FROM JAMA NEUROLOGY
Six months of high-intensity treadmill walking largely preserved motor function in patients with recently diagnosed Parkinson’s disease, a phase 2 study has determined.
Patients randomized to the high-intensity exercise arm stayed very close to their baseline motor scores on the Unified Parkinson’s Disease Rating Scale ( UPDRS ), while the scores of those randomized to a wait list increased a mean of 3 points over 24 weeks. The scores of patients randomized to an intermediate-intensity treadmill workout increased 2 points over the study, which was not significantly different than the increase seen in the control group, Margaret Schenkman, PhD , and her colleagues wrote Dec. 11 in JAMA Neurology .
The intervention did not slow or improve any other Parkinson’s symptoms, but it did show that high-intensity walking workouts are safe for patients with early disease and may be beneficial, said Dr. Schenkman, a physical therapist at the University of Colorado at Denver, Aurora.
“A larger efficacy trial is warranted to determine whether exercising at 80%-85% maximum heart rate produces meaningful clinical benefits in de novo Parkinson disease,” wrote Dr. Schenkman and her colleagues. “Meanwhile, clinicians may safely prescribe exercise at this intensity level for this population.”
The Study in Parkinson Disease of Exercise ( SPARX ) randomized 128 patients with newly diagnosed Parkinson’s to 30-minute treadmill workouts, four times weekly, at either 80%-85% or 60%-65% maximum heart rate. They were compared against a control group of wait-listed patients.
Subjects were a mean of 64 years old and had been diagnosed for about 3-4 months before enrolling. Their mean total UPDRS score was 23.
Both active arms hit the gym a mean of 3 days/week and were able to exercise at their target heart rates, confirming the feasibility of treadmill workouts for this patient population.
The mean change in UPDRS motor score in the high-intensity group was an increase of 0.3 at 24 weeks, compared with an increase of 3.2 in the usual care group – a statistically significant difference. The mean change in the moderate-intensity group was an increase of 2.0, a nonsignificant difference.
Adverse events consisted largely of falls and musculoskeletal pain. There were 6 falls in the high-intensity group, 5 in the moderate-intensity group, and 11 in the control group. Of these falls, one in the high-intensity and one in the moderate-intensity group were considered serious.
SPARX was largely funded by a grant from the National Institute of Neurological Disorders and Stroke. None of the investigators reported having any financial conflicts.
SOURCE: Schenkman M et al. JAMA Neurol. 2017 Dec 11. doi: 10.1001/jamaneurol.2017.3517