patients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical Therapy Versus a General Exercise Programme in Patients with Hoehn Yahr Stage II Parkinson's Disease: A Randomized Controlled Trial. Dipasquale, S., Meroni, R., Sasanelli, F., et al.[2019]

Exercise is a crucial part of managing Parkinson's disease (PD) and is shown to improve physical fitness, but there is a lack of standardized recommendations due to the variability in exercise interventions across 83 clinical trials.

The most common exercise prescription found was multimodal exercise for 60 minutes, twice a week over 12 weeks, highlighting the need for increased physical activity levels as an effective strategy for PD management.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical Activity, Exercise, and Physiotherapy in Parkinson's Disease: Defining the Concepts. Bouça-Machado, R., Rosário, A., Caldeira, D., et al.[2022]

Task-specific training with perturbations has been shown to effectively improve gait and balance in people with Parkinson's disease, potentially reducing the risk of falls, based on initial randomized controlled trials.

Combining task-specific training with cardiovascular exercise may enhance neuroplasticity, leading to better therapy outcomes, although the current quality of evidence for these approaches is still low and more rigorous studies are needed.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

[New approaches in exercise therapy for Parkinson's disease]. Wanner, P., Klamroth, S., Steib, S.[2022]

Recent high-level studies indicate that targeted physical training, including strength and endurance exercises, can significantly improve mobility and balance in Parkinson's disease patients.

Speech therapy, particularly the Lee Silverman Voice Treatment, has been effective in addressing speech issues in Parkinson's patients, but further research is needed to confirm the benefits of other therapies like occupational and swallowing therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Physical, occupational, speech and swallowing therapies and physical exercise in Parkinson's disease. Ransmayr, G.[2022]

A review of 53 randomized controlled trials on exercise and motor training for Parkinson's disease showed that most interventions were effective and well-supervised, lasting an average of 8.3 weeks, with high participant retention rates (69% retained ≥85% of participants).

However, the lack of detailed reporting on adherence and adverse events in 72% of trials may hinder clinicians' ability to implement these programs effectively in practice, as they need to weigh the benefits against potential risks.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise and motor training in people with Parkinson's disease: a systematic review of participant characteristics, intervention delivery, retention rates, adherence, and adverse events in clinical trials. Allen, NE., Sherrington, C., Suriyarachchi, GD., et al.[2021]

Recent advances in neuroscience have improved understanding of how rehabilitation and exercise can benefit individuals with Parkinson's disease (PD), leading to more referrals for early and continuous exercise programs.

The article highlights the Lee Silverman Voice Treatment as an effective speech therapy for PD, documenting its efficacy and unexpected outcomes, while also exploring the underlying mechanisms of speech disorders in PD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Intensive voice treatment in Parkinson's disease: Lee Silverman Voice Treatment. Sapir, S., Ramig, LO., Fox, CM.[2022]

Community-based exercise programs for individuals with Parkinson's disease (PD) show promise in improving health outcomes, but there is significant variability in the types of exercises and study designs used in the research.

While the feasibility and potential benefits of these programs are encouraging, the overall quality of the studies needs to be enhanced to better understand how different exercise modalities can support self-management in PD.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Exercise Made Accessible: the Merits of Community-Based Programs for Persons with Parkinson's Disease. Langbroek-Amersfoort, A., Schootemeijer, S., Bouten, L., et al.[2023]

Out of 236 clinical trials on exercise therapy for Parkinson's disease, only 29.7% reported their findings, and just 25.8% had results published in scientific journals, indicating a significant gap in the dissemination of research outcomes.

Most trials exhibited unclear risks of bias and lacked essential methodological details, such as randomization and blinding, which undermines the reliability of their findings and highlights the need for higher quality reporting in future studies.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Reporting and methodological quality of clinical trials on exercise therapy for Parkinson's disease. Silva, CM., Travessa, AM., Bouça-Machado, R., et al.[2020]

References

1. France pubmed.ncbi.nlm.nih.gov

[Exercices program and rehabilitation of motor disorders in Parkinson's disease]. [2006]

2. Netherlands pubmed.ncbi.nlm.nih.gov

Physical Therapy Versus a General Exercise Programme in Patients with Hoehn Yahr Stage II Parkinson's Disease: A Randomized Controlled Trial. [2019]

3. United States pubmed.ncbi.nlm.nih.gov

Physical Activity, Exercise, and Physiotherapy in Parkinson's Disease: Defining the Concepts. [2022]

4. Germany pubmed.ncbi.nlm.nih.gov

[New approaches in exercise therapy for Parkinson's disease]. [2022]

5. Austria pubmed.ncbi.nlm.nih.gov

Physical, occupational, speech and swallowing therapies and physical exercise in Parkinson's disease. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

Exercise and motor training in people with Parkinson's disease: a systematic review of participant characteristics, intervention delivery, retention rates, adherence, and adverse events in clinical trials. [2021]

7. England pubmed.ncbi.nlm.nih.gov

Intensive voice treatment in Parkinson's disease: Lee Silverman Voice Treatment. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Exercise Made Accessible: the Merits of Community-Based Programs for Persons with Parkinson's Disease. [2023]

9. England pubmed.ncbi.nlm.nih.gov

Reporting and methodological quality of clinical trials on exercise therapy for Parkinson's disease. [2020]