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Parkinson's Disease Progression Can Be Slowed With High Intensity Exercise

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  • Parkinson's Disease Progression Can Be Slowed With High Intensity Exercise

    Key Points

    Questions Is high- and moderate-intensity treadmill exercise safe for patients with Parkinson disease who are not yet taking medication, can they exercise at target intensity with hypothesized adherence 3 times per week, and are changes in motor symptoms sufficient to warrant further investigation?

    Findings This phase 2 randomized clinical trial of 128 participants established that 80% to 85% and 60% to 65% exercise intensities are safe and feasible. Furthermore, high-intensity treadmill exercise is nonfutile; therefore, an efficacy trial is warranted for high- but not moderate-intensity exercise.

    Meaning High-intensity treadmill exercise can be safely prescribed for patients with Parkinson disease; further investigation with a phase 3 exercise study is warranted to establish efficacy.

    Abstract

    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.

    Trial Registration clinicaltrials.gov Identifier: NCT01506479.


    Full Text
    This phase 2 randomized clinical trial examines the feasibility and safety of high-intensity treadmill exercise in patients with de novo Parkinson disease who a

  • #2
    This is important information. It is simlar to findings with dementia. Exercise is critical to continuing brain health.

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    • #3
      And if you think you don’t have risk for Parkinson’s, think again. Like dementia, prevalence increases dramatically in the 70s and 80s.

      Comment


      • #4
        I remember watching a video of a neurologist with PD prior and after a 100 mile cycling. He had a DBS implanted, but had turned it off for the video. The bike was a tandem, because there was no way he could have started the ride on a single. His chorea was of a magnitude that he couldn't get on the bike unassisted. Post ride it was difficult to tell he had PD. He was not any medications at the time, so this seemed like an excellent n of 1 demonstration of the power of intensive excercise. I've heard more than one well known movement disorder specialist say that the one thing they feel is most neuroprotective is exercise.

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