mHealth-assisted expiratory muscle strength training in Parkinson's disease patients: A proof-of-concept study

Abstract

Background: Expiratory muscle strength training (EMST) is acknowledged for its therapeutic benefits in Parkinson's disease (PD), yet long-term adherence remains a challenge. Objective: The primary aim of this study was to assess the preliminary effects of EMST coupled with a mobile health app (SpiroGym) on self-efficacy and exercise adherence in PD patients. The secondary aim was to assess the usability of the SpiroGym app. Methods: This single-group, multicenter, multinational proof-of-concept study involved 63 PD patients across four tertiary PD centers. Participants were enrolled in either a 1-week (n = 35) or 24-week (n = 28) EMST program coupled with SpiroGym app. Self-efficacy was assessed using the Self-Efficacy for Home Exercise Program scale (SEHEPS) and exercise adherence was monitored by SpiroGym app. Usability was evaluated using the System Usability Scale. Results: Post-intervention, significant improvements in SEHEPS were observed in 1-week group (d = 0.48; p = 0.02) and 24-week group (d = 0.57; p = 0.002). Adherence rates in the 24-week PD patient group were high throughout the course of the study. Post-training SEHEPS was found to correlate (rho = 0.55; adjusted p = 0.016) with adherence to EMST during the non-supervised maintenance phase. The SpiroGym app exhibited high usability (>85th percentile score), with no significant differences noted between short-term and long-term use, indicating sustained user satisfaction. Conclusions: The results of our study suggest a promising role for SpiroGym app in supporting adherence to home-based EMST in PD patients. Nevertheless, future comparative studies are required to confirm SpiroGym's effectiveness.