High-intensity treadmill exercise may slow progression of motor symptoms in early Parkinson’s disease

1. In this phase-2 randomized controlled trial, high-intensity treadmill exercise was associated with lower mean changes in the Unified Parkinson’s Disease Rating Scale motor score.

2. Adverse musculoskeletal events were not severe in the high-intensity exercise group.

Evidence Rating Level: 2 (Good)

Study Rundown: Parkinson disease is a progressive neurodegenerative disorder that does not have many disease-modifying medications or management strategies. It is unclear if exercise modifies disease severity. This study aimed to examine the feasibility and safety of high-intensity treadmill exercise in patients with de novo Parkinson disease who are not on medications and determine the effect on motor symptoms.

Over a 6-month period, patients who were assigned to the high-intensity treadmill exercise group had lower mean changes in their Unified Parkinson’s Disease Rating Scale motor score, signifying less progression of motor symptoms as compared to the moderate-intensity and no-exercise control group. Musculoskeletal adverse reactions were documented but not statistically compared across groups. Strengths of this study include assessment of both feasibility and compliance with exercise regimen, limitations include limiting investigation to only treadmill exercises and thus unclear if generalization to other endurance activities produce the same results.

Click to read the study, published in JAMA Neurology

Relevant Reading: Effects of Endurance Exercise Training on The Motor and Non-Motor Features of Parkinson’s Disease: A Review

In-Depth [randomized clinical trial]: This phase 2, multicentre randomized trial was conducted from May 2012 to November 30 2015 in Chicago, Denver and Pittsburgh, USA. Patients included had idiopathic Parkinson disease (Hoehn and Yahr stages 1 or 2) that were diagnosed within 5 years of enrollment, were aged 40 to 80 years and were not exercising at moderate intensity greater than 3 times per week. These patients were also not expected to require dopaminergic medication within 6 months. Patients were randomized to high intensity (80-85% maximum heart rate), moderate intensity (60-65% maximum heart rate). Primary outcome included feasibility measures looking at adherence to prescribed heart rate and exercise frequency of 3 days per week and clinical outcome of 6-month change in Unified Parkinson’s Disease Rating Scale motor score.

A total of 128 patients were included in the study. Exercise rates were 2.8 (95% CI 2.4-3.2) days per week in the high-intensity group and 3.2 (95% CI 2.8-3.6) days per week in the moderate intensity group, p = 0.13). Both groups were able to achieve their target heart rates. The mean changes in the Unified Parkinson’s Disease Rating Scale motor score were less in the high intensity exercise group: 0.3 (95% CI -1.7 to 2.3) as compared to 3.2 (95% CI 1.4 to 5.1) in the no exercise control group.

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