A High-Intensity Exercise Boot Camp for Persons With Parkinson Disease: A Phase II, Pragmatic, Randomized Clinical Trial of Feasibility, Safety, Signal of Efficacy, and Disease Mechanisms

Abstract

Background and Purpose: The feasibility, safety, and efficacy of a high-intensity multimodal exercise program (aerobic, strengthening, and balance training) have not been well vetted in persons with Parkinson disease (PD). Thus, the primary aim was to determine whether a high-intensity multimodal exercise boot camp (HIBC) was both feasible and safe in persons with PD. The secondary aim was to determine whether the program would produce greater benefit than a usual care, low-intensity exercise program (UC). An exploratory aim was to determine whether these programs affected putative disease-modifying mechanisms. Methods: Twenty-seven participants (19 men and 8 women) were randomized into 8 weeks of either the HIBC or UC supervised by physical therapists. For feasibility, participation, and meeting, Centers for Disease Control and Prevention (CDC) exercise guidelines were assessed. For safety, adverse events were monitored. For efficacy, the following outcome domains were assessed before and after participation: balance, motor activity, endurance and fatigue, strength, mental health, and quality of life. For disease-modifying mechanisms, circulating brain-derived neurotrophic factor (BDNF) and its genotype, superoxide dismutase, and cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-10) were monitored. Results: The HIBC was better at attaining CDC guidelines (P = 0.013) and spent more minutes in higher-intensity exercise per week (P < 0.001). There were no differences in adverse events (P = 0.419). The HIBC experienced significant improvements in 7/31 outcomes versus 3/31 in the UC arm. BDNF improved significantly for both groups from pre- to posttests (Ps ≤ 0.041) and an improved anti-inflammatory was observed for both groups. Discussion and Conclusions: A high-intensity multimodal exercise boot camp was feasible and safe in persons with PD. Compared with usual care, there were no differences in adverse events. Moreover, the high-intensity multimodal exercise program produced more improvement across more domains than usual care. Our results also suggest a possible link between improvement in outcomes and an improved anti-inflammatory milieu. Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A244).

High-Intensity Interval Cycle Ergometer Training in Parkinson's Disease: Protocol for Identifying Individual Response Patterns Using a Single-Subject Research Design

“…Accumulating scientific evidence supports the use of physical rehabilitation training and exercise as an effective nonpharmacologic therapy to improve motor symptoms, problems with mobility and gait (49,50), and non-motor features, including mood, cognition, and sleep [for review, see Reynolds et al (51)] for patients at all stages of PD. Intensive exercise may even induce neuroplastic disease-attenuating effects via endogenous production of neurotrophic factors, including BDNF (4,5,52,53).…”

“…Neurotrophic factors, including BDNF, are soluble endogenously produced polypeptides that are involved in the development, growth, functioning, and regulation of neurons and neuron-supporting cells. Studies indicate that continuous high-intensity training, moderate-intensity CAE, or low-intensity exercise enhances serum and plasma BDNF levels (12,22,52,56). A recent meta-analysis showed cumulative evidence of physical exercise induced improved serum BDNF protein levels in PD (11).…”

The Effect of Endurance Training on Brain-Derived Neurotrophic Factor and Inflammatory Markers in Healthy People and Parkinson's Disease. A Narrative Review

“…Twenty-two original studies with a total of 614 participants were included in this narrative review (Erickson et al, 2011;Ruscheweyh et al, 2011;Reihmane et al, 2013;Voss et al, 2013;Frazzitta et al, 2014;Leckie et al, 2014;Rinnov et al, 2014;Zoladz et al, 2014;de Gonzalo-Calvo et al, 2015;Marquez et al, 2015;Wagner et al, 2015;Cabral-Santos et al, 2016;Hwang et al, 2016;Kaspar et al, 2016;Maass et al, 2016;Marusiak et al, 2016;Schega et al, 2016;Brown et al, 2018;Slusher et al, 2018; Abkenar et al, 2019;Landers et al, 2019;O'Callaghan et al, 2019). The search strategy presented 1,033 records from PubMed/MEDLINE, 33 records from Web of Science, and five articles were identified through other sources.…”

“…Five studies included in this research were defined as RCT (Erickson et al, 2011;Wagner et al, 2015;Schega et al, 2016;Landers et al, 2019;O'Callaghan et al, 2019), one study was defined as control trial (CT) (Maass et al, 2016), ten studies qualified as quasi-experimental studies (QE) (Ruscheweyh et al, 2011;Voss et al, 2013;Frazzitta et al, 2014;Leckie et al, 2014;Rinnov et al, 2014;Marquez et al, 2015;Kaspar et al, 2016;Marusiak et al, 2016;Slusher et al, 2018;Abkenar et al, 2019) and six as pre-post studies (Reihmane et al, 2013;Zoladz et al, 2014;de Gonzalo-Calvo et al, 2015;Cabral-Santos et al, 2016;Hwang et al, 2016;Brown et al, 2018). The highest quality score (7-10 points according to the criteria) had five studies (Erickson et al, 2011;Frazzitta et al, 2014;Schega et al, 2016;Landers et al, 2019;O'Callaghan et al, 2019). Eleven studies performed the random allocation for subjects (criteria 2) (Erickson et al, 2011;Ruscheweyh et al, 2011;Voss et al, 2013;Frazzitta et al, 2014;Hwang et al, 2016;Kaspar et al, 2016;Maass et al, 2016;Schega et al, 2016;Abkenar et al, 2019;…”

“…In the context of PD and the benefits of endurance training in the slowing down the disease progression or improvement of the life quality, not many promising studies were so far conducted. The last 2 years brought new light on introducing endurance training as a part of rehabilitation or the lifestyle in PD due to two promising randomized clinical trials (RCT) (Landers et al, 2019;O'Callaghan et al, 2019).…”