September 24, 2019
By Will Boggs MD
NEW YORK (Reuters Health) - A home-based, remotely supervised program of aerobic exercise improves motor scores in patients with Parkinson's disease, researchers in the Netherlands report.
"The patients were able to perform aerobic exercise of a moderate intensity at home without direct supervision," Dr. Nicolien M. van der Kolk of Radboud University Medical Center, in Nijmegen, told Reuters Health by email. "Perhaps even more important was the fact that they were able to adhere to the program for 6 months."
High-intensity aerobic exercise has been shown to attenuate Parkinson's disease motor signs, but whether these benefits can be realized in a home-based setting remains unclear.
Dr. van der Kolk and colleagues evaluated the effect of home-based high-intensity aerobic exercise on motor signs of Parkinson's disease (tested off dopaminergic medication) in 130 patients with mild disease who were on common treatment regimens.
The aerobic exercise group was instructed to cycle on a stationary home-trainer for 30-45 minutes at least three times per week within a predetermined heart-rate zone. The active control group was instructed to do stretching, flexibility and relaxation exercises three times per week for 30 minutes per session.
Ten patients in each group did not complete their allocated exercise program, but did attend the six-month postintervention visit.
After six months, the Motor Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) had worsened significantly less in the exercise group (mean, 1.3 points) than in the control group (mean, 5.6 points), the researchers report in The Lancet Neurology, online September 11.
This difference in motor score is similar to that in previous studies that tested institution-based aerobic exercise programs that required fairly intensive supervision, the researchers note.
Physical fitness (as measured by maximum oxygen consumption) improved in the aerobic exercise group, but decreased in the active control group.
There were similar numbers of adverse events in the two groups, mostly unrelated to exercise, though a potential relationship could not be excluded in seven (11%) patients in the exercise group and four (6%) patients in the control group.
"Aerobic exercise attenuated motor symptoms without targeted training of these symptoms. In other words," Dr. van der Kolk explained, "it influenced signs that were not specifically trained by the intervention. This indicates that the effect might be mediated via direct beneficial effects of cardiovascular fitness on brain health."
"Aerobic exercise in Parkinson's disease has both general health benefits (increased fitness is likely to result in a reduced morbidity) and disease specific benefits (attenuation of motor signs, possibly reduction of Parkinson's disease medication)," she said. "We would recommend all Parkinson patients to exercise and preferably perform aerobic exercise."
"Many Parkinson's disease patients are looking for ways to influence their disease in a positive way, and performing aerobic exercise endorses patient empowerment," Dr. van der Kolk said. "The fact that aerobic exercise has effects on the motor signs of the disease just as medication does might prove to be the best evidence to increase intrinsic motivation for patients."
"The collective evidence suggests that high-intensity aerobic exercise should be recommended in people with mild Parkinson's disease with the goal of motor symptom modification," writes Dr. Terry Ellis of Boston University in a linked editorial. "Patient profile and preferences could guide the choice of aerobic exercise mode to optimize success and sustain adherence."
"Additional rigorous and longer-term studies are needed to inform the prescription of exercise programs with optimized benefits for all patients with Parkinson's disease," she said.
Dr. Allyson Flynn of the Faculty of Health, University of Canberra, in Australia, who was not involved in the research, recently demonstrated improvements in balance-related activities and gait speed after home-based prescribed exercise in people with Parkinson's disease. She told Reuters Health by email, "The evidence regarding efficacy of exercise for disease modification should be communicated to people with Parkinson's disease with mild disease severity. There is also a significant evidence base for exercise to improve gait and balance which can be applied to people with mild to more severe disease."
"Exercise prescription is complex," she said. "People with Parkinson's disease should be encouraged to consult with a health professional with exercise prescription qualifications (such as a physical therapist or exercise physiologist). This will ensure that the individual's goals, disease stage, impairments, and preferences are accounted for in order to achieve optimal outcomes."
SOURCE: https://bit.ly/2miX6vh and https://bit.ly/2mR4y0T
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