The purpose of the study was to assess the effectiveness of the impact of physical therapy on physical status and activities of daily living in elderly people with Parkinson's disease and senile asthenia. Materials and methods. The study involved 57 elderly people diagnosed with Parkinson's disease in combination with frailty. They were divided into two groups: group 1 – they were engaged according to the principles of polyclinic rehabilitation, and group 2 – they were engaged according to the developed program of physical therapy for 6 months, rehabilitation training was carried out three times a week. The aim of the program was to increase physical status and activities of daily living of patients with the implementation of active methods of physical therapy (kinesitherapy) and, thus, to maintain general physical activity; to increase muscle strength and flexibility; to facilitate the initiation of movements; to improve joint mobility; to maintain correct posture; to improve walking and maintain balance; to prevent pain syndromes and contractures; to prevent respiratory disorders; to adapt to the changed conditions of daily activity. The physical therapy program was created taking into account the specifics of each comorbid condition using functional training on the Prosedos platform, therapeutic exercises, massage, elements of occupational therapy, nutrition correction, patient education. We consistently achieved individual short- and long-term goals of rehabilitation in the SMART-format within the patient-centered rehabilitation model. This helped to select such elements of functional training, which made it possible to individually adjust the most affected movements in each patient, and interfere with normal functioning. The control group consisted of 24 people without signs of frailty and Parkinson's disease. The effectiveness of the program was assessed by the dynamics of the 6-minute walk test (distance traveled, level of fatigue according to the Borg scale), Mini-Balance Evaluation Systems Test, Barthel Activities of daily living Index, Lawton Instrumental activities of daily living Scale. Patients were examined twice – before and after rehabilitation measures (with an interval of 6 months). Results and discussion. In elderly patients with Parkinson's disease and sarcopenia, deterioration of physical status (expressed fatigue and a short distance according to the results of the 6-minute test), violation of indicators of static and dynamic balance and, as a result, violation of performance of instrumental and basic activities of daily life were found (p <0.05 of the parameters of the control group). The developed program of physical therapy caused a statistically significant better effect on the studied indicators of functioning and activities of daily life compared to the general polyclinic program for all studied indicators (р <0.05). Conclusion. Elderly patients with the comorbidity of Parkinson's disease and frailty need the development of physical therapy programs taking into account and correcting the specifics of each disease, which will increase the overall efficiency of recovery processes and improve the performance of activities of daily life

Keywords: rehabilitation, sarcopenia, senile asthenia, neurodegenerative diseases, geriatrics

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1. United Nations, Department of Economic and Social Affairs, Population Division. World Population Ageing 2019: Highlights. United Nations; New York. NY USA: 2019. Available from: https://www.un.org/en/development/desa/population/publications/pdf/ageing/WorldPopulationAgeing2019-Highlights.pdf
2. Cruz-Jentoft AJ, Bahat G, Bauer J, Boirie Y, Bruyère O, Cederholm T, et al. Sarcopenia: revised European consensus on definition and diagnosis. Age Ageing. 2019;48(1):16-31. PMID: 30312372. PMCID: PMC6322506. https://doi.org/10.1093/ageing/afy169
3. Cockayne S, Pighills A, Adamson J, Fairhurst C, Crossland S, Drummond A, et al. Home environmental assessments and modification delivered by occupational therapists to reduce falls in people aged 65 years and over: the OTIS RCT. Health Technol Assess. 2021;25(46):1-118. PMID: 34254934. PMCID: PMC8287374. https://doi.org/10.3310/hta25460
4. Armstrong MJ, Okun MS. Diagnosis and Treatment of Parkinson Disease: A Review. JAMA. 2020;323(6):548-560. PMID: 32044947. https://doi.org/10.1001/jama.2019.22360
5. Domingos J, Keus SHJ, Dean J, de Vries NM, Ferreira JJ, Bloem BR. The European Physiotherapy Guideline for Parkinson's Disease: Implications for Neurologists. J Parkinsons Dis. 2018;8(4):499-502. PMID: 30149464. https://doi.org/10.3233/JPD-181383
6. Jankovic J, Tan EK. Parkinson's disease: etiopathogenesis and treatment. J Neurol Neurosurg Psychiatry. 2020;91(8):795-808. PMID: 32576618. https://doi.org/10.1136/jnnp-2019-322338
7. Petermann-Rocha F, Balntzi V, Gray SR, Lara J, Ho FK, Pell JP, et al. Global prevalence of sarcopenia and severe sarcopenia: a systematic review and meta-analysis. J Cachexia Sarcopenia Muscle. 2022;13(1):86-99. PMID: 34816624. PMCID: PMC8818604. https://doi.org/10.1002/jcsm.12783
8. Sobhani A, Sharifi F, Fadayevatan R, Kamrani AAA, Moodi M, Khorashadizadeh M, et al. Low physical activity is the strongest factor associated with frailty phenotype and frailty index: data from baseline phase of Birjand Longitudinal Aging Study (BLAS). BMC Geriatr. 2022;22(1):498. PMID: 35689187. PMCID: PMC9188172. https://doi.org/10.1186/s12877-022-03135-y
9. Fernandes LV, Paiva AEG, Silva ACB, de Castro IC, Santiago AF, de Oliveira EP, et al. Prevalence of sarcopenia according to EWGSOP1 and EWGSOP2 in older adults and their associations with unfavorable health outcomes: a systematic review. Aging Clin Exp Res. 2022;34(3):505-514. PMID: 34398438. https://doi.org/10.1007/s40520-021-01951-7
10. Didokha IV, Aravitska MG. Vplyv zasobiv fizychnoyi terapiyi na riven kineziofobiyi, somatychni markery sarkopeniyi ta pokaznyky ryzyku padinnya u osib pokhylogo viku z khvoroboyu Parkinsona [Effects of physical therapy on the level of kinesiophobia, somatic markers of sarcopenia and indicators of fall risk in elderly persons with Parkinson's disease]. Art of Medicine. 2021;2(18):50-58. [Ukrainian]. https://doi.org/10.21802/artm.2021.2.18.50
11. Pang MY. Physiotherapy management of Parkinson's disease. J Physiother. 2021;67(3):163-176. PMID: 34154949. https://doi.org/10.1016/j.jphys.2021.06.004
12. Wanigatunga AA, Di J, Zipunnikov V, Kuo PL, Simonsick EM, Ferrucci L, et al. Association of Total Daily Physical Activity and Fragmented Physical Activity With Mortality in Older Adults. JAMA Netw Open. 2019;2(10):e1912352. PMID: 31577355. PMCID: PMC6777397. https://doi.org/10.1001/jamanetworkopen.2019.12352
13. Ashburn A, Pickering R, McIntosh E, Hulbert S, Rochester L, Roberts HC, et al. Exercise- and strategy-based physiotherapy-delivered intervention for preventing repeat falls in people with Parkinson's: the PDSAFE RCT. Health Technol Assess. 2019;23(36):1-150. PMID: 31339100. PMCID: PMC6680369. https://doi.org/10.3310/hta23360
14. Chivers Seymour K, Pickering R, Rochester L, Roberts HC, Ballinger C, Hulbert S, et al. Multicentre, randomised controlled trial of PDSAFE, a physiotherapist-delivered fall prevention programme for people with Parkinson's. J Neurol Neurosurg Psychiatry. 2019;90(7):774-782. PMID: 30944149. PMCID: PMC6585265. https://doi.org/10.1136/jnnp-2018-319448
15. Radder DLM, Lígia Silva de Lima A, Domingos J, Keus SHJ, van Nimwegen M, Bloem BR, et al. Physiotherapy in Parkinson's Disease: A Meta-Analysis of Present Treatment Modalities. Neurorehabil Neural Repair. 2020;34(10):871-880. PMID: 32917125. PMCID: PMC7564288. https://doi.org/10.1177/1545968320952799
16. Groessl EJ, Kaplan RM, Rejeski WJ, Katula JA, Glynn NW, King AC, et al. Physical Activity and Performance Impact Long-term Quality of Life in Older Adults at Risk for Major Mobility Disability. Am J Prev Med. 2019;56(1):141-146. PMID: 30573142. PMCID: PMC6309909. https://doi.org/10.1016/j.amepre.2018.09.006
17. Hulbert S, Rochester L, Nieuwboer A, Goodwin V, Fitton C, Chivers-Seymour K, et al. "Staying safe" - a narrative review of falls prevention in people with Parkinson's - "PDSAFE". Disabil Rehabil. 2019;41(21):2596-2605. PMID: 29774765. https://doi.org/10.1080/09638288.2018.1471167
18. Klinichnyy protokol nadannya medychnoyi dopomohy khvorym na khvorobu Parkinsona [Clinical protocol for providing medical care to patients with Parkinson's disease]. Available from: http://medstandart.net/browse/2517 [Ukrainian]
19. Procedos Platform. Powered by Gray’s Institute. Available from: https://procedos.com/
20. American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. 10th ed. Philadelhia, PA: Lippincott Williams & Wilkins; 2018.
21. Di Carlo S, Bravini E, Vercelli S, Massazza G, Ferriero G. The Mini-BESTest: a review of psychometric properties. Int J Rehabil Res. 2016;39(2):97-105. PMID: 26795715. https://doi.org/10.1097/MRR.0000000000000153
22. Duncan RP, Leddy AL, Cavanaugh JT, Dibble LE, Ellis TD, Ford MP, et al. Comparative utility of the BESTest, mini-BESTest, and brief-BESTest for predicting falls in individuals with Parkinson disease: a cohort study. Phys Ther. 2013;93(4):542-50. PMID: 23174567. PMCID: PMC3613340. https://doi.org/10.2522/ptj.20120302
23. Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61-5. https://doi.org/10.1037/t02366-000
24. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969;9(3):179-86. PMID: 5349366. https://doi.org/10.1093/geront/9.3_Part_1.179
25. Taylor D. Physical activity is medicine for older adults. Postgrad Med J. 2014; 90(1059):26-32. PMID: 24255119. PMCID: PMC3888599. https://doi.org/10.1136/postgradmedj-2012-131366
26. Koval N, Aravitska M. Efektyvnist korektsiyi pokaznykiv ryzyku padinnya ta fizychnoho statusu v osib pokhyloho viku z starechoyu asteniyeyu ta metabolichnym syndromom zasobamy fizychnoyi terapiyi [Еffect of physical therapy on fall-risk and physical status in older adults with frailty and metabolic syndrome]. Ukr Zh Med Biol Sportu. 2020;5(6):282-91. [Ukrainian]. https://doi.org/10.26693/jmbs05.06.282
27. Golubeva MG. Pryntsypy mistsevogo zastosuvannya fitopreparativ pry sportyvnykh travmakh [Principles of local application of phytopreparations at sporting traumas]. Pedagogika, psykhologiya ta medyko-biologichni problemy fizychnogo vykhovannya i sportu. 2009;9:32-35. [Ukrainian]
28. Gudyvok YaS, Golubeva MG. Mistseve zastosuvannya fitopreparativ pry travmatychnykh urazhennyakh [Local use of herbal preparations for traumatic lesions]. Fitoterapiya. Chasopys. 2008;3:11-19. [Ukrainian]
29. Aravitska MG. Analiz indyvidualnykh shlyakhiv pokrashchennya komplayensu khvorykh ozhyrinnyam yak aspekt vyznachennya tsiley reabilitatsiyi [Analysis of Individual Ways of Compliance Improvement in Obese Patients as an Aspect of Determining Rehabilitation Goals]. Ukr Zh Med Biol Sportu. 2019;6(22):362-369. [Ukrainian]. https://doi.org/10.26693/jmbs04.06.362
30. Byrchak V, Duma Z, Aravitska M. Effectiveness of the active physical therapy in restoring wrist and hand functional ability in patients with immobility-induced contracture of the wrist joint complicated by median nerve entrapment owing to distal forearm fracture. J Phys Educ Sport. 2020;20 (6):3599-3606. https://doi.org/10.7752/jpes.2020.0648
31. Kuravska Yu, Aravitska M, Churpiy I, Fedorivska L, Yaniv O. Efficacy of correction of pelvic floor muscle dysfunction using physical therapy in women who underwent Caesarean section. J Phys Educ Sport. 2022;22(3):715-723. https://doi.org/10.7752/jpes.2022.03090