Progression of Parkinson’s disease can be slowed by sustained physical activity

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

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

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

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

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The study, “Long-term effect of regular physical activity and exercise habits in patients with early-stage Parkinson’s disease,» was published in Neurology, the AAN medical journal.

While drugs, such as levodopa – the gold standard in the treatment of Parkinson’s disease – can relieve motor symptoms in the early stages, none are effective in slowing disease progression.

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

However, the majority of studies evaluating the impact of exercise and regular physical activity have only been conducted over short periods of time, making it difficult to understand the long-term effects of exercise and Intense daily physical activity on Parkinson’s disease.

To answer this, a team led by Tsukita and other Kyoto University researchers analyzed data from 237 patients with early-stage Parkinson’s disease – 73 of whom were female – with an average age of 63 years old and 158 healthy participants. Among the healthy volunteers, the average age was 64 years 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 disease develops and progresses by collecting data from people at every stage of the disease, with healthy volunteers serving as a control group.

The PPMI study not only includes data on motor and cognitive functions, 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 over 65, that assesses overall physical activity, including leisure activities such as walking and cycling, household activities such as gardening and professional activities, which include taking care of others. It uses the intensity, frequency and duration of physical activity over the previous week to calculate the total PASE score, ranging from zero to 793, with higher scores indicating more physical activity.

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

Standard cognitive tests were used to assess verbal (Hopkins Verbal Learning Test Revised) and memory (Letter-Number Sequencing Total Score) skills and time to perform mental tasks (Symbol Digit Modalities Test).

Trial participants were followed for up to six years.

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

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

Those who had 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 over this period.

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

The results showed that those with less than 15.5 hours of activity per week had, on average, a decline 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.

Taken together, these results suggest that maintaining a regular level of high physical activity can slow disease progression, including decline in motor and cognitive abilities.

“While the drugs may relieve symptoms for people with Parkinson’s disease, they have not been shown to slow the progression of the disease,” Tsukita said. “We found that regular physical activity, including household chores and moderate exercise, can actually improve long-term disease course.”

“Best of all, exercise is inexpensive 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 regular exercise can delay disease progression.

Additionally, activity levels were self-reported and may not be completely accurate.

However, the team believe these findings have “the potential to change doctors’ attitudes about exercise advice in patients with PD. [Parkinson’s disease].”

“Long-term, maintaining high levels of regular physical activity and exercise habits was strongly associated with better clinical outcome of Parkinson’s disease, with each type of physical activity having different effects,” concluded Researchers.

“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.

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