Exercise has been gaining favor as a recommendation for helping with the debilitating symptoms of Parkinson’s disease. However, precise exercise recommendations are not so clear.
People who have Parkinson’s disease can improve their walking speed, muscle strength, and overall fitness with a combination of treadmill and resistance exercise, according to a randomized controlled trial published in the February 2013 issue of JAMA Neurology. It’s good news for patients, whose walking ability and strength tend to deteriorate.
In the study, by Lisa M. Shulman, MD, professor of neurology at the University of Maryland and colleagues, 67 patients with mild-to-moderate gait or balance problems were enrolled into one of 3 types of exercise programs: higher-intensity treadmill exercise: 30 minutes at 70% to 80% of heart rate reserve; lower-intensity treadmill exercises: 50 minutes at 40% to 50% of heart rate reserve; or stretching and resistance exercise: 2 sets of 10 repetitions on each leg on 3 resistance machines: leg press, leg extension, and leg curl.
Exercise physiologists supervised all patients in the exercise sessions, which took place 3 times a week for 3 months, or 36 sessions altogether. Walking speed for 6 minutes, cardiovascular fitness measured by peak oxygen consumption, and muscle strength were evaluated.
Walking on the treadmill at the lower intensity proved best in improving walking speed, showing a twofold improvement in gait speed, 12% versus 6% for those exercising on the treadmill at a higher intensity. Stretching and resistance training yielded 9% improvement in gait speed. Participants in both treadmill groups improved their cardiovascular fitness, much more than the participants in the stretching and resistance exercise. Muscle strength improved only for people in the stretching and resistance training group.
The authors concluded that lower-intensity walking, stretching and resistance training appear to help the most in alleviating symptoms of Parkinson’s disease. However, exactly why the people walking at the more comfortable, lower intensity speed gained more improvement remains unclear. They wrote: “One explanation is that, when the velocity is increased, gait mechanics may become strained, “sloppy,” and less efficient as patients try to keep pace.”
A second randomized controlled trial, published in the November 2012 issue of Physical Therapy and led by Margaret Schenkman, PT, PhD, FAPTA, associate dean of physical therapy education, University of Colorado Anschutz Medical School in Denver, evaluated flexibility/balance/function exercise, supervised aerobic exercise, and home-based exercise (controls) among patients with Parkinson’s disease. Investigators found overall functional improvement was best for participants in the flexibility/balance/function exercise program. Walking economy (net metabolic rate per kilogram) only improved in the group doing aerobics.
Laura Brienesse, MS, Exercise Physiology, from the department of exercise and sports science, at the University of Sydney, Sydney, Australia, published a systematic review of studies of resistance training in Parkinson’s disease patients in the January issue of the Journal of the American Medical Directors Association, concluding that the quality of 5 studies on the topic was “moderately robust,” generally pointing to a positive effect in muscle strength and functional mobility outcomes. However, the review stopped short in making clear recommendations because standardized reporting of exercise programs and outcomes is wanting.
Further, researchers have not studied the value of exercise very much outside of a research setting. Another study led by Terry Ellis, PhD, clinical associate professor of physical therapy at Boston University, in the January 2013 journal Physical Therapy, revealed important perceptual barriers to exercise in patients with Parkinson’s disease living at home. Specifically, patients reported not having enough time to exercise, having low expectations that it would help, and fear of falling as barriers to trying to exercise.
In an article on the National Parkinson Disease Foundation website just posted pointing to the surge in exercise and Parkinson’s disease papers, Michael S. Okun, MD, the National Parkinson Disease Foundation’s Medical Director, writes: “As more studies clarify the types of exercise we should be prescribing for individual patients, more clinicians will need to develop strategies to defeat the barriers to implementing exercise programs in Parkinson’s disease. Exercise is likely to improve the quality of life for most Parkinson’s disease sufferers, but we must meet the public health challenge to get it adopted, and get it embraced by the Parkinson’s disease community.”