Clinical Recommendations to Guide Physical Therapy Practice for Individuals with Huntington’s Disease

Authors: Lori Quinn, Deb Kegelmeyer, Anne Kloos, Ashwini K. Rao, Monica Busse, Nora E. Fritz

The Clinical Practice Guideline on Physical Therapy Practice for Individuals with Huntington’s Disease is available for public comment.  The public comment period provides an opportunity for all stakeholders to review and provide feedback that may shape the final version of the CPG.  Please review and send feedback to Lori Quinn at lq2165@tc.columbia.edu or Nora Fritz at nora.fritz@wayne.edu. Comments are due by February 12, 2019.

Abstract: In the past decade, an increasing number of studies have examined the impact of physical therapy and exercise interventions in people with Huntington disease (HD). We performed a mixed methods systematic review utilizing Joanna Briggs Institute (JBI) methodology and included experimental and observational study designs. The search strategy resulted in 23 quantitative studies and three qualitative studies from which we extracted data using JBI standardized extraction tools. The results from this review suggested that physical therapy and exercise interventions could improve a number of impairments and activity limitations seen in people with HD. Here, we expand on the review findings to provide specific recommendations to guide clinical practice.

We recommend the following specific physical therapy and exercise interventions for people with HD: based on Grade A evidence, we strongly recommend aerobic exercise, alone or in combination with resistance training. Aerobic exercise, performed three times a week, at a minimum of 55% intensity, improves fitness and motor function. There is Grade A evidence to support the use of supervised training of functional activities. There is Grade B evidence that exercise training improves balance but has not been shown to decrease the frequency of falls. There is moderate support (Grade B recommendation) for the role of inspiratory and expiratory training in improving breathing function and capacity. Expert consensus recommends training of transfers, getting up from the floor, and providing strategies to caregivers for involvement in physical activity in the mid stages of HD. In the later stages, expert consensus recommendations include use of positioning devices, seating adaptations, and caregiver training.