Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease

Abstract

Objective:Owing to the lack of long-term observations and/or comprehensive adjustment for confounding factors, reliable conclusions regarding long-term effects of exercise and regular physical activity in Parkinson’s disease (PD) have yet to be drawn. Here, using data from the Parkinson’s Progression Markers Initiative study that includes longitudinal and comprehensive evaluations of many clinical parameters, we examined the long-term effects of regular physical activity and exercise habits on the course of PD.Methods:In this observational cohort study, we primarily used the multivariate linear mixed-effects models to analyze the interaction effects of their regular physical activity and moderate-to-vigorous exercise levels, measured through the Physical Activity Scale for the Elderly questionnaire, on the progression of clinical parameters, after adjusting for age, sex, levodopa-equivalent dose, and disease duration. We also calculated bootstrapping 95% confidence intervals (CIs), and conducted sensitivity analyses using the multiple imputation method and subgroup analyses using the propensity score matching to match for all baseline background factors.Results:237 early PD patients [median (interquartile range); age, 63.0 (56.0–70.0) years; Male, 69.2%; follow-up duration, 5.0 (4.0–6.0) years] were included. Regular physical activity and moderate-to-vigorous exercise levels at the 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 postural and gait stability [standardized fixed-effects coefficients of the interaction term (βinteraction) = -0.10 (95% CI, -0.14 to -0.06)], activities of daily living [βinteraction = 0.08 (95% CI, 0.04 to 0.12)], and processing speed [βinteraction = 0.05 (95% CI, 0.03 to 0.08)] in PD patients. 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)] and work-related activity levels were primarily associated with slower deterioration of processing speed [βinteraction = 0.07 (95% CI, 0.04 to 0.09)]. Multiple imputation and propensity score matching confirmed the robustness of our results.Conclusions:In the long-term, the maintenance of high regular physical activity levels and exercise habits was robustly associated with better clinical course of PD, with each type of physical activity having different effects.Trial Registration Information:Clinicaltrials.gov (NCT01176565). A link to trial registry page is https://clinicaltrials.gov/ct2/show/NCT01141023.Classification of Evidence:This study provides Class II evidence that sustained increase in overall regular physical activity levels in patients with early Parkinson disease was associated with slower decline of several clinical parameters.

Nerve ultrasound characteristics of immunoglobulin M neuropathy associated with anti‐myelin‐associated glycoprotein antibodies

“…using a self-made R script (DOI: 10.17632/s5tb6ych87.1) for statistical software R (version 4.0.2, freely available at https://www.R-roject.org), as described. [37][38][39] We used the Fisher exact test, Kruskal-Wallis rank-sum test, and Spearman 0 s rank correlation, as appropriate. For constructing the heatmap, the CSA values of each patient were Z-transformed using the CSA values of HCs (ie, subtracting the mean of the CSA values of HCs and dividing by the standard deviation of the CSA values of HCs).…”

“…All statistical analyses were conducted by K.T. using a self‐made R script (DOI: 10.17632/s5tb6ych87.1) for statistical software R (version 4.0.2, freely available at https://www.r-roject.org), as described 37‐39 . We used the Fisher exact test, Kruskal–Wallis rank‐sum test, and Spearman′s rank correlation, as appropriate.…”

Effect of Exercise and Rehabilitation Therapy on Risk of Hospitalization in Parkinson's Disease

“…In this analysis of the POP data, we demonstrate that increased exercise duration and intensity correlate with reduced odds of hospital encounter using longitudinal data, when controlling for variables such as disease stage, age, and cognitive function that can affect both exercise and hospitalization. Given the multiple benefits of exercise in preclinical models and controlled trials, the association with reduced hospitalization is not surprising 7,9–13 . These benefits may occur through improvement in aerobic capacity, mitochondrial function, immunity, angiogenesis, and release of neurotrophic factors 9,11–13 .…”

“…7,[9][10][11][12][13] These benefits may occur through improvement in aerobic capacity, mitochondrial function, immunity, angiogenesis, and release of neurotrophic factors. 9,[11][12][13] Furthermore, reductions in exercise duration or intensity within two study visit periods ($2 years) did not occur more frequently before an immediate subsequent hospital encounter. This finding suggests that the protective effects of exercise can be persistent even with short-term fluctuations in exercise.…”

Physical Exercise, a Potential Non-Pharmacological Intervention for Attenuating Neuroinflammation and Cognitive Decline in Alzheimer’s Disease Patients

“…Moderate endurance and resistance training PE improved quality of life, cardiovascular fitness and motor function without extending life expectancy in patients with ALS [ 238 , 239 , 240 ]. Aerobic and resistance PE, combined with training to improve balance, gait and coordination, improved quality of life motor function (balance, gait, reduced risk of falls), sleep and cognition in patients with PD [ 241 , 242 , 243 ]. Exercise may cause motor neuron injury in ALS patients with a risk-genotype [ 244 ].…”