Effect of physical exercise on mortality in patients with Parkinson's disease

Kuroda, Kenji; Tatara, Kozo; Takatorige, Toshio; Shinsho, Fumiaki

doi:10.1111/j.1600-0404.1992.tb08054.x

Cited by 80 publications

(42 citation statements)

References 15 publications

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“…Cohort work in the late 1970s through to the late 1980s revealed similar figures with mortality ratios of 1.42-2.47 (25)(26)(27)(28), with the notable exception of Hoehn's study, with an observed to expected mortality ratio of 1.2 (29,30).…”

Section: Postlevodopa Studiessupporting

confidence: 56%

Does levodopa therapy delay death in Parkinson's disease? A review of the evidence

Clarke

1995

Movement Disorders

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Studies examining the mortality from Parkinson's disease have been reviewed to assess the impact of levodopa therapy. These include national mortality data taken from death certificate returns, cohort studies comparing the deaths observed in a group of patients with those expected from population statistics, and case-control studies comparing deaths in patients with those in a matched control group. It is concluded that the decrease in crude mortality rate in the early 1970s in several western countries was mirrored by a decrease in observed to expected mortality rates in cohort studies over the same period. The rise in crude mortality in the late 1970s and early 1980s paralleled an increase in observed to expected mortality in cohort studies. These trends are compatible with the hypothesis that levodopa delayed the death of a cohort of frail elderly parkinsonian patients who succumbed approximately 5 years later, leading to an apparent "catch-up" increment in national mortality data. Whilst crude mortality in England and Wales does not appear to be increasing as fast as before the introduction of levodopa, recent cohort and case-control studies report mortality ratios comparable to those seen in the prelevodopa era. Further case-control studies are required to determine the position with current treatment regimens.

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Section: Postlevodopa Studiessupporting

confidence: 56%

Does levodopa therapy delay death in Parkinson's disease? A review of the evidence

Clarke

1995

Movement Disorders

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“…In humans, there is evidence that physical activity may slow the disease progression, perhaps because of increased neuroplasticity or through increased cardiovascular fitness [5]. Exercise is associated with increased longevity in this patient population [6]. There is some evidence that physical activity improves cognition in PD [7].…”

Section: Introductionmentioning

confidence: 99%

Back to the basics: Regular exercise matters in Parkinson's disease: Results from the National Parkinson Foundation QII Registry study

Oguh

Eisenstein

Kwasny

et al. 2014

Parkinsonism & Related Disorders

112

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“…10 Finally, longevity in PD has been associated with physical exercise. 11 However, expanding on these findings is substantial indirect evidence from a variety of sources suggesting that a neuroprotective effect from vigorous exercise in PD is biologically plausible and perhaps even likely, as summarized below.…”

Section: Studies In Humansmentioning

confidence: 99%

Does vigorous exercise have a neuroprotective effect in Parkinson disease?

2011

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Parkinson disease (PD) is progressive, with dementia and medication-refractory motor problems common reasons for late-stage nursing-home placement. Increasing evidence suggests that ongoing vigorous exercise/physical fitness may favorably influence this progression. Parkinsonian animal models reveal exercise-related protection from dopaminergic neurotoxins, apparently mediated by brain neurotrophic factors and neuroplasticity (predicted from in vitro studies). Similarly, exercise consistently improves cognition in animals, also linked to enhanced neuroplasticity and increased neurotrophic factor expression. In these animal models, immobilization has the opposite effect. Brain-derived neurotrophic factor (BDNF) may mediate at least some of this exercise benefit. In humans, exercise increases serum BDNF, and this is known to cross the blood-brain barrier. PD risk in humans is significantly reduced by midlife exercise, documented in large prospective studies. No studies have addressed whether exercise influences dementia risk in PD, but exercised patients with PD improve cognitive scores. Among seniors in general, exercise or physical fitness has not only been associated with better cognitive scores, but midlife exercise significantly reduces the later risk of both dementia and mild cognitive impairment. Finally, numerous studies in seniors with and without dementia have reported increased cerebral gray matter volumes associated with physical fitness or exercise. These findings have several implications for PD clinicians. 1) Ongoing vigorous exercise and physical fitness should be highly encouraged. 2) PD physical therapy programs should include structured, graduated fitness instruction and guidance for deconditioned patients with PD. 3) Levodopa and other forms of dopamine replenishment therapy should be utilized to achieve the maximum capability and motivation for patients to maintain fitness. Neurology Parkinson disease (PD) is progressive. Although the dopaminergic nigrostriatal system receives much attention, progression in nondopaminergic circuits eventually becomes the primary substrate for major PD disability. Nursing home placement is typically the consequence of cognitive impairment/dementia or nondopaminergic motor deficits, especially levodopa-refractory balance and gait problems. 1A major focus of PD research has been on "disease-modifying" or "neuroprotective" agents to slow PD progression. No drugs have surfaced, to date, that unequivocally have that property. However, often overlooked in this discussion is the potential benefit of sustained vigorous exercise on PD progression. Exercise is well-known to have general health benefits, including improvement of cardiovascular and cerebrovascular health, reduction of osteoporosis/fracture risk and age-related sarcopenia, improvement of psychological affect, and perhaps even a general anti-inflammatory effect.2 However, accumulating evidence, albeit indirect, suggests that ongoing vigorous exercise may have a neuroprotective effect in PD, beyond th...

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Effect of physical exercise on mortality in patients with Parkinson's disease

Cited by 80 publications

References 15 publications

Does levodopa therapy delay death in Parkinson's disease? A review of the evidence

Does levodopa therapy delay death in Parkinson's disease? A review of the evidence

Back to the basics: Regular exercise matters in Parkinson's disease: Results from the National Parkinson Foundation QII Registry study

Does vigorous exercise have a neuroprotective effect in Parkinson disease?

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