Regular exercise can slow progression

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New research shows the benefits of regular physical activity to improve outcomes in Parkinson’s disease. Westend61/Getty Images
  • Regular moderate to vigorous physical activity improves the clinical progression of early stage Parkinson’s disease.
  • Different types of activities have different effects on disease progression.
  • Regular physical activity may improve long-term clinical outcomes of Parkinson’s disease.

Parkinson’s disease (PD) is one of the most common neurodegenerative diseases, after Alzheimer’s disease. The condition affects people of all races and cultures. Globally, it affects around 10 million people who are usually over 60, but it can occur in younger people – 1 in 10 are under 50.

It is a progressive disease with symptoms that begin gradually.

Symptoms include:

  • tremor of the face, legs, arms, or hands
  • rigidity or stiffness in the limbs and trunk
  • slow movement with balance and coordination issues
  • cognitive decline in later stages of the disease

The exact cause of the condition is unknown, but experts believe it develops due to genetic and environmental factors. Research has shown that the symptoms arise due to the death of dopamine-generating cells in the substantia nigra, the part of the brain responsible for movement, reward, and addiction.

Currently, levodopa, a drug that the brain converts to dopamine, helps manage symptoms of PD. However, individuals may experience side effects and the drug does not delay disease progression.

However, new research from Kyoto University in Japan has shown that exercising twice a week can slow the progression of PD in people in the early stages of the disease.

Health experts have long suggested that exercise is a way to modify the progression of PD. Studies have shown that high-intensity exercise can improve motor function as dance training improves balance and gait stability.

Now, a recent study in Neurology showed that the effect of exercise extends beyond the duration of the physical activity itself. It also suggests that regular exercise may modify the progression of PD in the long term.

The study involved 237 patients with early-stage PD and 158 healthy volunteers. The researchers gave them annual questionnaires to record exercise intensity, frequency and duration. They also administered cognitive tests to assess their memory and verbal skills.

At the start of the study, researchers found that patients with PD had worse motor, cognitive and autonomic functions than the healthy group. However, there was no difference in regular physical activity and intensity levels between the groups.

The study conducted by Dr. Kazuto Tsukita found that overall regular physical activity had a significant effect on participants’ balance and stability. Patients with early-stage PD who took 4 hours of moderate-to-vigorous exercise each week had a slower decline in balance and gait compared to those who exercised less.

Talk to Medical News Today, Dr Tsukita explained: “A very important message from our research is that the areas that are most improved by exercise are those that cannot be improved by medication (i.e. postural stability and walking, processing speed, etc.).”

He went on to say, “I believe exercise should be used in conjunction with, and not instead of, drug therapy.”

Dr Rebecca Gilbert, scientific director of the American Parkinson Disease Association (APDA), who was not involved in the study, echoed those comments. Dr. Gilbert said DTM:

“The vast majority of people with PD, even those who exercise the most rigorously, end up needing PD medication. The goal of exercise should not be to replace drug therapy, but rather to work with drug therapy to maximize quality of life.

Dr Gilbert went on to say that in his opinion, “one of the strengths of the study is that it investigated not only the effects of exercise, but also of physical activity, defined as the activities of daily living performed in the course of work, leisure, or household-related activities, which require effort.

Interestingly, the researchers found that different types of activity had different clinical effects.

“Increased physical activity was correlated with slower deterioration of a number of PD symptoms, implying that energy expenditure of all kinds, not just formal exercise, is crucial in management of PD symptoms,” commented Dr. Gilbert.

Specifically, the study showed that moderate-to-vigorous exercise increased individuals’ balance and stability over time compared to household, work, and leisure activities in general. Similarly, work-related activity levels showed a stronger reduction in lower processing speed.

Researchers gave participants 90 seconds to match numbers to numbers to measure mental processing speed. With a maximum score of 110, those who exercised less went from a score of 44 to 40 in 6 years. People who exercised more only lost one point from 44 to 43.

The study showed that disease progression was better impaired in those who maintained physical activity over time, showing an association between maintaining a regular exercise regimen and delaying the effects of the disease.

“This suggests that people with PD who may not have been particularly active early in their disease have much to gain by increasing their activity levels once the disease is ongoing,” said Dr Gilbert. .

The study authors acknowledge that self-reporting can reduce the accuracy of the numbers and that the “observational nature of our study […] makes it impossible to draw a conclusion as to causation. They accept that these are the limitations of the study.

Speaking of future research, Dr. Tsukita said DTM: “The next step is definitely a [randomly controlled trial (RCT)] with long-term exercise intervention. There is a tendency to emphasize high-intensity exercise in the exercise domain of PD, but our study strongly indicates that exercise can alter the long-term course of PD, even in small amounts if supported. Therefore, future RCTs should also focus on sustained exercise, for example using motivational apps.

The APDA offers free booklets, presentations and videos to guide people with PD through specially designed exercises that people can perform safely at home.

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