Enhancing Adherence to Home-Based Expiratory Muscle Strength Training in Parkinson Disease: Randomized Controlled Trial of an mHealth Intervention.

In participants at risk for nonadherence, the mHealth-assisted EMST group demonstrated a smaller decline in adherence during weeks 8 to 24 than controls.

• The at-risk cohort comprised 34 participants (control, n=17; experimental, n=17), defined a priori at week 8 as SEHEPS less than 59.
• The experimental group completed 1073 (95% CI 643-1502) expiratory maneuvers versus 525 (95% CI 358-692) in the control group during weeks 8 to 24.
• The between-group difference in adherence was statistically significant (β=496.9, 95% CI 130.7-863.3; P=.008).
• The mixed-effects model showed no significant 3-way interaction (group×interval×SEHEPS risk; P=.14).

Maximum expiratory pressure increased in both groups from weeks 0 to 24, with larger gains in the experimental mHealth group.

• The experimental group showed gains of +43.1 cmH₂O (95% CI 32.4-53.8 cmH₂O).
• The control group showed gains of +22.8 cmH₂O (95% CI 13.8-31.8 cmH₂O).
• The difference between groups was statistically significant (P=.006) with a Cohen d=0.74, indicating a medium-to-large effect size.

Self-efficacy for home exercise (SEHEPS) improved after intensive training in both groups, but only the experimental group exceeded the minimal detectable change threshold.

• SEHEPS improvement was observed in both groups following the 8-week intensive training phase.
• Only the experimental (mHealth) group exceeded the 12-point minimal detectable change at the 95% confidence limit.
• SEHEPS scores below 59 at week 8 were used to define participants as 'at risk for nonadherence' during the subsequent unsupervised maintenance phase.

The trial enrolled 75 individuals with Parkinson disease who were randomized to conventional EMST or mHealth-assisted EMST with the SpiroGym app.

• Participants were randomized 1:1 to conventional EMST (control; n=38) or SpiroGym-enhanced EMST (experimental; n=37) using a simple computer-generated randomization sequence.
• Groups were well matched at baseline: mean disease duration 7.0 (SD 5.7) vs 7.3 (SD 4.7) years; mean Hoehn-Yahr 1.97 (SD 0.6) vs 2.0 (SD 0.5).
• All participants completed 8 weeks of semisupervised intensive EMST with biweekly in-person reassessments, followed by 16 weeks of unsupervised maintenance training.
• No study-related adverse events occurred.

The SpiroGym app provided real-time performance monitoring, direct visual feedback, and longitudinal progress tracking as enhancements to conventional EMST.

• SpiroGym was developed by Czech Technical University.
• The app was used as an mHealth adjunct to the same EMST protocol administered to the control group.
• This study is described as the first randomized controlled trial to integrate mHealth with EMST.

Assessing self-efficacy after the supervised EMST phase may help identify individuals who would benefit from digital support in real-world Parkinson disease care.

• Risk for nonadherence was defined a priori using a SEHEPS score less than 59 at week 8, the transition point to unsupervised training.
• The authors suggest mHealth-assisted EMST is a practical approach for maintaining exercise adherence in individuals identified as at risk.
• The study focused specifically on sustaining long-term exercise adherence, unlike prior studies in the EMST field.