Archery and Parkinson's disease: Chen 2023 study

In a randomised trial in Taichung, Taiwan, 31 people with idiopathic Parkinson's disease were assigned either to a course of seated traditional archery (16) or to usual care (15); 29 completed the final assessments, 15 and 14 respectively. The course ran for 12 weeks, with one two-hour session a week.

Compared with the controls, the archery group improved more on a test of finger dexterity (the Purdue pegboard): the difference between the two groups' changes was 2.07 pegs with the right hand, 1.59 with the left and 1.36 with both hands together. They also improved more on all three parts of the UPDRS, where a lower score means milder symptoms: -2.22 for part I in the table (-2.25 in the text), -3.81 for part II and -9.10 for part III. The same holds for lower limb strength (3.57) and for the Timed Up and Go, in which the person stands up from a chair, walks and sits down again (-1.51). Effect sizes, calculated as Z divided by the square root of N, ranged from 0.372 to 0.631, medium to large by the authors' benchmarks. Upper limb strength, flexibility, cardiorespiratory endurance and static balance did not change differently between the groups.

Among the individual UPDRS items, the archery group improved more than the controls on depressed mood, handwriting, turning in bed, facial expression, rigidity of the right arm, finger tapping with the left hand and agility of the left leg. There were no adverse events during the course.

Participants were recruited at China Medical University Hospital and had to be at least 40, on stable medication, at Hoehn and Yahr stage 1 to 4 and without significant cognitive impairment; most were at stage 2, and over 60% reported more than four hours of exercise a week. Of the 39 randomised (20 and 19), four in each group withdrew during the baseline assessments, before the course began. The course was designed by three traditional archery instructors licensed by the Taiwanese federation together with the neurologists. For safety it was shot seated, in two classes of about ten people, with one instructor for every three or four participants and a physiotherapist present. It had three stages: basic technique (three weeks), advanced shooting (four) and integrated practice (five). Each session opened with about 15 minutes of warming up and stretching with elastic bands, which participants were also given to use at home. The controls received an interview and a leaflet of stretching exercises; both groups had a supportive phone call once a month.

The primary outcome was the Purdue pegboard, in which the person places as many pegs as possible in a set time; the others were parts I, II and III of the UPDRS, a battery of physical tests for older adults and the Timed Up and Go. Changes from before to after were compared with non-parametric tests (Wilcoxon within groups, Mann-Whitney between groups), only in those who completed the study.

The sample is small and the analysis covers only those who completed the assessments (15 and 14 people), with no intention-to-treat analysis; eight of the 39 left before the course even started, and the participant flow chart and the text disagree on the number of initial volunteers (56 against 59). The paper does not say whether the assessors knew which group each participant was in, and the UPDRS relies partly on the examiner's judgement and on what the patient reports. It does not state at what point in the medication cycle the measurements were taken, although participants were given a logbook to record it.

Nor does the comparison isolate archery: the archery group had two hours a week of guided activity in company, with a warm-up and elastic bands to use at home, while the controls received a leaflet. Part of the improvement may come from the activity and the social contact as such, and an active control, another group activity of the same length, would say more. Many outcomes were compared with no correction for multiple comparisons, and some effects, such as the one on the left leg, are hard to link to shooting from a chair. There is no follow-up after the end of the course.

This study is about archery as a rehabilitation activity for people with mild to moderate Parkinson's disease, not about how archers perform. It shows that a course of seated traditional archery, with experienced instructors and a physiotherapist present, can be run safely with these patients, and that after three months those who took part were doing better than those who received only a leaflet on several measures of dexterity, mobility and symptoms.

For an instructor or club thinking about courses for this group, the paper describes a workable set-up: seated shooting, small groups, one instructor for every three or four people, and a warm-up with elastic bands. It does not show that archery works better than other group activities, or how long the benefits last. Any decision about treatment stays with the neurologist and physiotherapist who look after the person.