Brisk Walking Exercise Improves Nonmotor Parkinson Disease Symptoms

Margaret Mak, PhD

Data from a prospective, 2-arm, 6-week, single-blinded randomized controlled trial suggest that a brisk walking program may be able to alleviate the nonmotor symptoms experienced by patients with Parkinson disease (PD).¹

All told, the group randomized to the experimental program (n = 32) experienced a significant increase in their Movement Disorder Society–Unified Parkinson’s Disease Rating Scale nonmotor (MDS-UPDRS-I) scores, for a mean reduction of 2.4 points (±0.4; P <.001) compared with the control group (n = 32). The group-by-time interaction was also significant (P <.05).

Additionally, Pittsburgh Sleep Quality Index (PSQI) and Parkinson Disease Questionnaire-39 summary index (PDQ-39 SI) scores were nonsignificantly reduced by 1.6 and 1.2 points, respectively, compared with the control group (n = 32). No adverse effects were reported during the training period.¹

These data were presented at the International Parkinson and Movement Disorders Society (MDS) Virtual Congress 2021, September 17-22, by Margaret Mak, PhD, Shun Hing Education and Charity Fund Professor in Rehabilitation Sciences, associate dean, Faculty of Health and Social Sciences, and professor of Rehabilitation Sciences, Hong Kong Polytechnic University. This work was conducted as a follow-up to the group’s prior pilot study of the program.²

“Brisk walking is a moderate-intensity aerobic training that involves good coordination of large steps and large arm swing,” Mak said in her presentation, adding that “Our previous pilot study’s results indicated that the 6-week brisk walking program also increased in motor performance, balance, and walking capacity among people with mild to moderate PD; however, the effects of brisk walking on nonmotor symptoms, sleep quality, and health-related quality of life [had] not been investigated.”

WATCH NOW: Peer Exchange: Recognizing and Managing Advanced Parkinson Disease

Mak told NeurologyLive that she believes this type of program could be easily implemented and tailored for patients in clinical practice, particularly noting that this can be achieved without additional exercise equipment. "The use of a smartwatch to give feedback to [patients] about goal attainment encourages them to continue training. It requires a low level of manpower and resources, just a weekly group training supervised by physiotherapists, with tapered supervision after 6 weeks," she explained.

"Group training can provide mutual support and tapered supervision can empower and motivate [patients] for good exercise compliance," Mak added.

The 64 total patients in the trial were randomized to the 2 aforementioned groups after a baseline assessment. All participants attended six 90-minute weekly sessions under physiotherapy supervision. Those in the experimental group underwent a group brisk walking exercise regimen tracked with a smartwatch tracker device, the data from which was accessible via online portal. The regimen featured some consistent warm-up and cool-down tasks, with training increasing after certain time points (FIGURE).

FIGURE. 90-Minute Brisk Walking Class for Patients With Parkinson Disease

The control group, on the other hand, practiced upper limb stretching and strengthening, as well as dexterity training while sitting. Their regimen consisted of 20-minute warm-up and cool-down exercises plus 50 minutes of upper limb, lower limb, and trunk stretches, followed by TheraBand upper limb strengthening for 15 minutes.

Although Mak and colleagues noted that the brisk walking program appears to alleviate nonmotor symptoms of PD after 6 weeks post-training, she added in her presentation that “further study is important to investigate the long-term effects of this program.”

"We have recruited more patients and are collecting more data on the 6-month training effect and the carry-over effect after treatment completion to examine whether this training can be sustained after treatment ended. In the future study, we can include other nonmotor outcomes such as fatigue and mood, as well as motor outcomes such as MDS-UPDRS scores," Mak told NeurologyLive.

This is not the first work to suggest that aerobic exercise can benefit patients with PD. Data published in 2019 in The Lancet Neurology by van der Kolk et al. suggest that those with mild PD can benefit from a high-intensity aerobic exercise intervention, when gamified and delivered in an at-home fashion, specifically attenuating disease symptoms. That single-center assessment, called 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.³

Park-in-Shape’s aerobic exercise included cycling on a stationary home-trainer for 30 to 45 minutes thrice weekly, compared with a nonaerobic regimen of stretching, flexibility, and relaxation exercises for 30 minutes thrice weekly. Ultimately, the aerobic group reported significantly improved OFF state MDS-UPDRS motor section scores compared to the control group, differing by 4.2 points (95% CI, 1.6-6.9; P = .0020).

For more coverage of MDS 2021, click here.

REFERENCES
1. Mak MKY, Ren L-J, Wong-Yu ISK. Efficacy of a 6-week brisk walking program in improving non-motor symptoms in people with Parkinson disease - a randomized controlled trial. Presented at: MDS Congress 2021; September 17-22; Virtual. Poster 416.
2. Wong-Yu IS, Choi E, Lai TK, et al. Efficacy of a mobile technology-based brisk walking program in improving dynamic balance and motor performance in people with Parkinson disease - a randomized controlled trial. J Parkinsons Dis. 2019;9:153.
3. 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. 2019;18(11):998-1008. doi:10.1016/S1474-4422(19)30285-6