Summary: Exercise could be the best medicine for people in early stages of Parkinson’s disease, researchers say. A new study reveals people with early stage Parkinson’s who embarked on high intensity exercise three times a week showed a decrease in worsening motor symptoms.
Source: Northwestern University.
High-intensity exercise three times a week is safe for individuals with early-stage Parkinson’s disease and decreases worsening of motor symptoms, according to a new phase 2, multi-site trial led by Northwestern Medicine and University of Colorado School of Medicine scientists.
This is the first time scientists have tested the effects of high-intensity exercise on patients with Parkinson’s disease, the second most common neurodegenerative disorder and the most common movement disorder, affecting more than a million people in the United States.
It previously had been thought high-intensity exercise was too physically stressful for individuals with Parkinson’s disease.
The paper will be published in JAMA Neurology Dec. 11, 2017.
Parkinson’s symptoms include progressive loss of muscle control, trembling, stiffness, slowness and impaired balance. As the disease progresses, it may become difficult to walk, talk and complete simple tasks. Most people who develop Parkinson’s are 60 and older.
“If you have Parkinson’s disease and you want to delay the progression of your symptoms, you should exercise three times a week with your heart rate between 80 to 85 percent maximum. It is that simple,” said co-lead author Daniel Corcos, professor of physical therapy and human movement sciences at Northwestern University Feinberg School of Medicine.
Because medications for Parkinson’s have adverse side effects and reduced effectiveness over time, new treatments are needed.
The randomized clinical trial included 128 participants ages 40 to 80 years old from Northwestern University, Rush University Medical Center, the University of Colorado and the University of Pittsburgh.
Participants enrolled in the Study in Parkinson Disease of Exercise (SPARX) were at an early stage of the disease and not taking Parkinson’s medication, ensuring the results of the study were related to the exercise and not affected by medication.
“The earlier in the disease you intervene, the more likely it is you can prevent the progression of the disease,” Corcos said. “We delayed worsening of symptoms for six months; whether we can prevent progression any longer than six months will require further study.”
Scientists examined the safety and effects of exercise three times weekly for six months at high intensity, 80 to 85 percent of maximum heart rate, and moderate intensity, 60 to 65 percent of maximum heart rate. They compared the results to a control group who did not exercise.
After six months, participants were rated by clinicians on a Parkinson’s disease scale ranging from 0 to 108. The higher the number, the more severe the symptoms.
Participants in the study had a score of about 20 before exercise. Those in the high intensity group stayed at 20. The group with moderate exercise got worse by 1.5 points. The group that did not exercise worsened by three points. Three points out of a score of 20 points is a 15 percent change in the primary signs of the disease and considered clinically important to patients. It makes a difference in their quality of life.
“We are stopping people from getting worse, which is significant, particularly if we catch them early in the disease,” Corcos said.
What sets this study apart from others is the high number of participants, and that they exercised for a relatively long period of time. Most exercise studies are 12 weeks, Corcos said.
“We gave them a proper workout,” Corcos said. “This is not mild stretching. This is high intensity. It’s part of the idea that exercise is medicine.”
Corcos and colleagues confirmed it was safe for the participants to do high-intensity exercise by giving them a cardiologist-supervised graded exercise test to evaluate the heart’s response to exercise.
Previous studies in humans suggest high-intensity exercise improves motor symptoms, but the evidence wasn’t sufficient to determine whether exercise intensity modifies symptoms or disease progression. In addition, most studies have not precisely measured or controlled exercise intensity and none have been conducted at 80 to 85 percent maximum heart rate.
“Several lines of evidence point to a beneficial effect of exercise in Parkinson’s disease,” said Dr. Codrin Lungu, program director at the National Institute of Neurological Disorders and Stroke. “Nevertheless, it’s not clear which kind of exercise is most effective. The SPARX trial tries to rigorously address this issue. The results are interesting and warrant further exploration of the optimal exercise regimes for Parkinson’s.”
Co-authors on the study include co-lead author Margaret Schenkman, Charity G. Moore, Wendy M. Kohrt, Deborah A. Hall, Anthony Delitto, Dr. Cynthia L. Comella, Deborah A. Josbeno, Cory L. Christiansen, Dr. Brian D. Berman, Dr. Benzi M. Kluger and Edward L. Melanson.
Funding: The study was funded by grants from the National Institutes of Health (NS074343, TR000005, TR001082, DK048520, HD055931) and the Parkinson’s Disease Foundation.
Source: Marla Paul – Northwestern University
Publisher: Organized by NeuroscienceNews.com.
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Original Research: Abstract for “Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial” by Margaret Schenkman, PhD, PT; Charity G. Moore, PhD; Wendy M. Kohrt, PhD; Deborah A. Hall, MD, PhD; Anthony Delitto, PhD, PT; Cynthia L. Comella, MD; Deborah A. Josbeno, PT, PhD; Cory L. Christiansen, PhD, PT; Brian D. Berman, MD, MS; Benzi M. Kluger, MD; Edward L. Melanson, PhD; Samay Jain, MD; Julie A. Robichaud, BS-PT, MHS, PhD; Cynthia Poon, PhD; and Daniel M. Corcos, PhD in JAMA Neurology. Published online December 11 2017 doi:10.1001/jamaneurol.2017.3517
Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial
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  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.
“Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial” by Margaret Schenkman, PhD, PT; Charity G. Moore, PhD; Wendy M. Kohrt, PhD; Deborah A. Hall, MD, PhD; Anthony Delitto, PhD, PT; Cynthia L. Comella, MD; Deborah A. Josbeno, PT, PhD; Cory L. Christiansen, PhD, PT; Brian D. Berman, MD, MS; Benzi M. Kluger, MD; Edward L. Melanson, PhD; Samay Jain, MD; Julie A. Robichaud, BS-PT, MHS, PhD; Cynthia Poon, PhD; and Daniel M. Corcos, PhD in JAMA Neurology. Published online December 11 2017 doi:10.1001/jamaneurol.2017.3517