High-frequency rTMS and home-based exercise in individuals with Parkinson's disease: A double-blind randomized controlled trial

Abstract

Objective: This study aimed to investigate the effects of combining repetitive Transcranial Magnetic Stimulation (rTMS) with home-based exercise (HB) over 10 sessions and examined locomotion outcomes over 8 weeks in individuals with Parkinson's disease (PD). Methods: Thirty-nine individuals with mild to moderate PD were randomly assigned to real rTMS combined with HB (real rTMS + HB), sham rTMS combined with HB (sham rTMS + HB), and a control group. The intervention groups received 10 sessions of rTMS alongside an 8-week HB program. Results: Significant improvements (p < 0.05) were found in both intervention groups over time for clinical outcomes and turning characteristics compared to the control group. No significant clinical or kinematic differences were observed between the real and sham rTMS + HB groups. Only the real rTMS + HB group showed reduced motor-evoked potential amplitude after 10 sessions and at 8-week follow-up. Conclusion: Home-based exercise improved locomotion in individuals with PD. Although real rTMS modified cortical excitability, it did not provide additional clinical or kinematic benefits beyond home-based exercise alone. Significance: The combination of rTMS combined with home-based exercise may influence cortical excitability; however, locomotion improvements in individuals with PD appear to be primarily driven by home-based exercise, and the neuromodulatory role of rTMS warrants further investigation.