Patients with early Parkinson’s disease, who regularly exercised for 1 to 2 hours at least two times in a week were better equipped to walk and carry out activities of daily life, according to findings of a six-year study recently reported in the journal Neurology. They also showed less cognitive decline.¹

This observational study with a follow up period of six years,  enrolled 237 patients, aged 56 to 70 years, with early-stage Parkinson’s disease to examine the impact of regular physical activity and exercise on various functions. Males constituted 69% of the study population. Data was obtained from the self-reported Parkinsons Progression Markers Initiative (PPMI) study, an ongoing international, multicenter study, which began in 2012.

The baseline time and intensity of physical activities like leisure activity, household activity and occupational activity and exercise were determined with the help of the Physical Activity Scale for the Elderly (PASE) questionnaire. Verbal and memory skills were also measured using common cognitive tests.

The deterioration in postural and gait stability after five years was found to be slower in patients who did moderate-to-vigorous exercise like walking or dancing for a minimum of 4 hours in a week when compared to patients who did not get this amount of exercise.

Work-related activity levels were mainly associated with slower decline of processing speed. People who did less than 15.5 hours of work per week, on average, showed a decrease from 44 to a 40 on the test six years later. But, those who did more than 15.5 hours of work over the same period showed a decline from 44 to 43.

A finding of note in this study was the observation that it was the ability to maintain exercise for the study duration and not baseline activity levels, which was associated with the progression of disease. Also, various types of activities affected the disease course differently. While regular moderate to vigorous exercise reduces the decline in gait and postural function, work-related activities were mainly associated with slower decline in processing speed, and household activities were particularly associated with slower decline in activities of daily living (ADL).

The symptoms of Parkinson’s disease were also rated on a scale of 0 to 4. Higher scores were indicative of severe impairment of function. The average score increased from 1.4 to 3.7 over the course of the study period in patients who did below average levels of moderate to vigorous exercise, or exercised less than 1 to 2 hours, 1-2 times in a week. Whereas, the score increased from 1.4 to 3.0 in patients who got above average levels of moderate to vigorous exercise.

Parkinson’s disease is a progressive disease typically characterized by tremors, rigidity, bradykinesia and postural instability, which affect the activities of daily living and thus the quality of life. Some patients may experience faster progression of disease with greater disabilities. Exercise helps improve the symptoms as also demonstrated in this study, which further highlighted that sustaining high levels of physical activity over the years had more beneficial long-term outcomes and therefore was more important. Hence, physicians should counsel their patients with Parkinson’s disease about the need to start and maintain a regular exercise schedule.

Reference

1. Tsukita K, et al. Long-term effect of regular physical activity and exercise habits in patients with early Parkinson Disease. Neurology Jan 2022, 10.1212/WNL.0000000000013218; DOI: 10.1212/WNL.0000000000013218