Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting

Abstract

Objectives: To (1) investigate effects of aerobic walking on motor function, cognition, and quality of life in Parkinson disease (PD), and (2) compare safety, tolerability, and fitness benefits of different forms of exercise intervention: continuous/moderate intensity vs interval/alternating between low and vigorous intensity, and individual/neighborhood vs group/facility setting. Methods:Initial design was a 6-month, 2 3 2 randomized trial of different exercise regimens in independently ambulatory patients with PD. All arms were required to exercise 3 times per week, 45 minutes per session.Results: Randomization to group/facility setting was not feasible because of logistical factors.Over the first 2 years, we randomized 43 participants to continuous or interval training. Because preliminary analyses suggested higher musculoskeletal adverse events in the interval group and lack of difference between training methods in improving fitness, the next 17 participants were allocated only to continuous training. Eighty-one percent of 60 participants completed the study with a mean attendance of 83.3% (95% confidence interval: 77.5%-89.0%), exercising at 46.8% (44.0%-49.7%) of their heart rate reserve. There were no serious adverse events. Across all completers, we observed improvements in maximum oxygen consumption, gait speed, Unified Parkinson's Disease Rating Scale sections I and III scores (particularly axial functions and rigidity), fatigue, depression, quality of life (e.g., psychological outlook), and flanker task scores (p , 0.05 to p , 0.001). Increase in maximum oxygen consumption correlated with improvements on the flanker task and quality of life (p , 0.05). Conclusions:Our preliminary study suggests that aerobic walking in a community setting is safe, well tolerated, and improves aerobic fitness, motor function, fatigue, mood, executive control, and quality of life in mild to moderate PD. Classification of evidence:This study provides Class IV evidence that in patients with PD, an aerobic exercise program improves aerobic fitness, motor function, fatigue, mood, and cognition. Figure Test; FSS 5 Fatigue Severity Scale; HR max 5 maximal heart rate; HRR 5 heart rate reserve; PD 5 Parkinson disease; PDQUALIF 5 Parkinson's Disease Quality of Life Scale; PIS 5 percent increase score; RT 5 reaction time; UPDRS 5 Unified Parkinson's Disease Rating Scale; Vȯ 2 5 maximum oxygen uptake.

Physical activity and exercise attenuate neuroinflammation in neurological diseases

“…Several studies have demonstrated that regular aerobic exercise improves balance and motor symptoms, reduces indicators of depression, improves cardiovascular health, and enhances overall quality of life in PD patients in short-term and long-term follow up studies alike (Canning et al, 2015;Frazzitta et al, 2015;Frazzitta et al, 2014;Uc et al, 2014). Two studies showed that these improvements in PD symptoms correlated with a normalization in the level of circulating biomarkers of PD.…”

Quality improvement in neurology: Parkinson disease update quality measurement set

“…Recent evidence suggests that exercise has multiple important health benefits that should be leveraged by patients with PD. Exercise improves the physical and mental functioning levels and quality of life for patients with PD, [22][23][24][25][26] and early intervention with exercise can prevent falls. 26 It should be recommended to all patients with PD.…”

“…Exercise improves the physical and mental functioning levels and quality of life for patients with PD, [22][23][24][25][26] and early intervention with exercise can prevent falls. 26 It should be recommended to all patients with PD. The work group declined to develop an exception for this measure as it is believed that all patients can benefit from this counseling and counseling must be tailored to individual patient needs.…”

A Practical Consensus Guideline for the Integrative Treatment of Parkinson's Disease in Shanghai, China

“…These integrative therapies or exercises are helpful in improving rigidity, balance disorder, and parts of the non-motor symptoms, and some patients have self-initiated these activities or treatments during all periods or stages of anti-parkinsonism treatment [31,32,33]. Psychological guidance is useful to reduce depression, and health care is important to prevent inflammation, nutrition impairment, falls, and fractures.…”