Trial of Weekly, Intense Exercise in Delaying Parkinson’s Starts Enrolling

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by Mary Chapman |

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Enrollment of Parkinson’s patients has begun in a clinical trial seeking to determine whether high-intensity endurance treadmill exercise can slow progression in people with early-stage disease who have not begun taking Parkinson’s medications.

Called a Study in Parkinson Disease of Exercise, or SPARX3 (NCT04284436), the Northwestern University-sponsored clinical trial aims to build upon an earlier study (NCT01506479) that provided evidence that such exercise, four times a week, is more effective than regular moderate-intensity workouts at slowing a worsening in motor function.

Endurance exercise was also found to be safe and tolerable in the earlier study.

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While medications are available to treat Parkinson’s symptoms such as tremor and rigidity, none slow the disease’s progression, which varies from patient to patient.

Past research has shown that exercise helps to ease motor and non-motor symptoms, with findings suggesting that at least two and a half hours of weekly exercise can slow decline and promote a better life quality. Mounting evidence also links physical activity to brain health, with regular exercise helping to delay brain aging and the onset of neurodegenerative disorders.

“We’re not suggesting that exercise will eliminate Parkinson’s disease, but the results of SPARX2 signaled that exercise can slow the rate of disease progression,” Cory Christiansen, PhD, principal investigator for the multisite SPARX3 trial at the University of Colorado (UC), said in a press release.

Confirming through SPARX3 that high-intensity exercise (80-85% of maximum heart rate) works best to slow Parkinson’s progression would give physicians more pointed guidance in advising patients.

“It’s easy to tell someone to exercise, but what kind of exercise? The study could offer clinicians the ability to be more precise in their prescription of exercise and the intensity,” Christiansen said. “And once you’re dialed in as a patient, you don’t really need to go to a physician to tell you to exercise. People will have the ability to be more in charge of their own health.”

In the earlier study, 128 newly diagnosed and non-treated patients were assigned to six months of either no exercise, or to moderate exercise (60–65% of maximum heart rate) or high-intensity exercise (80–85% of maximum heart rate) four times a week. People in the high-intensity group kept their motor abilities — as assessed with the MDS-UPDRS-Part III score — while those in the moderate-intensity program experienced a two-point reduction, and those not exercising had a three-point drop in these scores, results showed.

SPARX3, a larger and geographically more diverse study, aims to recruit 370 adults, ages 40 to 80, who were diagnosed with Parkinson’s in the previous three years and have not yet begun using anti-parkinsonian medication. It is taking place at 27 U.S. sites and two in Canada. Enrolled patients will be assigned to either moderate- or high-intensity treadmill exercise.

Sites currently recruiting are in San Francisco, California; Aurora, Colorado; Gainesville, Florida; Chicago, Illinois; Baton Rouge, Louisiana; Cleveland, Ohio; Portland, Oregon; Pittsburgh, Pennsylvania; Galveston, Texas; and Salt Lake City, Utah. More information, including contacts for those interested in learning more, can be found here.

SPARX3 will help to show whether the exercise approach is “generalizable to a broad [Parkinson’s] population” and whether regional differences play a part, Christiansen said.

The study calls for participants to undergo their randomly assigned treadmill endurance training for 30 minutes four times a week for 1.5 years (18 months). Five minutes of warmup will precede each session, which ends with a five-minute cool-down period.

Study teams will closely supervise the programs. For example, enrollees’ heart rates will be evaluated in real time to assure that patients remain in the appropriate exercise intensity range. After the exercise program ends, participants will be followed for another six months to assess the sustainability of benefits seen.

Beyond assessing whether high-intensity exercise is superior to a moderate workout at holding off worsening motor function, the study will also evaluate how long patients go before beginning dopamine-targeted therapy, and changes from the start of exercise (baseline measures) in their walking and cognitive abilities, life quality, and cardiorespiratory fitness.

The study, conducted in collaboration with the University of Pittsburgh, will also evaluate changes from baseline in the nerve cells progressively lost in Parkinson’s, blood levels of neuronal survival, and inflammation biomarkers. By collecting participants’ genetic data, researchers will also assess whether genetics play a role in patients’ response to exercise.

“What I always say to my patients is I can give you medications that will make you function as well as you can, but the reason I’m doing it is so you can exercise,” said Jeanne Feuerstein, MD, a movement disorders specialist at UC and a SPARX3 neurologist and site co-investigator. “That’s the key for you to actually modify the progression of the disease.”

Feuerstein said that when she began her career 15 years ago, it was rare to hear physicians emphasize exercise to patients. Now, that’s commonplace.

“Exercise has been considered part of the standard of care for people with Parkinson’s disease for at least five years,” she said. “Because of that, we now have more emphasis on specific types of exercise.”

SPARX3 is due to conclude in July 2025.

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