The GREAT Program: Promoting Physical, Psychological and Economic Health in an Aging Population

Monday, 28 July 2014: 7:20 AM

Joseph DeRanieri, DM, MSN, RN
Ingrid Pretzer-Aboff, PhD. MSN, RN
School of Nursing, University of Delaware, Newark, DE


Lack of activity is a major risk factor for the aging population. This is particularly true for the 1.5 million individuals with Parkinson’s disease (PD) and 4.4 million stroke survivors whose daily function, mobility and communication are often impaired leading to a sedentary and isolating lifestyle. Each year the United States spends over $25 billion dollars treating PD patients and over $65 billion dollars a year to treat stroke patients. There is growing evidence that therapeutic exercise is an effective method to significantly increase physical activity, function and quality of life for people with stroke and PD and to also decrease the overall utilization of health care services. However, the availability of appropriate community programs is rare. Our aim was to test the feasibility and impact of a unique tri-therapeutic program that physical, occupational, with speech language therapy techniques. And to also track resulting health care utilization. This program fills a gap that exists in the rehabilitation spectrum between traditional therapy and community gyms in an effort to improve function and activity levels.


This study utilized a single group repeated measures design; one group for PD patients and one group for stroke patients.  Testing was completed at baseline, 3, and 6 months post start of group exercise. Fifteen volunteers with PD and 12 volunteers with stroke were enrolled into a one hour (2x per week) group session run by physical or occupational therapy assistants under the supervision of licensed therapists. This 12 week program incorporated vocalizations, breathing exercises, memory and recognition, fine and gross motor mobility exercises for extremities and trunk, balance activities and progressive distance walking techniques.  We also tracked patients for one year following the 12 week intervention, to assess hospital admissions and overall utilization of health care services. 


Our preliminary results show a significant increase in balance, speech volume, quality of communication, walking speeds, and improved cognition. Significant improvements were seen in walking speed (6 meter walk test), voice loudness, quality of life (PDQ-39, communication), cognition (MOCA), and disability (UPDRS, total). Additionally, subjects reported improved clarity of voice. Post intervention interview indicated that socialization was exceedingly important to the group’s adherence. Results of our preliminary study indicate the potential for reduced admissions to acute care, rehabilitation and nursing facilities as well as reduced utilization of other health care services.


People with PD and stroke benefit from this tri-therapeutic program. The PT, OT and speech components were easy to integrate during all exercise classes and demonstrated significant clinical benefits.  The researchers were also able to demonstrate a decrease in hospital admissions and a decrease in utilization of health care services.