Regular, Sustained Physical Activity May Help Slow Disease Progression

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by Patricia Inácio, PhD |

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Regular and sustained physical activity, including daily pursuits such as walking or gardening, may help slow the progression of Parkinson’s in people with early-stage disease, a long-term follow-up study suggests.

Patients who exercised regularly over five years showed better motor and cognitive outcomes.

“Our results are exciting, because they suggest it may never be too late for someone with Parkinson’s to start an exercise program to improve the course of their disease,” Kazuto Tsukita, MD, of Kyoto University, in Japan, and the study’s lead researcher, said in a press release from the American Academy of Neurology (AAN).

“We found that to slow progression of the disease, it was more important for people with Parkinson’s to maintain an exercise program than it was to be active at the beginning of the disease,” Tsukita said.

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The study, “Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease,” was published in Neurology, the medical journal of the AAN.

While medications, such as levodopa — the gold standard in Parkinson’s treatment — can alleviate motor symptoms in the early stages, none is effective at slowing the disease’s progression.

A growing body of clinical evidence has shown that aerobic exercise can ease motor symptom progression in Parkinson’s disease. Other practices such as tai chi and dance training also can improve patients’ gait and balance.

However, the majority of studies assessing the impact of exercise and regular physical activity have been conducted only for short periods of time, precluding the understanding of the long-term disease-modifying effects of exercise and intense daily physical activity in Parkinson’s.

To answer this, a team led by Tsukita and other researchers at Kyoto University analyzed data from 237 early-stage Parkinson’s patients — of whom 73 were women — with a mean age of 63, and 158 healthy participants. Among the healthy volunteers, the mean age was 64, and 60 were women.

All were enrolled in the Parkinson’s Progression Markers Initiative or PPMI (NCT01141023), launched in 2010 by The Michael J. Fox Foundation for Parkinson’s Research. This observational study is designed to better understand how Parkinson’s develops and progresses by collecting data on people at every stage of disease, with healthy volunteers serving as a control group.

The PPMI study includes not only data on motor and cognitive function, but also participants’ physical activity levels, as measured by the Physical Activity Scale for the Elderly (PASE) questionnaire.

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This is a self-reported questionnaire, designed for people older than 65, and assesses overall physical activity, including leisure activities such as walking and biking, household activities like gardening, and occupational pursuits, which includes taking care of others. It uses the intensity, frequency, and duration of physical activity over the prior week to calculate the total PASE score, ranging from zero to 793, with higher scores indicating more physical activity.

Motor function was evaluated using part III of the Movement Disorder Society Unified Parkinson’s Disease Rating Scale (MDS-UPDRS). Each parameter is scored from zero to four, and higher scores indicate more severe impairment. Here, such function was evaluated during patients’ “off” times, or periods of time when levodopa medication wears off and motor symptoms re-appear.

Standard cognitive tests were used to assess the participants’ verbal (Hopkins Verbal Learning Test Revised) and memory skills (total score of the Letter-Number Sequencing test), and the time needed to complete mental tasks (Symbol Digit Modalities Test).

Participants in the trial were followed for up to six years.

Researchers observed that the Parkinson’s patients — despite showing significantly greater motor and cognitive impairments compared with the controls at the start of the trial — had similar levels of regular physical activity, including of moderate to vigorous exercise, relative to the healthy volunteers.

The findings showed that the levels of physical activity at the start of the trial were not linked with disease progression. Instead, the most important factor was maintaining physical activity across time: people who had at least four hours of moderate to vigorous exercise — such as walking or dancing — per week showed a slower decline in balance and walking abilities five years later compared with those with less activity.

Those with below-average levels of moderate to vigorous exercise, or less than one to two hours once or twice a week, increased their MDS-UPDRS scores, on average, from 1.4 to 3.7 after six years. Patients who performed above-average levels of moderate to vigorous exercise saw an average increase of 1.4 to 3.0 during that period.

In the test to assess mental speed, researchers gave participants a paper and a pencil and 90 seconds to match numbers with geometric figures. The maximum score on the test was 110.

The results showed that those with less than 15.5 hours of activity per week had, on average, a drop of 4 points six years later, from a score of 44 to 40. Patients with more than 15.5 hours of weekly activity only dropped by 1 point, to a score of 43.

Overall, these findings suggest that maintaining a regular level of high physical activity may slow the progression of the disease — including the decline of motor and cognitive abilities.

“Although medications can provide people with Parkinson’s some symptom relief, they haven’t been shown to slow the progression of the disease,” said Tsukita. “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,” he added.

The researchers noted that the study was not without limitations, namely that it only showed an association between exercise and delayed disease progression. In other words, it suggests but does not prove that regularly exercising can delay the progression of the disease.

Also, the levels of activity were reported by patients themselves and may not be completely accurate.

However, the team believes these findings have “the potential of changing the attitude of physicians regarding exercise counseling in patients with PD [Parkinson’s disease].”

“In the long-term, the maintenance of high regular physical activity levels and exercise habits was robustly associated with better clinical course of PD, with each type of physical activity having different effects,” the researchers concluded.

“Furthermore, the present study could serve as a guide for future randomized controlled trials with greater emphasis on sustained exercise in patients with PD,” they added.