Exercise slows early-stage Parkinson’s disease progression

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A team of researchers at Northwestern Medicine and the University of Colorado School of Medicine wanted to find out whether high- or moderate-intensity exercise was safe for patients with Parkinson’s disease. Would it help with the disease’s symptoms, the progressive loss of muscle control, tremors, stiffness?

According to a Chicago Tribune report, five years later, those scientists have an answer: Yes. Increasing disease severity in early-stage Parkinson’s disease patients can be slowed with a few days of exercise weekly. The results of their trial found vigorous exercise is a safe way to potentially delay the progression of Parkinson’s disease.

“The real question is: Is there any disease or any disorder for which exercise is not good?” said Daniel Corcos, one of the lead authors of the study and a professor of physical therapy and human movement sciences at Northwestern’s Feinberg School of Medicine. “I haven’t found any.”

The report says about 1m Americans live with Parkinson’s disease, according to the Parkinson’s Foundation, which funded the study. That’s more than the total number diagnosed with muscular dystrophy, Lou Gehrig’s disease and multiple sclerosis, the organization says. Sixty thousand are diagnosed across the US each year.

Parkinson’s disease is the result of impaired or dying cells in the part of the brain responsible for movement. As in Rogers’ case, most with Parkinson’s disease see symptoms begin slowly. Balance, posture, walking and talking can progressively become more difficult, leading to disability in many cases.

The onset of symptoms can be distressing for families, especially because the causes of Parkinson’s disease are not fully understood.

While prior studies have examined the effect of endurance exercise on motor symptoms, this one is the first to look at the effects of high-intensity regimens. Previously, some medical professionals believed rigorous exercise was too physically demanding for those with Parkinson’s disease, researchers said. And though another clinical trial is needed to conclusively establish the efficacy of such workouts on Parkinson’s disease, Corcos, who holds a doctorate in kinesiology, said improved blood flow to the brain because of exercise might explain the results.

The 127 participants in the exploratory study, which was also funded by grants from the National Institutes of Health, were broken into three groups: those who, like Rogers, followed a vigorous weekly workout regimen for six months, those who followed a moderate one for the same duration and a control group that did not exercise. None was taking any medication for the condition at the time, and all who exercised used a treadmill only.

Researchers based symptom severity on a scale and measured on average how much better or worse the groups got.

Symptoms of the disease did not change or improve significantly for most of those who took part in high-intensity exercise. Participants in the moderate-intensity exercise group saw their symptoms worsen by 7.5%, while researchers observed symptoms of those in the control group worsen by 15%.

“Several lines of evidence point to a beneficial effect of exercise in Parkinson’s disease,” said Dr Codrin Lungu, a programme director at the National Institute of Neurological Disorders and Stroke.

Still, the report says, Parkinson’s disease has no cure. Medicines that stimulate dopamine are currently standard treatment but can cause unwanted, uncontrolled movements, called dyskinesia, as the disease progresses. Corcos said he believes the exploratory study’s findings reinforce the notion that “exercise is medicine.” But, just like a pill, he said, consistency is critical to seeing and retaining benefits. “It has to be a sustained lifetime commitment,” he said.

Importance: Parkinson disease is a progressive neurologic disorder. Limited evidence suggests endurance exercise modifies disease severity, particularly high-intensity exercise.
Objectives: To examine the feasibility and safety of high-intensity treadmill exercise in patients with de novo Parkinson disease who are not taking medication and whether the effect on motor symptoms warrants a phase 3 trial.
Design, Setting, and Participants: The Study in Parkinson Disease of Exercise (SPARX) was a phase 2, multicenter randomized clinical trial with 3 groups and masked assessors. Individuals from outpatient and community-based clinics were enrolled from May 1, 2012, through November 30, 2015, with the primary end point at 6 months. Individuals with idiopathic Parkinson disease (Hoehn and Yahr stages 1 or 2) aged 40 to 80 years within 5 years of diagnosis who were not exercising at moderate intensity greater than 3 times per week and not expected to need dopaminergic medication within 6 months participated in this study. A total of 384 volunteers were screened by telephone; 128 were randomly assigned to 1 of 3 groups (high-intensity exercise, moderate-intensity exercise, or control).
Interventions: High-intensity treadmill exercise (4 days per week, 80%-85% maximum heart rate [n = 43]), moderate-intensity treadmill exercise (4 days per week, 60%-65% maximum heart rate [n = 45]), or wait-list control (n = 40) for 6 months.
Main Outcomes and Measures: Feasibility measures were adherence to prescribed heart rate and exercise frequency of 3 days per week and safety. The clinical outcome was 6-month change in Unified Parkinson’s Disease Rating Scale motor score.
Results: A total of 128 patients were included in the study (mean [SD] age, 64 [9] years; age range, 40-80 years; 73 [57.0%] male; and 108 [84.4%] non-Hispanic white). Exercise rates were 2.8 (95% CI, 2.4-3.2) days per week at 80.2% (95% CI, 78.8%-81.7%) maximum heart rate in the high-intensity group and 3.2 (95% CI, 2.8-3.6; P = .13) days per week at 65.9% (95% CI, 64.2%-67.7%) maximum heart rate in the moderate-intensity group (P < .001). The mean change in Unified Parkinson’s Disease Rating Scale motor score in the high-intensity group was 0.3 (95% CI, −1.7 to 2.3) compared with 3.2 (95% CI, 1.4 to 5.1) in the usual care group (P = .03). The high-intensity group, but not the moderate-intensity group, reached the predefined nonfutility threshold compared with the control group. Anticipated adverse musculoskeletal events were not severe.
Conclusions and Relevance: High-intensity treadmill exercise may be feasible and prescribed safely for patients with Parkinson disease. An efficacy trial is warranted to determine whether high-intensity treadmill exercise produces meaningful clinical benefits in de novo Parkinson disease.

Margaret Schenkman; Charity G Moore; Wendy M Kohrt; Deborah A Hall ; Anthony Delitto; Cynthia L Comella; Deborah A Josbeno; Cory L Christiansen; Brian D Berman; Benzi M Kluger; Edward L Melanson; Samay Jain; Julie A Robichaud; Cynthia Poon; Daniel M Corcos

Chicago Tribune report
JAMA Neurology abstract

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