Exercise Slows Progression, Cognitive Decline in Early Parkinson's

Batya Swift Yasgur, MA, LSW

January 17, 2022

Just 1 to 2 hours of moderate-to-vigorous exercise twice a week appears to slow disease progression and cognitive decline in patients with early Parkinson's disease (PD), new research shows.

Investigators followed over 200 patients with early stage PD for up to 6 years, assessing exercise levels at baseline and throughout the study period. They found those who engaged in 4 hours of moderate-to-vigorous exercise per week had a slower decline in postural and gait stability and processing speed 5 years later versus their peers with lower exercise levels.

Even those who were physically active 1 to 2 hours twice weekly experienced slower disease progression compared with those who were physically active for 1 hour.

"The maintenance of regular physical activity levels and exercise habits is the critical part to improve the disease course of PD over 5 years; in other words, regular physical activity and exercise habits, even in small doses, can make a difference when maintained," lead author Kazuto Tsukita, MD, of the Department of Neurology, Graduate School of Medicine, Kyoto University, Japan, told Medscape Medical News.

"The message I would like to convey to PD patients is please continue to engage in physical activity, even in small amounts. It's never too late to start doing something physically active," Tsukita said.

The study was published online January 13 in Neurology.

Disease-Modifying Effects

"Exercise has long been postulated as a promising intervention that can modify the long-term clinical course of patients with PD," the authors write.

In addition to exercise, any regular physical activity that includes things like daily life activities that require movement and expenditure of energy has also shown promise in slowing the disease course in PD. However, follow-up periods in these studies have been "short," the researchers note.

To investigate the potential "long-term disease-modifying effects" of exercise and high daily physical activity levels in PD patients the researchers drew on data from the Parkinson's Progression Markers Initiative, a large international longitudinal study.

The study included an array of demographic and disease-related factors, including motor function, cognitive function, and regular physical activity as measured by the Physical Activity Scale for the Elderly (PASE). The PASE measures time and intensity of leisure activity, household activity, and occupational activity.

Researchers examined the effects of these activities on motor and cognitive function, the presence of depression, and autonomic and sleep-related symptoms by studying 237 patients with early PD (median [IQR] age, 63.0 [56.0-70.0] years; 69.2% men) for a median of 5 years.

Global cognitive function was assessed using the Montreal Cognitive Assessment (MoCA) and depression was assessed using the 15-item Geriatric Depression Scale (GDS).

Global motor function was evaluated using the Movement Disorder Society-Sponsored Revision of the Unified Parkinson's Disease Rating Scale (MDS-UPDRS), with specific motor symptoms evaluated using the Postural Instability/Gait Disturbance (PIGD) subscore. Activities of daily living were measured using the Modified Schwab and England Activities of Daily Living (MSE-ADL) scale.

Patients with PD were compared with 158 healthy controls. Although the patients with PD showed significantly greater impairment in motor, cognitive, and autonomic functions at baseline, there were no significant differences with healthy controls in terms of regular physical activity and moderate-to-vigorous exercise levels at baseline.

Low Cost, Few Side Effects

During follow-up, regular physical activity level in patients with PD gradually decreased (PASE total score declined by 4.5 points per year), whereas no significant change was observed longitudinally in healthy controls.

By contrast, moderate-to-vigorous exercise (1-2 hours, 1-2 times/week) showed a "decreasing trend" in both groups that was not significant.

In patients with PD, average physical activity levels over time were significantly associated with slower deterioration of postural and gait stability, activities of daily living, and processing speed (Table 1).

Table 1. Interaction Effect of Physical Activity Levels on Clinical Parameters of PD

Clinical parameter βinteraction (95% CI) P value
Postural and gait stability –0.10 (-0.14 to –0.06) < .01
Activities of daily living 0.08 (0.04 - 0.12) < .01
Processing speed 0.05 (0.03 - 0.08) < .01

Moderate-to-vigorous exercise levels were associated with slower decline of postural and gait stability, whereas work-related activity levels were primarily associated with slower deterioration of processing speed (βinteraction –0.09 [–0.13 to –0.05] and 0.07 [0.04 to 0.09], respectively, both P < .01).

"Multiple imputation and propensity-score matching confirmed the robustness of our results," the authors report.

"Although medications can provide people with Parkinson's some symptom relief, they haven't been shown to slow the progression of the disease," Tsukita said in a press release.

"We found that regular physical activity, including household tasks and moderate exercise, may actually improve the course of the disease over the long run. Best of all, exercise is low cost and has few side effects," she added.

Effective Adjunctive Therapy

Commenting for Medscape Medical News, Bastiaan R. Bloem, MD, PhD, and Sirwan Darweesh, MD, PhD, both of Radboud University Medical Center, Nijmegen, Netherlands, said the findings "could suggest that engaging in exercise at moderate (or higher) intensity may sustainably slow the progression of PD and the overall volume of exercise — even at low intensity — may yield additional beneficial effects."

However, "it is possible that some of the observed associations in this study may reflect 'reverse causality,' meaning that those individuals who exercised regularly may simply have had a more benign phenotype of PD," Bloem and Darweesh, who were not involved with the study, noted in an email.

The findings "should motivate patients with PD to regularly engage in physical exercise," they stated. "Their treating physicians, physiotherapists, and other members of the clinical team should encourage patients to participate in regular exercise and support patients and families in identifying suitable ways of achieving that goal, tailored to each individual's personal preferences and abilities."

In an accompanying editorial, Margaret K.Y. Mak, MD, of the Department of Rehabilitation Sciences, Hong Kong Polytechnic University, and Heidi Beck Schwartz, MD, professor of clinical neurology, University of Rochester Medical Center, New York, write: "With the evidence of improved physical and cognitive functions and its potential effect of modifying disease progression, regular exercise can be considered as an adjunct therapy for PD."

No source of study funding was reported. Tsukita has disclosed no relevant financial relationships. Disclosures for the other authors are listed with the article. Bloem, Darweesh, Mak, and Schwartz have disclosed no relevant financial relationships.

Neurology. Published online January 12, 2022. Full text, Editorial

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