Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease

Abstract

IMPORTANCEParkinson 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 PARTICIPANTSThe 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 [9] 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.

Vastly Different Exercise Programs Similarly Improve Parkinsonian Symptoms: A Randomized Clinical Trial

“…However, a 6-month-long treadmill intervention with exactly the same intensity as EXE and CYC did not produce timeproportionally larger effects [8]. Exercise effects are often not sustained in PD patients [34] and we cannot tell whether the program slowed disease progression.…”

“…A synthesis of previous data is consistent with a physical fitness effect. Treadmill [6][7][8], CYC [9,10], and seated resistance training [11], with a low or no specificity to the temporal and spatial dynamics of standing and walking postures and balance, all improved PD patients' mobility and balance as well or even more effectively than did balance, Tai Chi, dance, yoga, and walking training [3]. As in the present experiment, the patients in these studies were physically untrained and high-intensity and high-frequency exercise is particularly effective in improving motor performance [2].…”

“…Patients could have modified their physical activity and diet during the study period, affecting the results, but we did not measure these factors. While the 100% adherence and 0% dropout rates make a high exercise intensity feasible [8], therapists delivered exercise sessions in a designated hospital facility, conditions often unavailable to PD patients. However, patients could perform agility exercises or cycle on an ergometer at home with remote supervision, reducing costs and staff burdens [26,35].…”

“…Exercises not specific to patients' mobility dysfunction can also improve PD patients' mobility by a functionally meaningful margin. For example, exercise therapy using a treadmill [5][6][7][8], stationary cycling (CYC) [9,10], and seated resistance training [11] with a low specificity for the temporal and spatial dynamics of standing and walking balance all improved PD patients' mobility, postural control, and balance. As demonstrated by a small effect size of 0.4 in a meta-analysis [3], the evidence is unclear with regard to the superiority of any specific exercise program in improving PD patients' mobility and balance.…”

Exercise for people with Parkinson’s: a practical approach

“…Disease progression , with animal model and clinical studies suggesting a potential neuroprotective role of exercise 17. Higher-intensity activity (increasing to 80% maximal heart rate) appears particularly effective, probably mediated by changes to cerebral blood flow, enhanced turnover of neurotropins (such as brain-derived or glial-derived factors), neurotransmitter modulation and improved cortical plasticity 17–21…”