Joseph R. Anticaglia MD
Medical Advisory Board
Parkinson Disease (PD) is a disorder of muscle coordination, not muscle weakness. It accounts for approximately 80% of movement disorders and it is the second most common neurodegenerative brain disease trailing only Alzheimer’s. This condition happens when nerve cells (neurons) in part of the brain called the substantia nigra die and don’t produce enough dopamine.
The lack of dopamine brings about uncoordinated movements and motor symptoms, such as tremors, balance instability, muscle stiffness, slowness of movement and gait problems. PD is a relentless, progressive disease. At this moment there is no cure, but ‘can one slow the progression of this disease?’
Can Exercise Stall Parkinson’s?
It’s recognized that exercise is good for your physical, mental, and emotional well-being. Furthermore, studies suggest that exercise promotes neuroplasticity, the process of forming and reorganizing brain nerve connections. Might intense exercise be able to slow down or reverse the motor or non-motor symptoms of PD?
Since medications for Parkinson’s have a history of being less effective after several years, intense endurance exercise has been researched as a method to delay the initiation of drug treatment while allowing patients to function as normally as possible.
In a 2018 JAMA Neurology article, the authors evaluated the usefulness of high intensity treadmill exercises in newly diagnosed PD patients. There were 128 participants in this study including men and women. No one reported balance problems. No one was taking PD medication, and none exercised regularly.
They divided the participants in this study into three groups. The control group did not exercise on the treadmill. Another group did moderately intense exercising on the treadmill (60 to 65% of the heart’s maximal heart rate) and a third group did intense exercise so that their heart rate was consistently between 80 to 85% of the heart’s maximal heart rate.
The participants of the third group exercised intensely three times per week for six months with minimal adverse events. The authors reported that “high-intensity treadmill exercise in patients with mild Parkinson disease is particularly important.” Besides improving gait, mobility and general fitness, the findings importantly “suggested” that intense exercising is helpful in slowing the progression of PD.
The authors in doing their research, as reported in the 2018 JAMA article, adopted the protocol of human clinical trial phases. They substituted exercise for a drug or device.
In this phase, the authors concluded that intense endurance exercise is “safe” to use in patients who are diagnosed with early stage Parkinson’s disease
This phase used considerable number of participants and demonstrated that the motor and non-motor symptoms of Parkinson’s disease “benefited” from intense endurance exercise. The findings strongly suggest that doing endurance exercise, as noted above, slows downs the progression of PD and delays the need such medication.
This aspect of research involves randomized, double blind studies utilizing several hundred or more patients. Phase 3’s primary ojective, whether it’s a drug, device or something else, is to find out whether or not it’s efficacious. Exercise endurance research is ongoing in PD patients, and it aims to answers key questions:
- Does intense endurance exercising work to slow down the motor and non-motor symptoms and signs of PD?
- What is the “right dose” of endurance exercise?
- Is high-intensity endurance exercise effective as a first-line therapy for recently diagnosed people with Parkinson’s disease?
- Are there any laboratory tests that are helpful in PD patients engaging in endurance exercise?
Intense exercising may not be for you, but regardless of the stage of your disease you can do things to stay active. Find the exercise you like to do alone or with other people that is safe. Do it regularly. It’s helpful to include in your intense exercise program:
Aerobic exercises that challenge your heart and lung
Strength workouts that build muscle mass and strength
Flexibility training can improve posture and range of motion
Balance exercises helps with coordination.
Intense exercise may delay the initiation of Parkinson medication. In addition, being active
improves sleep, uplifts mood and upgrades your memory. It’s worth the effort to find the “right dose” of activity that suites your needs.
- Margaret Schenkman, PhD, PT, et al; Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease A Phase 2 Randomized Clinical Trial; JAMA, Neurology February 2018
- Alessandro Oliveira de Carvalho, et al; Physical Exercise for Parkinson’s Disease: Clinical and Experimental Evidence; Clin Pract Epidemiol Ment Health. March 30, 2018
- Corcos, Daniel Montie (PD/PI); Study in Parkinson Disease of Exercise Phase 3 Clinical Trial: SPARX3; Effective start date 9/25/2019
- Joseph R. Anticaglia, MD; Parkinson Disease — Motor Symptoms; Doctor’s Column, HC Smart, 2020
- Joseph R. Anticaglia, MD; Parkinson’s Disease Non-Motor Symptoms Doctor’s Column, HC Smart, 2020
- National Institute of Neurological Disorders and Stroke; Parkinson’s Disease: Hope Through Research; 2019
- Parkinson Foundation: What is Parkinson’s Disease?
- Michael J. Fox Foundation for Parkinson’s Research
This article is intended solely as a learning experience. Please consult your physician for diagnostic and treatment options.