Exercise for Parkinson's Disease was recently studied with results adding to a growing body of evidence that one key to easing symptoms of the progressively debilitating movement disorder known as Parkinson’s disease could be getting patients to move regularly. The randomized five-year study, funded by the National Institutes of Health (NIH), was led by Margaret Schenkman, PhD, director of the Physical Therapy Program at the University of Colorado School of Medicine’s Department of Physical Medicine and Rehabilitation. It compared three groups of patients who have the disorder, which affects muscle control, movement and balance.
Two of the groups took part in four-month supervised exercise for Parkinson's Disease programs – one focused on flexibility and functional training, the other on aerobic conditioning. The third received only a booklet with home exercises to follow, and joined a once-a-month group exercise session. Schenkman says one of the questions she and her colleagues (see box) aimed to answer was “to see which group did the best functionally.”
The study followed the patients for 16 months. Though Schenkman has thus far analyzed only data for the first four months of the study, indications are the patients in the supervised programs did better than the ones who were not. “Those who trained for flexibility did better on function and range-of-motion,” as measured by the Unified Parkinson’s Disease Rating Scale, which is a standard used to follow the disease’s progression, and by Functional Axial Rotation, a measure of overall range of motion.
Those who took part in aerobic conditioning did better on 5-meter walk times, the time to turn and their ability to stand. Both groups could walk farther in six minutes than the patients who were in the home program. The research clearly suggests that while exercise may not reverse the effects of Parkinson’s disease, it certainly can mitigate some of the symptoms. “If you train for flexibility, you can improve flexibility,” Schenkman says. “If you train for aerobic endurance, that improves.”
But the study raises other questions, she adds. “Initiating exercise as a regular part of the management of their disease will help people live more easily with the disorder,” Schenkman maintains, “but we have to figure out a way to make exercise easily accessible for them.” And, like most of the rest of us, people with Parkinson’s disease may find it difficult to sustain an exercise program. “The literature shows it’s not easy to keep exercising,” Schenkman points out. “That’s a cultural shift for people in general.”
A retrospective qualitative study Schenkman conducted with her department colleague Heather Ene, MD, and two other colleagues shed light on potential barriers to exercise for Parkinson’s patients. The researchers interviewed 19 participants in the NIH study, all but three of whom graduated. The participants uniformly reported they had joined the study hoping that exercise would prevent declines in their ability to function or slow the progression of the disease. Some felt better, and believed the exercise was beneficial. But while all said they remained “somewhat active” after the study, 80 percent said they didn’t exercise “with the same intensity.” The patients also said they wanted help with an exercise program, Schenkman adds. “They said they wanted their medical provider to guide them to exercise.”
Schenkman, who has worked for 25 years with people who have Parkinson’s disease, has long been a proponent of incorporating exercise and physical therapy with other treatments. But not all neurologists are committed to it to the same degree, she adds. “Some neurologists are on top of the research and are aware of the importance of exercise,” she says. “Some tend not to mention it. There’s more awareness of it now, but for busy clinicians, exercise doesn’t always rise to the top of their list when they are helping patients figure out how to manage the overall medical impact of the disease and to determine the best medications.”
Some of that uncertainty points to the need for more research, Schenkman believes. “There are many studies in the literature that demonstrate the benefits of exercise, but we still don’t know what the best approach is, nor do we know how intense it should be or with what frequency.”
There is some evidence from animal studies, she adds that vigorous exercise may actually “slow down the disease. Those studies have certainly caught the attention of many neurologists,” Schenkman notes. “But we don’t yet know about the impact on humans. This type of study would require expensive imaging. That’s hard to finance, and we need to determine the right [imaging] techniques first so we can ask the right questions.”
In any event, Schenkman maintains, help for people with Parkinson’s disease will not come from a single source. Drugs such as L-Dopa (levodopa), which converts to dopamine in the brain, eventually result in debilitating side effects, including dyskinesia (inability to execute voluntary movements), dystonic posturing (prolonged muscular contractions), and inconsistent nerve responses.
“These drugs will work well for a time during the day and then abruptly stop,” she explains. “This is referred to as an ‘on-off phenomenon.’ There are efforts in pharmacology to find new treatments, but if patients could exercise rather than using drugs early in the disease, that could help them big time. Potentially we could help to delay the onset of symptoms. “But exercise alone won’t do the job and drugs alone won’t either. We have to find the right mix,” Schenkman concludes.
Other researchers involved in the NIH study of the effects of a supervised exercise program, led by Margaret Schenkman:
» »Wendy Kohrt, PhD, professor in the Geriatric Medicine Division of the CU School of Medicine
» »Robert Schwartz, MD, Geriatric Medicine division head
» »Deborah Hall, MD, PhD, formerly at UC Denver and now at Rush University Medical Center
» »Anna Barón, PhD, Colorado School of Public Health