Aerobic Exercise Can Attenuate Mild Parkinson Disease Symptoms

Bastiaan R. Bloem, MD, PhD, medical director, department of neurology, Radboud University Medical Center

Bastiaan R. Bloem, MD, PhD

New study results of a group of patients with Parkinson disease of mild severity suggest that a high-intensity aerobic exercise intervention, when gamified and delivered in an at-home fashion, can attenuate the symptoms of the disease.¹

The single-center assessment, dubbed Park-in-Shape, included 130 patients randomized to either the aerobic intervention (n = 65) or active control (n = 65) group and followed for 6 months. Ultimately, the aerobic group reported significantly improved off state Movement Disorders Society—Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor section scores compared to the control group, differing by 4.2 points (95% CI, 1.6—6.9; P = .0020).

“Aerobic exercise can be done at home by patients with Parkinson's disease with mild disease severity and it attenuates off-state motor signs,” wrote study author Bastiaan R. Bloem, MD, PhD, medical director, department of neurology, Radboud University Medical Center, and colleagues. “Future studies should establish long-term effectiveness and possible disease-modifying effects.”

The aerobic group, who were instructed to cycle on a stationary home-trainer for 30 to 45 minutes thrice weekly, had a mean MDS-UPDRS motor score of 1.3 points (standard error [SE], 1.8) compared to 5.6 points in the control group (SE, 1.9), who were instructed to do stretching, flexibility, and relaxation exercises for 30 minutes thrice weekly. Both groups received remote supervision from either a physical therapist or research assistant.

In an accompanying editorial, Terry Ellis, PT, PhD, NCS, associate professor and chair, department of physical therapy & athletic training, and director, center for neurorehabilitation, Boston University, noted that the telehealth elements of the Park-in-Shape trial’s program are important to optimize engagement. “Exercise trials using motivational apps with remote coaching by a physical therapist have been shown to improve outcomes in sedentary people with Parkinson’s disease,” she wrote.²

“Although telehealth approaches hold promise, numerous regulatory barriers and restrictions from third-party payers in the USA limit the uptake of these approaches,” Ellis continued. “The Park-in-Shape trial reveals the feasibility of integrating telehealth approaches in exercise trials, although more evidence showing feasibility, effectiveness, and cost containment is needed to shift health-care policies further.”

In total, 72 sessions were expected to be completed. Over the 6-month study period, each group was aerobic exercise was done in an average of 54 sessions (standard deviation [SD], 29; 75% of sessions), with stretching done during a mean of 60 sessions (SD, 28; 83% of sessions).

Additionally, the aerobic group experienced a VO₂ max improvement of 2.0 mL/kg per minute, compared to the control group which experienced a 0.4 mL/kg per minute decrease (difference, 2.4 mL/kg per min; 95% CI, 1.1—3.7; P <.0001). No other secondary outcomes revealed a significant difference between groups.

Bloem and coauthors noted that there are risks when assigning any exercise to patients with Parkinson disease,” especially when it is home-based, strenuous, and with minimal supervision,” as the risk of musculoskeletal injuries, cardiac events, and falls is apparent. “In our trial, only 2 falls occurred, both of which were unrelated to the exercise,” they wrote.

In total, 27 adverse events (AEs) were reported in 23 patients in the aerobic exercise group and 29 in 21 patients in the active control group. A possible relationship to the intervention was unable to be excluded from 11% (n = 7) patients in the aerobic exercise group and 6% (n = 4) in the control group. These included arthralgia or back pain (aerobic, 3%; control, 6%) and palpitations (aerobic, 6%) and mostly concerned a worsening or reoccurrence of a pre-existing condition. In total, 3 patients discontinued their randomized intervention as a result of an AE.

“To our knowledge, this is one of the largest high-quality aerobic exercise studies in Parkinson’s disease,” Bloem and colleagues detailed. “The results add to previous work because of the new setting (fully home-based vs highly supervised fitness facility in earlier work), the double-blind design, and the unique motivational program, with only minimal and almost exclusively remote supervision, versus a more intense and direct supervision scheme in earlier work. This multifaceted home-based approach has good potential for a wider implementation with good long-term adherence.”

REFERENCES

1. van der Kolk NM, de Vries NM, Kessels RPC, et al. Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson's disease: a double-blind, randomised controlled trial. Lancet Neurol. Published online September 11, 2019. doi: 10.1016/S1474-4422(19)30285-6.

2. Ellis T. Exercise in Parkinson's disease: are we narrowing in on the essential elements? Lancet Neurol. Published online September 11, 2019. doi: 10.1016/S1474-4422(19)30348-5.