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Short- and Long-Term Benefits of Different Exercise Routines for People with Parkinsonís

For people with Parkinson’s disease (PD), different exercise routines provide different short- and long-term benefits, according to a study in the November 2012 issue of the journal Physical Therapy. This new information may help doctors recommend appropriate exercise programs for people living with PD.

Previous clinical trials have shown that exercise can ease some symptoms of PD. However, most of these studies examined only the short-term benefits of exercise, typically studying participants for only three to six months.

Yet because PD is a chronic disease that worsens with time, researchers led by Margaret Schenkman, P.T., Ph.D., at the University of Colorado Anschutz Medical Campus reasoned that long-term exercise is needed to overcome ongoing loss of strength, flexibility and balance.

Dr. Schenkman and her colleagues compared the short- and long-term effects of two supervised exercise programs with those of a control program.  They randomly assigned 121 people with early- or mid-stage PD (Hoehn & Yahr stages one to three) to one of these three exercise routines: 1) a flexibility/balance/function (flexibility) program designed specifically for people with PD; 2) a standard aerobic endurance (aerobic) program, and 3) as a control, a home-based program of exercises recommended by the National Parkinson Foundation. The flexibility exercises were previously shown to improve flexibility, balance, and function in people elderly people. The aerobic program consisted of exercise on a treadmill, stationary bike or elliptical machine. The control group performed exercises outlined in the National Parkinson Foundation’s booklet Fitness Counts.

Physical therapists supervised the first two programs three times a week for the first four months, and then tapered supervision down to once a month for a total of 16 months. The control group exercised at home, with one supervised group session per month. Doctors tested the participants' overall physical abilities, balance and walking economy before they began exercising and after four, 10, and 16 months of exercise. The doctors were blinded to the participants' exercise group, which means that they did not know which people were in which group.

Results

  • In four months, the participants in the flexibility group improved more than those in the aerobic group or the control group on a test of general fitness. This test measured the participants’ abilities to perform everyday tasks like making a bed, unloading groceries and getting up from the floor. However, there were no differences between the groups at 10 and 16 months.
  • There were no differences between the groups in a test of balance at four, 10 or 16 months.
  • In the test of walking economy, which measured how much oxygen the participants consumed at four different walking speeds, the aerobic group improved more than the flexibility group at four, 10, and 16 months and more than the control group at four and 16 months.

What Does It Mean?

All types of exercise appear beneficial for people with PD. This study is unique because of its comparison of different types of exercise and the relatively long follow up of study participants (16 months). The effects of exercise vary depending on the type of exercise performed but all types appear beneficial for people with PD. 

The study demonstrated short-term benefits of exercise with a fitness routine designed to increase flexibility and balance for people with PD.  The participants performing this routine demonstrated better general fitness after four months.  But these effects did not last, which was surprising to the researchers. 

Only aerobic exercise demonstrated long-term benefits.  The participants performing the aerobic routine demonstrated more efficient or economical walking, that is they used less oxygen to walk the same distance as before.  An improved economy of walking with the aerobic routine could lead to better endurance, less fatigue and fewer falls for people with Parkinson’s.  Even those in the control group did well; they did not experience a decrease in physical performance as expected for a person with PD.  Almost 80 percent of the participants completed the entire 16-month study, suggesting that these exercises are practical for people with PD to maintain over a long period of time.

What might skew these results?  Because of the strong benefits of exercise, there was an ethical concern about asking anyone to not exercise, so a “no-exercise” control group was not included.  Also, the study and its participants were all in Colorado, one of the fittest states in the United States. People who live there might already be more likely to exercise, even in the control group, limiting the application of these results to other parts of the country.  It also means that the effects might be larger for those who do not already regularly exercise.

This study suggests that people with early- and mid-stage PD will benefit from long term exercise. People could use the flexibility program to improve their overall physical abilities and an aerobic program to improve their long-term endurance. However, the participants reported that they needed ongoing support to maintain regular exercise over the long term, highlighting the need for health professionals to provide appropriate support and encouragement for people living with PD to establish and maintain good exercise habits.

Learn More

If you would like to learn more about exercise, physical therapy and falls prevention in Parkinson's disease, browse these PDF resources or call PDF's HelpLine at (800) 457-6676.


Reference: Schenkman, M., Hall, D.A., Barón, A.E., Schwartz, R.S., Mettler, P. Kohrt, W.M. (2012). Exercise for People in Early- or Mid-Stage Parkinson Disease: A 16-Month Randomized Controlled Trial. Physical Therapy, 92(11), 1395-1410. doi:10.2522/ptj.20110472

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Source Date: Jan 10 2013