BACKGROUND: Exercise confers short-term benefits for individuals with PD. OBJECTIVE: Compare short- and long-term responses among two supervised exercise programs and a home-based exercise control group. DESIGN: 16-month randomized controlled exercise intervention including: flexibility/balance/function exercise (FBF), supervised aerobic exercise (AE), and home-based exercise (CON). SETTING: University outpatient clinic. PATIENTS: 121 individuals with PD; Hoehn and Yahr stages 1 to 3. INTERVENTION: FBF (individualized spinal and extremity flexibility exercises followed by group balance/functional training), supervised by a physical therapist; AE (treadmill, bike and/or elliptical trainer), supervised by an exercise trainer. Supervision was 3 days/wk for 4 months, and then monthly (16 months total). Controls exercised at home using the National PD Foundation 'Fitness Counts' program, with 1 supervised group clinic-based session/month. MEASUREMENT: Outcomes obtained by blinded assessors, were determined at 4,10 and 16 months. Primary outcomes: overall physical function (Continuous-Scale Physical Functional Performance, CS-PFP); balance (Functional Reach, FR); and walking economy (VO2 mL/kg/min). Secondary outcomes: Unified PD Rating scale (UPDRS) Activities of Daily Living (ADL) and Motor Subscales, and quality of life (PDQ-39). RESULTS: Of 121 participants: 86.8%, 82.6%, and 79.3% completed 4, 10, and 16 months respectively. Results were: CS-PFP: improvement at 4 months was greater in the FBF group than control (mean difference 4.3; 95% CI 1.2 to 7.3) and AE (mean difference 3.1; 95% CI 0.0 to 6.2). FR was not different between groups at any time point. Walking economy: AE improved compared to FBF at 4 (mean difference -1.2; 95% CI -1.9 to -0.5), 10 (mean difference -1.2; 95% CI -1.9 to -0.5), and 16 months (mean difference -1.7; 95% CI -2.5 to -1.0). The only secondary outcome that showed significant differences was UPDRS ADL: FBF performed better than controls at 4 (mean difference -1.47; 95% CI -2.79 to -0.15) and 16 months (mean difference -1.95; 95% CI -3.84 to -0.08). LIMIATIONAT: Absence of a non-exercise control. CONCLUSIONS: Findings demonstrated overall functional benefits at 4 months for FBF and improved walking economy (up to 16 months) for AE.

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