Maintaining a regular exercise program may be key

A sustained increase in regular physical activity was linked to slower decline on several clinical parameters in early Parkinson’s disease (PD), a longitudinal observational study found.

Over a median of 5 years, the average level of overall regular activity had significant interaction effects on scores of postural instability and gait, activities of daily living, and processing speed in patients with early PD, reported Kazuto Tsukita, MD, of Kyoto University, Japan, and co-authors in Neurology.

Regular physical activity and moderate-to-vigorous exercise levels at baseline did not significantly affect the subsequent clinical progression of PD. However, average regular overall physical activity levels over time were significantly associated with slower deterioration of all of the following:

  • Postural instability and gait scores (βinteraction −0.10, 95% CI −0.14 to −0.06).
  • Activities of daily living scores (βinteraction 0.08, 95% CI 0.04-0.12).
  • Processing speed scores (βinteraction 0.05, 95% CI 0.03-0.08).

Moderate-to-vigorous exercise levels were preferentially associated with slower decline of postural and gait stability (βinteraction −0.09, 95% CI −0.13 to −0.05). Work-related activity levels were primarily associated with slower deterioration of processing speed (βinteraction 0.07, 95% CI 0.04-0.09).

“Our results are exciting, because they suggest it may never be too late for someone with Parkinson’s to start an exercise program to improve the course of their disease,” Tsukita said in a press release. “That’s because we found that to slow progression of the disease, it was more important for people with Parkinson’s to maintain an exercise program than it was to be active at the beginning of the disease.”

Because some earlier observational studies showed baseline activity levels were associated with better clinical course of PD over a few years, “we were initially surprised by our observation that not their ’baseline’ level but the ’maintenance’ of their level is the key factor associated with better clinical course of PD over a longer period of time,” the researchers noted.

“However, given the gradual decline in physical activity levels in patients with PD and the reported gradual decline in the effectiveness of interventional exercise, it seems quite plausible that the focus should be on a sustained increase in exercise and regular physical activity levels to improve long-term clinical outcomes,” they observed.

The study also showed that different types of activities may have different effects on the disease course of PD, Tsukita and colleagues added.

“An encouraging aspect of our study for both clinicians and PD patients is that medication-refractory symptoms such as postural instability, gait disturbance, and the impairment of processing speed might be especially susceptible to the positive effect of high regular physical activity levels,” they wrote.

Extensive animal literature supports exercise to improve cognitive-behavioral outcomes and increase neurogenesis, brain volume, and functional connectivity, noted Alexander Choi, MD, of Banner Sun Health Research Institute in Sun City, Arizona, who was not involved with the research.

“Multiple clinical studies in Parkinson’s support that exercise that leads to improved cardiovascular fitness provides a number of benefits,” Choi wrote in an email to BreakingMED.

“Specific types of exercise that involve cognitive engagement, such as dancing, low-impact boxing/aerobic classes, high-cadence cycling, and tai chi further improve the coordination of movement through strengthening neural networks that are compensatory to the impaired automatic pathways in Parkinson’s,” he added.

A recent randomized trial showed that aerobic exercise had beneficial effects on structural and functional brain properties of Parkinson’s patients. “Physical exercise influences the brain in people with PD,” study author Rick Helmich, MD, PhD, of Radboud University in the Netherlands, noted in an email to BreakingMED. “It changed functional connectivity between the basal ganglia and the cortex, such that less affected regions of the basal ganglia were strengthened. Physical exercise also prevented progressive loss of gray matter over time.”

Tsukita and colleagues evaluated patients with early PD (n=237) and healthy controls (n=158) enrolled in the Parkinson’s Progression Markers Initiative multicenter study. Longitudinal evaluations in the cohort included an annual estimate of activity level in the week prior to the visit measure by the Physical Activity Scale for the Elderly (PASE) questionnaire, which assesses regular physical activities (leisure, household, work, and exercise) for intensity, frequency, and duration.

Activity levels and types were tracked with the course of participants’ motor and cognitive functions, depression, autonomic symptoms, and sleep-related symptoms. Results were adjusted for age, sex, levodopa equivalent daily dose, and disease duration.

Participants with PD had a median age of 63 and a median disease duration of 3 years; 69.2% were male. All had three or more sets of evaluation data available and a first-evaluation baseline “off” motor score (i.e., with PD medications withheld) for reference. Baseline regular physical activity levels and moderate-to-vigorous exercise levels were not significantly different between the PD and control groups.

“We believe that our findings have important implications for daily clinical practice and future clinical trials,” Tsukita and colleagues wrote.

The results “highlight the importance of supporting patients with PD in daily clinical practice to enable them to maintain their physical activity levels,” they continued. “To maintain high physical activity levels for PD patients, it is essential that they themselves are convinced of the benefits of high physical activity levels.”

The findings also can provide content for individualized counseling on regular physical activity and can guide future randomized controlled trials toward greater emphasis on continuous exercise to demonstrate disease-modifying effects of exercise, the researchers noted.

Mobile apps that enable remote supervision and motivation for exercising patients show promise in this area and have been studied in PD, noted Tsukita and colleagues. “These results certainly represent a big step forward in proving the disease-modifying effect of long-term exercise on the course of PD,” they wrote.

Study limitations include the inability to infer causal relationships inherent to observational study design and a non-objective measure of physical activity. It’s also possible that regular physical activity may have different effects on different genotypes in early PD, “as suggested by a recent important observational study showing the interaction effects among regular physical activity, APOE genotype, and global cognitive function,” Tsukita and co-authors noted.

  1. A sustained increase in regular physical activity was linked to slower decline on several clinical parameters in early Parkinson’s disease, a longitudinal observational study found.

  2. Over a median of 5 years, the average level of overall regular activity had significant interaction effects on scores of postural instability and gait, activities of daily living, and processing speed.

Paul Smyth, MD, Contributing Writer, BreakingMED™

The researchers reported no targeted funding.

Tsukita, Choi, and Helmich had no disclosures.

Cat ID: 130

Topic ID: 82,130,730,130,37,192,925