UMD Study Reports Benefits of Exercise for PD Patients
Low-intensity exercise improves walking in people with Parkinson's disease, according to an MJFF-funded study presented today at the Annual Meeting of the American Academy of Neurology in Hawaii. According to Lisa Shulman, MD, who led the research team conducting the study at the University of Maryland School of Medicine, the best form of exercise for those with PD may in fact be low-intensity walking coupled with stretching and resistance training. The study found this type of exercise to be more beneficial than high-intensity workouts.
Bastiaan Bloem, MD, a researcher on the MJFF-funded ParkFit Study, which measured the effectiveness of active lifestyle promotion in PD patients, explains that Shulman's findings underscore the importance of exercise in PD. But he also says that much work remains to be done to pinpoint the most beneficial form of exercise for those living with the disease.
MJFF: To begin, what are the benefits of exercise for those with PD?
Bloem: First, we know that regular exercise has benefits in general. It slows down cognitive decline, helps to prevent bone loss, and is good for pulmonary and cardiovascular health.
Second, there are disease-specific benefits for people with Parkinson's. Their motor symptoms improve, and there is hope that cognition may improve as well. We are looking into this as part of the ParkFit study. Additionally, inactive people sleep worse, are at a greater risk for osteoporosis, and may develop constipation. All of these symptoms are particularly prevalent in Parkinson's patients. There is hope that these symptoms may improve with exercise.
MJFF: In the simplest terms, what does the Shulman study mean to patients who are already exercising or looking to begin a regimen?
Bloem: Given that Shulman's findings were to my mind unexpected, and that it's a relatively small study, the work needs replication before we can draw practical conclusions for patients' day-to-day regimens. Patients should not immediately change the way they exercise until we see further evidence.
With that said, the strength of this study is that it was lab-based. People were placed on a treadmill, so they received a very closely controlled and moderated intervention.
It is best for patients to find a mode of exercise that they enjoy so that they continue to do it, and it's important that it be safe. Certainly, the treadmill is safe. There were no adverse events in the Shulman study. If you push physical activity in daily life, people might stumble more. Treadmill training, on the other hand, can be closely supervised.
But for the time being, this study may have a greater impact on scientists than on patients. We may need to think carefully about how we design exercise therapy for patients with PD.
MJFF: How might the Shulman findings impact the future design of exercise therapy?
Bloem: I'll use ParkFit as an example. Everyone knows that exercise is good, yet only a few people actually do it. Particularly with Parkinson's patients, because of physical disability, depression, and lack of confidence, people are extra inclined to lead a sedentary lifestyle. Our hypothesis was that patients were more likely to maintain an exercise program if it suited their abilities and desires. We trained coaches throughout the Netherlands to push 300 patients to increase their physical activity in daily life (and 300 control patients to move more safely, instead of moving more). The coaches devised programs individually tailored to patients' preferences -- some chose the treadmill, others bicycles, others volleyball or basketball.
But it is certainly more difficult to control this sort of home-based approach than in the Shulman study, which was conducted completely in a lab. Our approach is more real-life and expansive, but certainly, it comes with both strengths and weaknesses. For example, our early results are showing a clinically and statistically relevant increase in the amount of physical activity in the ParkFit group. But while we are able to quantify the amount of exercise these patients are engaging in to this point, we cannot carefully control intensity, as Shulman did.
MJFF: What about other exercise studies that have seemed to contradict the new findings?
Bloem: These further highlight the importance of continuing to investigate Shulman's conclusions.
A 2009 study conducted by Jay Alberts of Cleveland Clinic and Angela Ridgel of Kent State University, for example, found that forced, not voluntary, exercise best improved motor function in Parkinson's disease patients. They found that pedaling at a rate 30 percent greater than the preferred voluntary rate was actually more effective than pedaling at the preferred rate. This of course, intuitively goes against the findings of the Shulman study.
MJFF: In light of that inherent contradiction, how would you advise patients to interpret the results reported today?
Bloem: What I think is most important right now is to again emphasize that exercise is critical for patients with PD. All of the studies that we have discussed show that. This is where the research process continues to be critical as we work together to identify what in fact is the best kind of physical activity.
Bastiaan Bloem is medical director of the Parkinson Center Nijmegen of the Radboud University Nijmegen Medical Center in the Netherlands.
NOTE: The medical information contained in this article is for general information purposes only. The Michael J. Fox Foundation has a policy of refraining from advocating, endorsing or promoting any drug therapy, course of treatment, or specific company or institution. It is crucial that care and treatment decisions related to Parkinson's disease and any other medical condition be made in consultation with a physician or other qualified medical professional.