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Different Exercise Routines Can Benefit People with Parkinson's

A new study has shown that physical exercise improves gait speed, cardiovascular fitness and muscle strength in people with Parkinson's disease (PD). The research, which was published online November 5 in the Archives of Neurology, suggests a specific way that people with PD can manage their disease.

Previous clinical trials have shown that exercise can ease some symptoms of PD. However, because these trials were small and studied different types of exercise in different ways, it has been difficult for doctors to recommend a specific type of exercise to people living with PD.

The new study overcame some of these limitations by using a larger group and a carefully planned study design. Researchers led by Lisa Shulman, M.D., at the University of Maryland School of Medicine compared three different types of exercise for people with PD. The researchers recruited 67 people with PD and randomly assigned them to one of three exercise groups: a higher-intensity treadmill exercise, a lower-intensity treadmill exercise, or stretching and resistance training.

The people in the higher-intensity treadmill group walked on a treadmill for 30 minutes, three times per week, at a pace and incline that raised their heart rate to 70-80 percent of their maximal heart rate reserve, which is defined as the maximum heart rate minus the resting heart rate. People in the lower-intensity treadmill group walked for a longer time, 50 minutes, at a lower intensity, that raised their heart rate to 40-50 percent of their reserve. Finally, the people in the stretching and resistance group performed two sets of 10 repetitions for each leg on three resistance machines: the leg press, leg extension and leg curl. Then, they performed upper and lower body stretching exercises.

The study participants did these exercises three times per week for three months. Before and after the three-month exercise period, doctors tested the participants' gait speed, cardiovascular fitness and muscle strength. The doctors were blinded to the participants' exercise group, which means that they did not know which people were in which group.

Results

  • All three types of exercise improved gait speed, which was measured by the distance volunteers could walk around orange cones in six minutes.
  • People in the lower-intensity treadmill group showed the greatest improvement in gait. They could walk 12 percent farther in six minutes than they could before the three-month exercise period. People in the stretching and resistance exercise group showed the second-best improvement, with a nine percent increase in distance, followed by people in the higher-intensity treadmill group with a six percent increase.
  • Only treadmill exercises improved cardiovascular fitness.
  • Only stretching and resistance training improved muscle strength. People in this group could lift an average of 16 percent more weight in the leg press and leg extension after the three-month exercise period.
  • The participants did not report any changes in non-motor symptoms of PD, including depression, fatigue or falls.

What Does It Mean?

Doctors have long recognized the health benefits of exercise, and previous research has shown that exercise could benefit people with PD. However, doctors have not known whether to recommend a certain type of exercise as most helpful for people with PD.

This study reinforces the importance of exercise in symptom management, but also shows that different types of exercise provide different benefits. All three types of exercise that were studied here improved gait speed. However, only treadmill exercise improved cardiovascular fitness, and only stretching and resistance training improved strength.

The important conclusions of this study are first, that low intensity treadmill exercise is beneficial (if performed regularly) for people with PD and second, that the combined effect of treadmill exercise and stretching and resistance exercise may be complimentary. The second finding will have to be verified in a study including a study group that participates in both types of exercise.

This study did not include a placebo group.  This is most likely because the researchers did not feel it was ethical to exclude willing participants from an exercise plan. It is important to check with your doctor before beginning any exercise program. The people in this study were closely supervised during exercise and wore a nonweight-bearing harness to prevent falls, which can be important safeguards for people with PD who are concerned about falls.

Reference: Lisa M. Shulman, Leslie I. Katzel, Frederick M. Ivey, John D. Sorkin, Knachelle Favors, Karen E. Anderson, Barbara A. Smith, Stephen G. Reich, William J. Weiner, and Richard F. Macko. (2012) Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. Archives of Neurology, published online November 5, 2012. doi:10.1001/jamaneurol.2013.646

Source Date: Dec 10 2012