Land- and water-based sports activities in natural environments as a group exercise for Parkinson’s disease: proof-of-concept pilot study

Purpose: To test, in persons with Parkinson’s disease (PwPD), safety, feasibility and PRE-to-POST changes of land- and water-based activities on clinical, psychosocial and motor-functional domains. Methods: Single-group interventional, feasibility study. Twelve mildly disabled participants (9 M:3W; Hoehn–Yahr: 2) volunteered for a 10-week, biweekly outdoor multisport program of alternating sessions of land- and water-based activities (basic skills, kayaking, surfing, sailing). The abovementioned were assessed at baseline (PRE), after the program (POST), and three months after intervention completion (FOLLOW-UP). Results: None of the participants reported adverse events during the intervention period. The compliance rate was high (88%). PRE-to-POST pairwise comparisons with Bonferroni adjustments showed significant reductions in UPDRS-I (mentation/behaviour/mood; − 2.2 ± 1.2pts; Z = − 3.02; p = 0.003) and BDI-II (− 2.8 ± 2.6pts; Z = 2.66; p = 0.008), and significant increases in distance covered during 6MWT (+ 8.3 ± 8.1%; p = 0.03) and 2MWT (+ 11.2 ± 13.0%; p = 0.03), which were maintained at follow-up (6MWT: + 5.9 ± 6.4%; p = 0.02; 2MWT: + 8.1 ± 7.3%; p = 0.003). A significant reduction in TUG time (− 9.1 ± 8.3%; p = 0.04) was detected and retained at FOLLOW-UP (− 9.8 ± 9.0%; p = 0.03). Gait analysis by wearable inertial sensors revealed significantly increased gait speed (+ 9.4 ± 10.1%; p = 0.04) maintained at FOLLOW-UP (+ 7.6 ± 7.5%; p = 0.005). No changes were detected in balance and strength. Conclusions: Green–blue exercise proved safe and feasible in mildly disabled PwPD, as demonstrated by high compliance rate and absence of adverse events. Data suggest that supervised, land and water activities that challenge the individual in natural environments are appealing health-enhancing initiatives to cope with PwPD’ physical and psychosocial constraints. Lack of improvements’ retention in selected motor-functional outcomes at the 3-month FOLLOW-UP confirms the need for constant exercise rather than one-off programs.