Exercise improves mobility and function for patients with Parkinson’s disease

Randomized clinical trial shows there is more than one benefit from exercise

Parkinson’s disease is a chronic and progressive movement disorder; the symptoms continue and worsen over time. Nearly one million people in the United States are living with Parkinson’s disease according to the Parkinson’s Disease Foundation.

Current treatments for Parkinson’s disease are not the highest quality. Exercise is generally safe, inexpensive, and associated with secondary benefits, interest in exercise for the treatment of motor symptoms of the disease is increasing, authors write in the study’s background.

In this new study led by Dr. Lisa M. Schulman, MD, professor of neurology at University of Maryland Medical Center and Co-Director, Maryland Parkinson’s Disease and Movement Disorders Center along with colleagues conducted a randomized clinical trial of three types of exercise to compare the effectiveness of treadmill exercises and stretching and resistance exercises in improving gait speed, strength, and fitness for patients with Parkinson disease

The study was conducted at The Parkinson's Disease and Movement Disorders Center at the University of Maryland and the Baltimore Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center, involved 67 patients with Parkinson’s disease who had gait impairment and were randomly assigned to one of three groups; a higher intensity treadmill exercise (30 minutes at 70 percent to 80 percent of heart rate reserve); a lower-intensity treadmill exercise (50 minutes at 40 percent to 50 percent of heart rate reserve); and stretching and resistance exercises (two sets of 10 repetitions on each leg on three resistance machines). These exercises were performed 3 times a week for 3 months.

According to the study’s results all three types of physical exercise improved distance on a six minute walk; lower intensity treadmill exercise 12% increase, stretching and resistance exercises 9% increase and higher intensity treadmill exercise 6% increase. Both types of treadmill training improved cardiovascular fitness, whereas stretching and resistance had no effect. Only stretching and resistance improved muscle strength 16% increase.

The study’s authors write in their conclusion “The effects of exercise were seen across all 3 exercise groups. The lower-intensity treadmill exercise resulted in the greatest improvement in gait speed. Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness. Only the stretching and resistance exercises improved muscle strength. Therefore, exercise can improve gait speed, muscle strength, and fitness for patients with Parkinson disease. The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation.”

This study published online first appears in the Archives of Neurology.

In an editorial Dr. Liana S. Rosenthal, M.D, instructor of neurology and Dr. Ray Dorsey, M.D., M.B.A., associate professor of neurology, both from The Johns Hopkins University School of Medicine, Baltimore, Maryland, write "In this issue of the journal, Shulman and colleagues offer compelling evidence that exercise can improve gait and fitness among individuals with PD."

At the end of their editorial they write "In essence, exercise puts the patient -- not a pill -- at the center of care, which is exactly where patients want and ought to be."

In a systemic review and meta-analysis on the effectiveness of exercise intervention for people with Parkinson’s disease conducted by the Primary Care Research Group, Peninsula Medical School and School of Sport and Health Sciences, University of Exeter, both in the United Kingdom had written in their abstract The objective is to systematically review randomized controlled trials, reporting on the effectiveness of exercise interventions on outcomes (physical, psychological or social functioning, or quality of life) for people with PD had reported the following findings on exercise:

Muscle strength was reported in four studies with a significant improvement in leg muscle strength in two studies.

Significant improvement in walking speed following exercise intervention was reported in four studies.

A significant improvement in balance was reported in four out of the five studies however, one study reported a favorable improvement on the Sensory Orientation Test (SOT) but not on the Berg Balance Scale but did find improvement in functional reach.

In their discussion the research team had wrote “we have identified that exercise is of benefit to people with PD in respect to physical functioning.”

More information on Parkinson’s disease may be found online at the following sites:

National Parkinson’s Foundation

American Parkinson’s Disease Foundation

The Michael J. Fox Foundation for Parkinson’s Research