The Impact of Regular Physical Activity on Parkinson's Disease
If a company was able to produce a pill that offered all the benefits of exercise the company would become the most profitable in the world. Exercise both endurance training like running and strength training are proven to positively impact our mental health, the health of our brain, the health of our heart, the health of our bones, our sexual health, and increase our ability to stay independent and healthier longer. The benefits of exercise are far reaching for all of us and the benefits of exercise don’t stop even once you’ve been diagnosed with a neurological disease like Parkinson’s Disease.
Parkinson’s Disease
Parkinson’s Disease affects nearly 1 million Americans and is the second most common age-related neurodegenerative disease in the world. Parkinson’s is typically recognized by its motor symptoms, including resting tremor, slowness of movement(bradykinesia), rigidity, and loss of postural reflexes. While the majority of individuals with Parkinson’s disease are over the age of 65 nearly 5% of cases are present before the age of 60.
Today we’re going to explore a recent study that looked at how regular exercise can impact Parkinson’s Disease and hopefully leave you with some details that’ll have you wanting to run to your local gym to lift some weights and start incorporating morning or nightly walks into your routine..
What the Past Research Has Stated
To this date there’s been a significant amount of research that has looked at how physical exercise affects Parkinson’s Disease. I outline what some of this research has shown below. However, up to this point the research on long-term health effects of exercise on Parkinson’s is lacking and that’s the research we will going over after a short synopsis of what the research has shown up to this point.
Here’s what the research has so far shown. Physical activity plays a significant role in managing Parkinson's Disease (PD) symptoms traditionally and exercise is beneficial for PD patients for several reasons:
Improves Motor Symptoms: Studies have confirmed that exercise training is beneficial for patients with PD, improving symptoms such as hypokinesia, tremor, and muscular rigidity. Most published studies report benefits from exercise training, providing an overview of essential studies and conclusions for practical exercise training in PD (Reuter & Engelhardt, 2002).
Enhances Neuroplasticity: Exercise-induced neuroplasticity in the basal ganglia plays a crucial role in PD. Activity-dependent processes induced by exercise may mitigate cortically driven hyper-excitability in the basal ganglia observed in the parkinsonian state, offering insights into novel therapeutic treatments capable of reversing or delaying disease progression (Petzinger et al., 2010).
Increases Levels of Neurotrophic Factors: Exercise has been shown to enhance neuroplasticity in persons living with PD, with research suggesting that non-pharmacological approaches like exercise have a far greater effect on PD than previously believed. Studies utilizing animal models of PD have begun to explore the molecular mechanisms of exercise-induced changes, suggesting that exercise may promote brain repair or reorganization through the adaptation of compromised signaling pathways (Hirsch & Farley, 2009).
Improves Mood and Mental Health: Exercise has potential benefits for mood, cognition, and sleep in PD, suggesting that aerobic exercise and strength training can improve mood and sleep habits, although the evidence for cognitive benefits is more mixed (Reynolds et al., 2016).
A Dive Into the Latest Research
Clearly, there is a variety of benefits from engaging in physical exercise for individuals with Parkinson’s Disease. However, as we mentioned above there haven’t been long term studies and there haven’t been long term studies that adjust for confounding factors (unmeasured variables that influence the cause and or effect).
For this reason researchers couldn’t definitively say that regular physical exercise has positive long-term health effects for individuals with Parkinson’s Disease.
That is what the authors of the paper, “Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease” set out to find. The researchers did this by compiling information from a large dataset on individuals with Parkinson’s Disease from the Parkinson’s Progression Markers Initiative . The researchers looked at…
Effects of regular physical activity and moderate to vigorous exercise levels, measured with the Physical Activity Scale for the Elderly questionnaire
Progression of clinical parameters (these are all defined and outline in a later section)
Age
Sex
Levodopa(dose)
Disease Duration
The researchers then analyzed how each of the above influenced and affected each other. They did this through utilizing a statistical method called the multivariate linear mixed-effects models. Essentially what this does is look at how multiple factors (like physical activity and exercise) work together to influence an outcome (like the progression of a disease) over time.
Think of it like a recipe: You have various ingredients (factors) that can affect how your dish (outcome) turns out. Some ingredients might work well together, while others might not. This statistical model helps researchers understand these interactions.
In this study, the researchers wanted to know how regular physical activity and moderate to vigorous exercise (the "ingredients") affected the progression of certain clinical measurements (the "dish") in elderly people. The model also took into account other factors that could influence the results, such as age, sex, medication, and how long someone had the disease.
By using this model, the researchers could get a clearer picture of how physical activity and exercise work together to impact the progression of the disease over time, while controlling for other important variables.
Regular Physical Activity & It’s Effect on Parkinson’s Progression.
Before we dive into the research I want to stress why researchers really wanted to find out if exercise can help with slowing the progression of the disease. Parkinson’s Disease typically trends towards a decline in both motor and non-motor symptoms. This includes distraction, disorganization, anxiety, and a general slowness in thinking, and trouble finding the right words, these non-motor symptoms often occur alongside or following the development of motor system symptoms. The motor symptoms include; issue with balance, dystonia, general weakness, and more.
Levodopa the common prescription for Parkinson’s Disease is pretty effective in alleviating the motor symptoms, especially in the early stages of the disease. However, as the disease progresses from the beginning stages to late stages medication-resistant symptoms like cognitive impairment and issues with balance become more apparent and the treatment of Parkinson’s overall becomes harder to treat.
If it’s true that exercise can slow the progression of Parkinson’s Disease and slow the development of non-motor and motor symptoms than exercise has the potential to be a first line of defense and a main intervention to help individuals with Parkinson’s maintain their function and overall enjoyment of life for a longer period of time. Exercise would be the first disease modifying treatment that slows the progression of the disease.
The Research
The researchers looked at 237 Patients with Parkinson’s Disease (PD) and compared them to 157 healthy controls (HC). At the beginning of the study patients with PD showed significant motor, cognitive, nervous system dysfunction compared to the healthy control. However, regular physical activity levels and moderate to vigorous exercise levels were not significantly different between the two groups.
During the follow-up it was found that individuals with PD gradually decreased their regular physical activity over time while there was little to no change in the healthy controls.
The researchers looked at a lot more than just physical activity though. They also looked at all the variables in the list on the lower right. Let’s go over the findings on the lower left.
The Findings
“Higher regular physical activity levels, only when maintained, were robustly associated with slower deterioration of several clinical parameters(those on the right) in patients with PD.
Different types of activities may have different effects on the disease course of PD.
Habits of moderate to vigorous exercise were preferentially associated with slower decline in balance and movement control (postural and gait function).
Work-related activities were associated mainly with slower decline in processing speed.
Household activities were associated particularly with slower decline in activities of daily living, think washing dishes, taking out the trash, dressing and washing yourself.”
The Nuances
These findings are pretty incredible and some of them shed light on the nuances of a disease like Parkinson’s compared to the general population. In general a stronger and more fit individual at the beginning of knee surgery cancer treatment, antibiotic treatment, etc., is going to fare better, have better recovery, and a lower level of overall mortality if they are in good overall shape at the beginning of the intervention.
This is what previous observational studies on Parkinson’s Disease have also shown, “High baseline exercise habits and regular overall physical activity levels are associated with better clinical course of PD over a few years..”
However, in this study the researchers found that the baseline level of physical activity was not the major player in slowing disease progression. They found that maintenance of physical activity was the key factor associated with slowing symptoms and improved function over a longer period of time.
With this new information the researchers believe the focus should be on a sustained increase in exercise and regular physical activity levels to improve long- term clinical outcomes.
The research also backed up previous studies that showed.
Balance training like tai-chi, dancing, fencing, and aerobics has a large effect on improving balance in individuals with Parkinson’s. High-intensity aerobic training seems to be crucial to improve the global motor function. Becoming familiar with and regularly engaging in household chores is important for maintaining high ADL over time.
What The Researchers Looked At
Disease duration, y: The length of time, measured in years, that a person has had the disease being studied.
Hoehn Yahr stage: A scale used to describe the progression of Parkinson's disease symptoms, ranging from 1 (mild) to 5 (advanced).
Levodopa equivalent dose, mg: The total daily dose of Parkinson's disease medications, converted to an equivalent dose of levodopa in milligrams (mg).
"Off" MDS-UPDRS part 3 score: The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) part 3 score, which measures motor symptoms, assessed while the person is in an "off" state (when medication effects have worn off).
"Off" MDS-UPDRS tremor subscore: A subscore of the MDS-UPDRS that specifically measures tremor severity while the person is in an "off" state.
"Off" MDS-UPDRS PIGD subscore: A subscore of the MDS-UPDRS that measures postural instability and gait difficulty (PIGD) while the person is in an "off" state.
MoCA total score: The total score on the Montreal Cognitive Assessment (MoCA), a screening tool for cognitive impairment.
HVLT-R delayed recall T score: The T score (a standardized score) for the delayed recall portion of the Hopkins Verbal Learning Test-Revised (HVLT-R), which assesses verbal memory.
JLO total score: The total score on the Judgment of Line Orientation (JLO) test, which measures visuospatial perception.
LNS total score: The total score on the Letter-Number Sequencing (LNS) test, which assesses working memory and attention.
SDMT total score: The total score on the Symbol Digit Modalities Test (SDMT), which measures processing speed and attention.
SCOPA-AUT total score: The total score on the Scales for Outcomes in Parkinson's Disease-Autonomic (SCOPA-AUT) questionnaire, which assesses autonomic dysfunction.
GDS-15 total score: The total score on the 15-item Geriatric Depression Scale (GDS-15), a screening tool for depression in older adults.
ESS total score: The total score on the Epworth Sleepiness Scale (ESS), which measures daytime sleepiness.
RBDSQ total score: The total score on the REM Sleep Behavior Disorder Screening Questionnaire (RBDSQ), which screens for REM sleep behavior disorder.
MSE-ADL score: The score on the Modified Schwab and England Activities of Daily Living (MSE-ADL) scale, which assesses a person's ability to perform daily activities.
Takeaways
Overall the research showed that physical activity can be extremely beneficial for individuals with Parkinson’s Disease and that maintaining or increasing physical activity is one of the ways to slow the progression of symptoms. The research also backed up the common theme of neuroplasticity that we have discussed in the past, that when you repeatedly do something you get better at it and this holds true for individuals with Parkinson’s disease.
If you or someone you know has recently been diagnosed with Parkinson’s Disease or has been suffering for years there are ways to fight it, one of these ways is through physical activity, strength training, and balance training. If you’re looking on how to incorporate these activities into your life or to help a loved one through this disease reach out to me at drcoffman@optimizecolumbus.com or click here to schedule your complimentary consultation as both strength training and balance training are key aspects of our Data-Driven approach and we’ve worked with many individuals with Parkinson’s to help them move, feel, and heal better.. As always I hope you enjoyed this blog and always feel free to reach out.