High-Intensity Exercise May Slow Parkinson's Disease

Exercise is recommended for nearly all individuals because it improves physical and overall health; however, patients with certain diseases may not be able to partake in physical activity due to perceived safety concerns.

A new JAMA Neurology study suggests that patients with Parkinson’s disease (PD) can safely exercise and high-intensity physical activity may reduce the worsening of motor symptoms.

This is the first time that researchers have examined the effects of high-intensity exercise on patients with PD. Previously, it was thought that high-intensity physical activity would put too much physical stress on patients with PD, according to the authors.

Patients with PD can experience a loss of muscle control, slowness, stiffness, and impaired balance. With disease progression, patients may be unable to walk, talk, and complete day-to-day tasks.

“If you have Parkinson’s disease and you want to delay the progression of your symptoms, you should exercise 3 times a week with your heart rate between 80% to 85% maximum. It is that simple,” said co-lead author Daniel Corcos, PhD.

Current treatments for PD have significant side effects and the efficacy is diminished over time, leaving many patients without effective treatment options, according to the authors.

Included in the randomized clinical trial were 128 patients aged 40 to 80 years who had early-stage PD. No patients were taking prescription drugs to treat PD during the study and patients underwent a cardiologist-supervised exercise test to determine whether they were able to safely engage in physical activity.

“The earlier in the disease you intervene, the more likely it is you can prevent the progression of the disease,” Dr Corcos said. “We delayed worsening of symptoms for 6 months; whether we can prevent progression any longer than 6 months will require further study.”

Patients in the high-intensity (80% to 85% of maximum heart rate) cohort and moderate intensity (60% to 65% of maximum heart rate) cohort exercised 3 times per week for 6 months. The safety and efficacy of exercise were compared against a control group who did not exercise.

At 6 months, the authors rated patients from 0 to 108, with disease severity corresponding with higher numbers.

When patients engaged in high-intensity exercise, they remained at a score of 20, the same as baseline. Additionally, the scores of patients who participated in moderately intense exercise increased by 1.5 points compared with baseline, according to the study.

However, the scores of patients who did not exercise increased by 3 points, a 15% change in the signs of the condition, which would affect quality of life, according to the study.

“We are stopping people from getting worse, which is significant, particularly if we catch them early in the disease,” Dr Corcos said.

The authors noted that this study included a high number of patients who exercised for a long period of time compared with other studies.

“We gave them a proper workout,” Dr Corcos said. “This is not mild stretching. This is high intensity. It’s part of the idea that exercise is medicine.”

Previous studies showed that high-intensity exercise improved motor symptoms but did not show whether exercise could modify symptoms or disease progression. The authors also said that prior research did not control exercise intensity and none reached the high intensity threshold.

These new findings may provide patients with PD a potentially beneficial non-pharmacological therapy.

“Several lines of evidence point to a beneficial effect of exercise in Parkinson’s disease,” said Codrin Lungu, MD, program director at the National Institute of Neurological Disorders and Stroke. “Nevertheless, it’s not clear which kind of exercise is most effective. The SPARX trial tries to rigorously address this issue. The results are interesting and warrant further exploration of the optimal exercise regimes for Parkinson’s.”