Improving Motor Function and Quality of
Life in Early-Stage Parkinson’s Disease:
A Structured Exercise Intervention

Lauren Stenson MSN,
RN, CNDLTC, QCP, DNSCT (DNP Student)

Parkinson’s Disease (PD) is a progressive
neurodegenerative disorder affecting over one
million Americans.

Introduction

Motor symptoms include bradykinesia, rigidity,
tremor, and postural instability, significantly
reduce independence and quality of life.
Exercise is a powerful non-pharmacologic
intervention shown to improve mobility, strength,
and overall function.
Despite strong evidence, structured exercise
programs are not consistently integrated into
early PD care.

This DNP project evaluated a 12-week structured
exercise intervention in early-stage PD.
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Background
• Problem: Individuals with early-stage PD often experience functional decline and reduced
activity levels. This contributes to physical disability, increased fall risk, and reduced quality
of life.
• Purpose: The purpose of this project was to implement and evaluate a structured physical
exercise program designed to improve motor function and quality of life in adults with earlystage PD.
• Framework: The Iowa Model of Evidence-Based Practice guided this project. The model
emphasizes identifying a clinical need, implementing evidence-based change, and evaluating
outcomes to promote sustainable practice transformation.

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Research Question

Research
Question and
Hypothesis

• In adults with early-stage Parkinson’s Disease, how
does participation in a structured physical exercise
program, compared with no structured exercise
program, affect motor function and quality of life?
Hypothesis
• Participation in a structured exercise program will
improve:
• Motor function
• Mobility
• Quality of life
Measured using
• UPDRS-III
• Timed Up and Go (TUG)
• PDQ-39

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Theoretical
Framework:
Iowa Model of
EvidenceBased Practice

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Literature Review
Exercise = Key Non-Pharmacologic Strategy
Improves mobility, balance, and quality of life in early-stage Parkinson’s Disease (PD).
• Evidence Base:
• High-intensity, task-specific training promotes neuroplasticity (Petzinger et al., 2021).
• Structured aerobic, strength, and balance training improves confidence and function (Mak et al., 2017;
Schenkman et al., 2018).
• Practice Gap: Despite strong evidence, structured programs remain underused due to limited access and
provider referral barriers.
• Implication: Integrating evidence-based, supervised exercise early in PD care supports independence and
slows decline. Guided by the Iowa Model of Evidence-Based Practice for sustainable implementation.

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Despite strong evidence supporting exercise interventions in Parkinson’s
Disease:
• Fewer than 50% of patients receive structured exercise referrals
• Exercise recommendations are often general rather than programbased
• Access to specialized exercise programs remains limited

Practice Gap

Result
• Patients may experience preventable functional decline and reduced
quality of life.
Project Goal
• Translate evidence into practice by implementing a structured exercise
intervention for early-stage PD.

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Life in Early-Stage PD| 7

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Methods
Methods
Design & Setting
• Mixed method pretest-post test project conducted in a community rehabilitation center
• Participants
• Convenience sample of 10 adults age 50+ with early-stage PD (Hoehn & Yahr I–II)
• Intervention
• 12-week supervised exercise program; 2–3 sessions/week for 45–60 minutes
• Program Components
• Aerobic warm-up, resistance training, balance and flexibility, posture/breathing, and
cool-down

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Methods (continued)
Outcome

Tool

Focus

Motor Function

UPDRS-III

Movement performance

Mobility

Time Up and Go (TUG)

Gait and balance

Quality of Life

PDQ-39

Daily living impact

Process

Attendance logs,
feedback surveys

Adherence and
satisfaction

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Life in Early-Stage PD| 10

10 participants
completed the 12week structured
exercise program.

Mean UPDRS-III
score improved
from 27.5 preintervention to
21.4 postintervention.

All participants
improved in motor
function, with
individual
reductions of 5–7
points on the
UPDRS-III.

TUG performance
improved for all
participants,
indicating better
mobility and gait
speed.

Results

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Participant Characteristics

• Note. All participants were diagnosed
with early-stage Parkinson’s Disease
(Hoehn & Yahr stages I–II).
• Table 1: Participant Characteristics

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UPDRS-III
Motor
Function
Scores Preand PostIntervention

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Life in Early-Stage PD| 13

Mobility and Quality of Life Outcomes Pre- and
Post-Intervention
• Note. Lower scores indicate improved mobility (TUG) and improved quality of life (PDQ-39).
• Table 3: Mobility and Quality of Life Outcomes Pre- and Post-Intervention

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Process Measures - Attendance and Satisfaction

• Note. Satisfaction was assessed using a
post-intervention survey.
• Table 4: Process Measures - Attendance
and Satisfaction

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Results (cont.)
PDQ-39 scores decreased after the intervention, reflecting
improved quality of life.
Attendance was high; every participant attended at least 82% of
scheduled sessions.
Most participants reported being satisfied or very satisfied with the
program.
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Discussion

Structured exercise demonstrated clinically
meaningful improvements in motor function,
mobility, and quality of life.
The consistent reduction in UPDRS-III scores
supports exercise as a meaningful nonpharmacologic strategy during early disease stages.
High attendance and favorable satisfaction
responses support the feasibility and acceptability of
the intervention.
Findings are consistent with the literature supporting
early exercise to preserve function and leverage
neuroplasticity.
Limitations include small sample size, convenience
sampling, lack of a control group, and short
intervention duration.
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Clinical Significance of Findings

Mean UPDRS-III
improvement: 6.1 points

A ≥5-point reduction in
UPDRS-III scores is
considered clinically
meaningful in Parkinson’s
Disease research.

Findings suggest structured
exercise may:
Preserve functional independence
Reduce fall risk
Improve patient quality of life

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Implications for Nursing Practice
Nurses play a key role in:
• Educating patients about exercise benefits
• Referring patients to structured exercise programs
• Supporting adherence and motivation
• Collaborating with interdisciplinary rehabilitation teams

Exercise should be considered a core component of
Parkinson’s disease management.
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Program sustainability strategies include:

Sustainability
and Practice
Integration

Integrating
exercise referrals
into neurology
visits

Collaboration
with
rehabilitation
specialists

Community
exercise
partnerships

Electronic health
record prompts

Goal: Embed structured exercise into
routine Parkinson’s care.

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Life in Early-Stage PD| 20

Recommendations
for Future Research

Future studies should:
1. Include larger sample sizes
2. Use randomized controlled
designs
3. Evaluate long-term
outcomes
4. Explore optimal exercise
intensity and frequency
5. Assess program accessibility
across diverse populations

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Life in Early-Stage PD| 21

A structured 12-week
exercise program was
feasible and beneficial
for adults with earlystage Parkinson’s
Disease.

Summary

Future research should
include larger
randomized studies and
long-term follow-up.

Integrating structured
exercise into routine PD
care may improve patient
outcomes and support
independence.

Participants
demonstrated clinically
meaningful
improvements in motor
performance, mobility,
and perceived quality of
life.

Nurses and advanced
practice providers should
promote early referral to
evidence-based exercise
programs.

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Life in Early-Stage PD| 22

References
• Bloem, B. R., Okun, M. S., & Klein, C. (2021). Parkinson’s disease. The Lancet,
397(10291), 2284–2303.
• Canning, C. G., et al. (2020). Exercise therapy for prevention of falls in people with
Parkinson’s disease: A systematic review and meta-analysis. Movement Disorders, 35(11),
1909–1918.
• Langeskov-Christensen, M., Franzén, E., Grøndahl Hvid, L., & Dalgas, U. (2024). Exercise
as medicine in Parkinson’s disease. Journal of Neurology, Neurosurgery & Psychiatry,
95(11), 1077–1088.
• Mak, M. K., Wong-Yu, I. S., Shen, X., & Chung, C. L. (2017). Long-term effects of exercise
and physical therapy in people with Parkinson’s disease. Nature Reviews Neurology, 13(11),
689–703.
• Petzinger, G. M., et al. (2013). Exercise-enhanced neuroplasticity targeting motor and
cognitive circuitry in Parkinson’s disease. The Lancet Neurology, 12(7), 716–726.
• Schenkman, M., et al. (2018). High-intensity exercise in early Parkinson disease. Neurology,
90(14), e1418–e1426.
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Life in Early-Stage PD| 23

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Life in Early-Stage PD | 24

Thank you very
much!