Written by Greg Arnold, DC, CSCS. Exercise can improve gait speed, muscle strength, and fitness in patients with Parkinson’s disease.
As one of the most common nervous system disorders in the elderly, Parkinson’s Disease most often develops after the age of 50 and is characterized by a breakdown of the area of the brain that produces the nerve chemical dopamine which helps control movement (1). The symptoms of Parkinson’s start to show once 60-80% of the dopamine-producing part of the brain is destroyed and the body can no longer produce enough dopamine (2).
The latest statistics regarding the cost of Parkinson’s is $25 billion per year that breaks down to $25,000 per patient per year (3). The defining visual impairment in Parkinson’s patients is an impaired walking pattern that becomes most noticeable between stage 2 and stage 3 of Parkinson Disease (4).
This reduced gait quickly leads to a loss of quality of life and is a primary focus of treatment for Parkinson’s patients. As the current therapies, including dopaminergic medication and surgery, are inadequate to preserve mobility as PD progresses, other ways to help preserve mobility is crucial.
Now a new study (5) suggests that exercise may be an effective way to help Parkinson’s patient maintain mobility. In the study, 67 patients between the ages of 42 and 86 and diagnosed with Parkinson’s Disease performed 1 of 3 different exercise programs, 3 days per week for 3 months:
- Higher-Intensity Treadmill Training (23 patients) started with a 15 minute program and a heart rate of 40% to 50% of maximal heart rate (6). The intensity and duration of the exercise were increased by 5 minutes, 0.1 mph and 1% incline every 2 weeks as tolerated to reach 30 minutes at 70% to 80% of maximal heart rate by the end of the study.
- Lower-Intensity Treadmill Training (22 patients) started with a 15 minute program at 0% incline at their self-selected pace. This incline and speed remained the same for 3 months but the duration increased by 5 minutes every 2 weeks to reach 50 minutes at 40% to 50% of heart rate reserve. The longer duration was used (50 vs 30 minutes) to make the total work performed comparable to the higher-intensity treadmill group.
- Stretching and Resistance Training (22 patients) performed weight training exercises consisting of 2 sets of 10 repetitions of each leg separately of the leg press, leg extension, and leg curl. Weight was increased as tolerated. They then did stretching exercises comprised 1 set of 10 repetitions each of trunk rotation, hip abduction, and stretches of hamstrings, quadriceps, calves, and ankles performed on padded tables under supervision of an exercise physiologist.
To assess the effect of the program on the patients, the researchers used the 6-minute walk test whereby the patients were instructed to cover as much distance as possible in 6 minutes, turning every 100 ft as prompted by orange cones set across a clear space. Another gait measure was the 50-foot fast gait test. Researchers also measured cardiovascular fitness (called VO2 Max) and did strength tests on the patients, all of which were done 2 weeks before and 2 weeks after the training. By the end of the study, there were no serious adverse events, the exercise sessions never required interruption, and there were no changes in medications.
For the 6-minute walk test, those in the low-intensity treadmill program showed the greatest distance (161 feet, a 12% improvement, p = 0.001), followed by the weight-training and stretching group (107 feet, a 9% improvement, p = 0.02) and the high-intensity treadmill group (77 feet, a 6% improvement, p = 0.07). When looking at the 50-foot fast gait test, those in the low-intensity training group had a 7% decrease in time (13.01 to 12.09 seconds, p = 0.008) compared to a 4.2% decrease in the high-intensity group (13.84 to 13.27 seconds, p = 0.09) and no change in the weight-training/stretching group (12.87 to 12.84 seconds, p =0.93).
For cardiovascular fitness, VO2 max increased the most in the high-intensity group (20.85 to 22.39, a 7.3% increase, p = 0.003) compared to a 6.4% increase in the low-intensity group (23.58 to 25.11, p = 0.004) and no significant change in the weight-training/stretching group (p = 0.92).
Finally, only those in the weight-training/stretching group saw a significant increase in leg press strength (878.76 to 1021.9 pounds combined weight from single-leg presses, p < 0.001) with no significant improvements in either high-intensity group (p = 0.32) or the low-intensity group (p = 0.73).
For the researchers, “Exercise can improve gait speed, muscle strength, and fitness for patients with Parkinson disease” and that “The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation.”
Source: Shulman, Lisa M., et al. “Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease.” JAMA neurology 70.2 (2013): 183-190.
© 2013 American Medical Association. All rights reserved.
Posted May 13, 2013.
References:
- “Parkinson’s Disease” posted on the U.S. Library of Medicine’s website
- “PD 101” posted on the National Parkinson’s Disease website
- “Direct and Indirect Cost of Parkinson Disease” posted on the National Center for Biotechnology Information (NCBI) website. Bookshelf ID: NBK27880
- Shulman LM, Gruber-Baldini AL, Anderson KE, et al. The evolution of disability in Parkinson disease. Mov Disord. 2008;23(6):790-796.
- Shulman LM. Randomized Clinical Trial of 3 Types of Physical Exercise for Patients With Parkinson Disease. Arch Neurol 2012 Nov 5:1-8. doi: 10.1001/jamaneurol.2013.646. [Epub ahead of print]
- Macko RF, Ivey FM, Forrester LW. Task-oriented aerobic exercise in chronic hemiparetic stroke: training protocols and treatment effects. Top Stroke Rehabil. 2005; 12(1):45-57.
