High Intensity Treadmill Exercise Effective in Early Parkinson Disease

Margaret Schenkman, PhD

High-intensity treadmill exercise has shown to be both safe and effective at reducing disease progression for those in the early stages of Parkinson disease (PD) and not on medication to manage symptoms, according to new research.

“Of great importance, symptoms of PD did not progress appreciably, as measured by the motor subscale of the Unified Parkinson Disease Rating Scale (UPDRS), for those who exercised at 80% to 85% maximum heart rate, whereas symptoms progressed appreciably for those in the wait-listed control group,” study author Margaret Schenkman, PhD, Program Director for the Physical Therapy Program at the University of Colorado School of Medicine, told MD Magazine. “This investigation was the first dose-response study in people who have PD and are not yet on medications and are the most robust findings to date of exercise and PD.”

The Study in Parkinson Disease of Exercise (SPARX) was a phase 2, multicenter randomized clinical trial. Participants in the study came from outpatient and community-based clinics and were enrolled in the study for a period of 6 months, between May 1, 2012, through November 30, 2015. Individuals were diagnosed with idiopathic PD within the previous 5 years, aged 40 to 80 years, not exercising at moderate intensity greater than 3 times per week and not expected to need dopaminergic medication within the next 6 months.

Out of 384 individuals screened by telephone, 128 were randomly assigned to 3 groups: high-intensity exercise (4 days per week, 80-85% maximum heart rate), moderate-intensity exercise (4 days per week, 60-65% maximum heart rate) or control.

Results showed in that in the high-intensity group, exercise rates were 2.8 (95% CI, 2.4-3.2) days per week at 80.2% (95% CI, 78.8%-81.7%) maximum heart rate. For participants in the moderate-intensity group, exercise rates were 2.3 (95% CI, 2.8-3.6; P = .13) days per week at 65.9% (95% CI, 62.2%-67.7%) maximum heart rate (P <.001). The mean change in UPDRS motor score in the high-intensity group was 0.3 (95% CI, -1.7 to 2.3) compared to 2.3 (95% CI, 1.4 to 5.1) in the usual care group (P = .03).

“We set a threshold a priori for the difference between the UPDRS score with exercise and without. The difference met that threshold for those who exercised at 80% to 85% maximum heart rate, whereas the difference didn’t meet the threshold for those who exercised at 60% to 65% maximum heart rate,” Schenkman said. “This means we should conduct a phase 3 clinical trial, designed to give definitive guidance as to the appropriate dose of treadmill endurance exercise for people who have PD and are not yet on medications for the disorder.”

Schenkman says that physicians can prescribe high intensity exercise for people who are in the early stages of PD as long as there are no contraindications, such as cardiac disease. She advises people to confirm with a healthcare provider that they are safe to exercise.

“There is a growing body of evidence demonstrating the benefits of a variety of types of exercise for people who have PD, including strength training, flexibility training, balance training and combination training approaches,” Schenkman said. “As a clinician, I recommend high-intensity endurance training 3 times a week, as outlined in our study, [in addition to] flexibility, strength, and balance training for people as the disease progresses and depending on the symptoms experienced by the specific patient. I also recommend referral to a physical therapist who specializes in treating patients with PD who can guide the patient to the right program.”

The study, "Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease" was published in JAMA.