High-intensity exercise three times a week is safe for individuals with early-stage Parkinson’s disease and decreases worsening of motor symptoms, according to a new phase 2, multi-site trial led by Northwestern Medicine and University of Colorado School of Medicine scientists.

This is the first time scientists have tested the effects of high-intensity exercise on patients with Parkinson’s disease, the second most common neurodegenerative disorder and the most common movement disorder, affecting more than a million people in the United States.

It previously had been thought high-intensity exercise was too physically stressful for individuals with Parkinson’s disease.

The paper will be published in JAMA Neurology Dec. 11, 2017.

Parkinson’s symptoms include progressive loss of muscle control, trembling, stiffness, slowness and impaired balance. As the disease progresses, it may become difficult to walk, talk and complete simple tasks. Most people who develop Parkinson’s are 60 and older.

“If you have Parkinson’s disease and you want to delay the progression of your symptoms, you should exercise three times a week with your heart rate between 80 to 85 percent maximum. It is that simple,” said co-lead author Daniel Corcos, professor of physical therapy and human movement sciences at Northwestern University Feinberg School of Medicine.

Because medications for Parkinson’s have adverse side effects and reduced effectiveness over time, new treatments are needed.

The randomized clinical trial included 128 participants ages 40 to 80 years old from Northwestern University, Rush University Medical Center, the University of Colorado and the University of Pittsburgh.

Participants enrolled in the Study in Parkinson Disease of Exercise (SPARX) were at an early stage of the disease and not taking Parkinson’s medication, ensuring the results of the study were related to the exercise and not affected by medication.

“The earlier in the disease you intervene, the more likely it is you can prevent the progression of the disease,” Corcos said. “We delayed worsening of symptoms for six months; whether we can prevent progression any longer than six months will require further study.”

Scientists examined the safety and effects of exercise three times weekly for six months at high intensity, 80 to 85 percent of maximum heart rate, and moderate intensity, 60 to 65 percent of maximum heart rate. They compared the results to a control group who did not exercise.

After six months, participants were rated by clinicians on a Parkinson’s disease scale ranging from 0 to 108. The higher the number, the more severe the symptoms.

Participants in the study had a score of about 20 before exercise. Those in the high intensity group stayed at 20. The group with moderate exercise got worse by 1.5 points. The group that did not exercise worsened by three points. Three points out of a score of 20 points is a 15 percent change in the primary signs of the disease and considered clinically important to patients. It makes a difference in their quality of life.

“We are stopping people from getting worse, which is significant, particularly if we catch them early in the disease,” Corcos said.

What sets this study apart from others is the high number of participants, and that they exercised for a relatively long period of time. Most exercise studies are 12 weeks, Corcos said.

“We gave them a proper workout,” Corcos said. “This is not mild stretching. This is high intensity. It’s part of the idea that exercise is medicine.”

Corcos and colleagues confirmed it was safe for the participants to do high-intensity exercise by giving them a cardiologist-supervised graded exercise test to evaluate the heart’s response to exercise.

Previous studies in humans suggest high-intensity exercise improves motor symptoms, but the evidence wasn’t sufficient to determine whether exercise intensity modifies symptoms or disease progression. In addition, most studies have not precisely measured or controlled exercise intensity and none have been conducted at 80 to 85 percent maximum heart rate.

“Several lines of evidence point to a beneficial effect of exercise in Parkinson’s disease,” said Dr. Codrin Lungu, program director at the National Institute of Neurological Disorders and Stroke. “Nevertheless, it’s not clear which kind of exercise is most effective. The SPARX trial tries to rigorously address this issue. The results are interesting and warrant further exploration of the optimal exercise regimes for Parkinson’s.”

Published: December 11, 2017

Source: Northwestern Now

高强度运动延迟帕金森氏症的进展

发布日期：2017年12月11日
西北大学发布 

转到移动页面。

芝加哥 – 根据由西北医学院和科罗拉多大学分校领导的新的第二阶段多点试验，每周三次高强度运动对于早期帕金森病患者是安全的，并且减少了运动症状的恶化。医学科学家。

这是科学家第一次测试高强度运动对帕金森病患者的影响，帕金森病是第二种最常见的神经退行性疾病和最常见的运动障碍，影响了美国超过一百万人。

以前曾认为高强度运动对帕金森病患者来说过于紧张。

该论文将于2017年12月11日在JAMA Neurology上发表。

帕金森症状包括肌肉控制进行性减退，发抖，僵硬，缓慢和平衡受损。 随着疾病的进展，走路，谈话和完成简单任务可能变得困难。 大多数帕金森病患者年龄在60岁以上。

“如果你患有帕金森病，而且你想延缓症状的进展，那么你应该每周锻炼三次，心率在80％到85％之间，这是很简单的，”联合主编丹尼尔·科科斯（Daniel Corcos）教授说。西北大学费因伯格医学院的物理治疗和人体运动科学。

由于帕金森药物有不良的副作用，随着时间的推移有效性降低，需要新的治疗方法。

随机临床试验纳入了来自西北大学，拉什大学医学中心，科罗拉多大学和匹兹堡大学的128名40至80岁的参与者。

参加帕金森病运动研究（SPARX）的参与者处于疾病的早期阶段，不服用帕金森药物，确保研究结果与运动有关，并且不受药物影响。

Corcos说：“你介入的疾病越早，你就越可能预防疾病的进展。 “我们推迟了六个月的症状恶化，是否可以阻止进展超过六个月，需要进一步研究。”

科学家每周三次检查运动的安全性和效果，持续六个月，高强度，最高心率的80％到85％，中等强度，最高心率的60％到65％。 他们将结果与没有运动的对照组进行比较。

六个月后，参与者由帕金森病评分范围为0至108的临床医师评价。数目越高，症状越严重。

研究参与者在运动前有20分左右的成绩。 高强度组为20人。中度运动组为1.5分。 没有运动的组恶化了三分。 得分为20分的三分之一是这种疾病的主要体征有15％的变化，并且认为临床上对于患者是重要的。 这对他们的生活质量有所影响。

Corcos说：“我们正在阻止人们变得更糟，这很重要，特别是如果我们在疾病早期发现他们。

这项研究与其他研究不同之处在于参与者人数众多，而且他们行使了相当长的一段时间。 Corcos说，大多数运动研究是12周。

“我们给了他们适当的锻炼，”Corcos说。 “这不是轻度的拉伸，这是高强度的，这是锻炼是药物的一部分。”

Corcos及其同事证实，参与者通过给予心脏科医师监督的分级运动试验来评估心脏对运动的反应，从而进行高强度运动是安全的。

以前对人类的研究表明高强度运动可改善运动症状，但证据不足以确定运动强度是否改变症状或疾病进展。 此外，大多数研究没有精确测量或控制运动强度，没有进行过最高心率的80％到85％。

美国国立神经疾病与卒中研究所（National Institute of Neurological Disorders and Stroke）的项目主任Codrin Lungu博士说：“有几条证据表明，帕金森病的运动是有益的。” “然而，目前还不清楚哪一种运动最有效，SPARX试验试图严格解决这个问题，结果是有趣的，并且需要进一步探索帕金森氏症的最佳运动机制。