ObjectivesTo investigate the acute and adaptation cardiovascular and metabolic training responses in people with Parkinson’s disease (pwP).Design(1) A cross-sectional study of exercise response of pwP compared with sedentary controls and (2) an interventional study of exercise training in pwP.SettingCommunity leisure facilities.ParticipantspwP (n=83) and sedentary controls (n=55).InterventionsStudy 1 included participants from a two-arm-parallel single-blind phase II randomised controlled trial (RCT), that undertook a baseline maximal incremental exercise test and study 2 included those randomised to the exercise group in the RCT, who completed a 6-month weekly exercise programme (n=37). The intervention study 2 was a prescribed exercise program consisting of sessions lasting 60 min, two times a week over a 6-month period. The control group followed the same protocol which derived the same cardiorespiratory parameters, except that they were instructed to aim for a cadence of ~60 revolutions per minute and the unloaded phase lasted 3 min with an initial step of 25 W.Primary and secondary outcome measuresStepwise incremental exercise test to volitional exhaustion was the primary outcome measure.ResultsStudy 1 showed higher maximum values for heart rate (HR), VO2 L/min, VCO2 L/min and ventilation L/min for the control group; respiratory exchange ratio (RER), perceived exertion and O2 pulse (VO2 L/min/HR) did not differ between groups. In study 2, for pwP who adhered to training (n=37), RER increased significantly and although there was no significant change in aerobic capacity or HR response, reduced blood pressure was found.ConclusionsAn abnormal cardiovascular response to exercise was observed in pwP compared to controls. After the exercise programme, metabolic deficiencies remained for pwP. These observations add to the pathogenic understanding of PD, acknowledge an underling metabolic contribution and support that certain cardiovascular symptoms may improve as a result of this type of exercise.

Healthy diet has been linked to better age-related functioning, but evidence on the relationship of diet quality in late midlife and measures of physical capability in later life is limited. Research on potential sex differences in this relationship is scarce. The aim was to investigate the prospective association between overall diet quality, as assessed by the Healthy Eating Index-2015 (HEI-2015) at 60–64 years and measures of walking speed 7 years later, among men and women from the Insight 46, a neuroscience sub-study of the Medical Research Council National Survey of Health and Development. Diet was assessed at 60–64 years using 5-d food diaries, from which total HEI-2015 was calculated. At 69–71 years, walking speed was estimated during four 10-m walks at self-selected pace, using inertial measurement units. Multivariable linear regression models with sex as a modifier, controlling for age, follow-up, lifestyle, health/social variables and physical performance, were used. The final sample consists of 164 women and 167 men (n 331). Women had higher HEI-2015 and slower walking speed than men. A 10-point increase in HEI-2015 was associated with faster walking speed among women (B 0·024, 95 % CI 0·006, 0·043), but not men. The association remained significant in the multivariable model (B 0·021, 95 % CI 0·003, 0·040). In women, higher diet quality in late midlife is associated with faster walking speed. A healthy diet in late midlife is likely to contribute towards better age-related physical capability, and sex differences are likely to affect this relationship.

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Objectives A healthy diet has been linked to better physical function in older adults but evidence on the role of cumulative dietary exposure is scarce. Sex differences in the relationship are also underexplored. The objective was to explore the longitudinal association of diet quality in adulthood (from 36–64 y), in line with dietary guidelines, and walking speed as an objective measure of later life physical function. Methods Study sample was derived from the Insight 46 (n = 502), a neuroscience sub-study of the longitudinal National Survey of Health and Development, UK. Diet was assessed four times, at age 36 y, 43 y, 53 y and 60–64 y using five-day food diaries, from which the Healthy Eating Index-2015 (HEI) was calculated (0 - low quality, 100 - high quality). Walking speed was estimated in a 10-meter walk test at self-selected pace, using an inertial measurement unit at age 69–71 y. Linear mixed models with random effects and group-based trajectory modeling were used to assess individual and group changes in HEI in adulthood. Multivariable linear regression models with sex as modifier, controlling for multiple characteristics assessed the association between adulthood HEI trajectories and walking speed at 71 y. The final sample was 226 women and 230 men. Results Men and women improved diet quality linearly in adulthood (β: 0.6 HEI/y, 95% CI: 0.5, 0.7). Three linear HEI trajectories were identified (21% “Low” βo: 33, β: 3.6; 59% “Medium” βο: 38, β: 6.1; 20% “High” βο: 52, β: 5.5, P < 0.001). Women had faster increase rates, higher HEI at each age (β: 4 HEI points, 95% CI: 3, 6) and were more likely to belong to the “High” HEI trajectory than men (β: 1.97, P < 0.001). There was no overall association but in women a 10 point increase in predicted HEI trajectory and membership in the “High” vs “Medium”-“Low” HEI trajectories were associated with faster walking speed (β: 0.04 m/s, 95% CI: 0.01, 0.08, β: 0.06 m/s, 95% CI: 0.01, 0.11, respectively). Association was attenuated in multivariable models. No association was observed in men. Conclusions In women, higher diet quality in adulthood was associated with faster walking speed in later life. Achieving and maintaining high diet quality in adulthood is likely of importance to yield benefits in physical function. Funding Sources Medical Research Council UK Alzheimer's Research UK Dementias Platform UK Wolfson Foundation UK CLOSER UK.

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