HYPE?

Media portrayal:

HOPE?

Scientific interpretation:

Can physical exercise improve symptoms in Parkinson’s?

Original article: The Effects of Physical Activity in Parkinson’s Disease, Journal of Parkinson’s Disease: October 19, 2016.

The takeaway

Alongside medical treatments for Parkinson’s, physical exercise is an important adjunct. Over 30 years’ worth of research in this area has found that it improves arm and leg strength, as well as posture, gait (walking) and balance in people with Parkinson’s.

Why is it important?

Physical exercise is generally thought to be beneficial for health, but this review shows that it can actually improve some symptoms in Parkinson’s. Less evidence of positive effects exists for improvements in cognition and mood, highlighting areas for future research. Related to this, exercise was recently shown to be beneficial in Alzheimer’s.

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IMPACT

  • Novelty 75% 75%
  • Proximity 60% 60%
  • Deliverability 95% 95%

Impact Opinion

“The importance of exercise for people with Parkinson’s can not be overstated. Even if it simply involves performing some stretches or going for a walk, exercise is vital not only for keeping a health body, but also a better sense of wellbeing. And the truly great aspect of exercise is that the PD community can immediately apply it to their lives. This review of some many studies (over 1/3 of a century) provides a useful starting point for further investigations to determine which forms of exercise are more beneficial for each subtype of Parkinson’s.”

Background

This review summarises 106 trials carried out over 34 years in people with Parkinson’s on the effects of physical exercise, defined as a body movement produced by muscle that increases energy expenditure. This includes fitness exercises, sports, dance, martial arts, walking, physical therapeutic movements and occupational therapy. Which aspects of living with Parkinson’s does exercise improve?

The details

The categories of symptoms addressed included psychological and social functioning, activities of daily life, physical and cognitive symptoms. The greatest benefits of exercise were seen on endurance, strength/speed of the arms and legs, as well as posture, mobility, walking and balance. There were far fewer studies addressing the effect of exercise on cognition and mood, which could be one of the reasons why strong positive outcomes have not yet been reported.

One of the difficulties in understanding the effects of exercise or any treatment in Parkinson’s is that symptoms differ from person to another, and can also vary dramatically and unpredictably during the day. This means that studies may miss the full extent of any resulting changes in symptoms.

Next steps

Controlled trials with randomization are needed to address the effects of physical exercise on mood and cognition in people with Parkinson’s, as very little research has been undertaken in these areas. Future studies may address changes in symptoms using wearable sensors that allow continuous monitoring.

Another open question is how much exercise is enough to bring about improvement, and how feasible is it? A recent study (see below) addressed whether it is possible to complete a 3 day weekly programme of high intensity training (HIT) on a treadmill in newly diagnosed PwP. This was found to be feasible and movement related symptoms were also stable following 6 months of HIT, compared to standard care or moderate exercise. A larger efficacy trial is now needed to find out whether HIT 3 times a week can improve symptoms in Parkinson’s.

Related work

Schenkman, M., Moore, C. G., Kohrt, W. M., Hall, D. A., Delitto, A., Comella, C. L., . . . Corcos, D. M. (2017). Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial. JAMA Neurol. doi:10.1001/jamaneurol.2017.3517: https://www.ncbi.nlm.nih.gov/pubmed/29228079

Where can I find out more?

Trial on exercise and cognition – https://clinicaltrials.gov/ct2/show/NCT02267785

 

Trial on exercise, gait and cognition – https://clinicaltrials.gov/ct2/show/NCT02231073

Original article: The Effects of Physical Activity in Parkinson’s Disease, Journal of Parkinson’s Disease: October 19, 2016. Lauze, M., Daneault, J. F., & Duval, C.

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