Exercise may modify disease progression in persons with Parkinson disease (PD).
OBJECTIVE:
The purpose of this longitudinal cohort study was to determine factors that predict motor, activity, and participation-based outcomes over two years in exercisers with PD.
METHODS:
A convenience sample with idiopathic PD was included in the analysis [n = 74; mean age 66.7(8.4) years; male 54%; median months post diagnosis 69.0(76.0), median Hoehn and Yahr score 1.0(2.0)]. Exercise behaviors (minutes of exercise/week, peak rate of perceived exertion (RPE) and mode of exercise) and outcomes of impairment [grip strength], activity [10-meter walk test, functional reach test, activity specific balance confidence scale] and participation [Parkinson Disease Questionnaire-39] were assessed at baseline, 6, 12, 18 and 24 months.
RESULTS:
Using generalized estimating equations at least one exercise behavior was a significant predictor across most of the models (p≤0.026), with higher RPE predicting better outcomes in all activity and participation domains. Younger age, male gender and lower disease severity also significantly predicted better outcomes over time (p≤0.041).
CONCLUSIONS:
Exercise behaviors contributed to activity and participation-based outcomes over two years in exercisers with PD. Participation in high-intensity exercise programs may enhance maintenance of health and function over time in individuals with PD.
Alves,G., Wentzel-Larsen,T., Aarsland,D., & Larsen,J. P. (2005). Progression of motor impairment and disability in Parkinson disease: A population-based study. Neurology, 65(9), 1436–1441.
2.
Bernardini,J., Callen,S., Fried,L., & Piraino,B. (2004). Inter-rater reliability and annual rescoring of the Charlson comorbidity index. Advances In Peritoneal Dialysis. Conference On Peritoneal Dialysis, 20, 125–127.
3.
Bohannon,R. W. (1997). Comfortable and maximum walking speed of adults aged 20-79 years: Reference values and determinants. Age and Ageing, 26(1), 15–19.
4.
Borg,G. (1998). Borg’s Perceived Exertion and Pain Scales. Champaign, IL: Human Kinetics.
5.
Charlson,M. E., Pompei,P., Ales,K. L., & MacKenzie,C. R. (1987). A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation. Journal of Chronic Diseases, 40(5), 373–383.
6.
Combs,S. A., Diehl,M. D., Filip,J., & Long,E. (2014). Short-distance walking speed tests in people with Parkinson disease: Reliability, responsiveness, and validity. Gait & Posture, 39(2), 784–788. doi:10.1016/j.gaitpost.2013.10.019
.
7.
Combs,S. A., Diehl,M. D., Staples,W. H., Conn,L., Davis,K., Lewis,N., & Schaneman,K. (2011). Boxing training for patients with Parkinson disease: A case series. Physical Therapy, 91(1), 132–142.
8.
Dal Bello-Haas,V., Klassen,L., Sheppard,M. S., & Metcalfe,A. (2011). Psychometric properties of activity, self-efficacy, and quality-of-life measures in individuals with Parkinson disease. Physiotherapy Canada, 63(1), 47–57. doi:10.3138/ptc.2009-08
.
9.
Dibble,L. E., Hale,T. F., Marcus,R. L., Droge,J., Gerber,J. P., & LaStayo,P. C. (2006). High-intensity resistance training amplifies muscle hypertrophy and functional gains in persons with Parkinson’s disease. Movement Disorders, 21(9), 1444–1452.
10.
Duncan,P. W., Weiner,D. K., Chandler,J., & Studenski,S. (1990). Functional reach: A new clinical measure of balance. Journals of Gerontology, 45(6).
11.
Ellis,T., Cavanaugh,J. T., Earhart,G. M., Ford,M. P., Foreman,K. B., Fredman,L.,... Dibble,L. E. (2011). Factors associated with exercise behavior in people with Parkinson disease. Physical Therapy, 91(12), 1838–1848. doi:10.2522/ptj.20100390
12.
Fisher,B. E., Li,Q., Nacca,A., Salem,G. J., Song,J., Yip,J.,... Petzinger,G. M. (2013). Treadmill exercise elevates striatal dopamine D2 receptor binding potential in patients with early Parkinson’s disease. Neuroreport, 24(10), 509–514. doi:10.1097/WNR.0b013e328361dc13
.
13.
Fisher,B. E., Wu,A. D., Salem,G. J., Song,J., Lin,C. H., Yip,J.,... Petzinger,G. (2008). The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson’s disease. Archives of Physical Medicine and Rehabilitation, 89(7), 1221–1229.
14.
Flansbjer,U., Holmbäck,A. M., Downham,D., Patten,C., & Lexell,J. (2005). Reliability of gait performance tests in men and women with hemiparesis after stroke. Journal of Rehabilitation Medicine, 37(2), 75–82.
15.
Goetz,C. G., Poewe,W., Rascol,O., Sampaio,C., Stebbins,G. T., Counsell,C.,... Seidl,L. (2004). Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale: Status and recommendations. Movement Disorders, 19(9), 1020–1028.
16.
Hagell,P., & Nygren,C. (2007). The 39 item Parkinson’s disease questionnaire (PDQ-39) revisited: Implications for evidence based medicine. Journal of Neurology, Neurosurgery & Psychiatry, 78(11), 1191–1198.
17.
Hooker,S. P., Foudray,C. K., McKay,L. A., Pasquil,C. M., Seitzinger,L. S., Welsh,M. D., & Waters,C. H. (1996). Heart rate and perceived exertion measures during exercise in people with Parkinson’s disease. Journal of Neurologic Rehabilitation, 10(2), 101–105.
18.
Huang,Y.-q., Gou,R., Diao,Y.-s., Yin,Q.-h., Fan,W.-x., Liang,Y.-p.,... Liu,F. (2014). Charlson comorbidity index helps predict the risk of mortality for patients with type 2 diabetic nephropathy. Journal Of Zhejiang University Science B, 15(1), 58–66. doi:10.1631/jzus.B1300109
.
19.
Jenkinson,C., Fitzpatrick,R., Peto,V., Greenhall,R., & Hyman,N. (1997). The Parkinson’s Disease Questionnaire (PDQ-39): Development and validation of a Parkinson’s disease summary index score. Age and Ageing, 26(5), 353–357.
20.
Kowal,S. L., Dall,T. M., Chakrabarti,R., Storm,M. V., & Jain,A. (2013). The current and projected economic burden of Parkinson’s disease in the United States. Movement Disorders, 28(3), 311–318. doi:10.1002/mds.25292
.
21.
Ma,Y., Mazumdar,M., & Memtsoudis,S. G. (2012). Beyond repeated-measures analysis of variance: Advanced statistical methods for the analysis of longitudinal data in anesthesia research. Regional Anesthesia and Pain Medicine, 37(1), 99–105. doi:10.1097/AAP.0b013e31823ebc74
.
22.
Milanovič,Z., Sporiš,G., & Weston,M. (2015). Effectiveness of high-intensity interval training (HIT) and continuous endurance training for VO2max improvements: A systematic review and meta-analysis of controlled trials. Sports Medicine, 45(10), 1469–1481. doi:10.1007/s40279-015-0365-0
23.
Oguh,O., Eisenstein,A., Kwasny,M., & Simuni,T. (2014). Back~to the basics: Regular exercise matters in parkinson’s disease: Results from the National Parkinson Foundation QII registry study. Parkinsonism & Related Disorders, 20(11), 1221–1225. doi:10.1016/j.parkreldis.2014.09.008
.
24.
Olsen,C. F., Telenius,E. W., Engedal,K., & Bergland,A. (2015). Increased self-efficacy: The experience of high-intensity exercise of nursing home residents with dementia - a qualitative study. BMC Health Services Research, 15, 379–379. doi:10.1186/s12913-015-1041-7
.
25.
Pohl,M., Rockstroh,G., Rückriem,S., Mrass,G., & Mehrholz,J. (2003). Immediate effects of speed-dependent treadmill training on gait parameters in early Parkinson’s disease. Archives of Physical Medicine and Rehabilitation, 84(12), 1760–1766.
26.
Post,B., Merkus,M. P., de Haan,R. J., & Speelman,J. D. (2007). Prognostic factors for the progression of Parkinson’s disease: A systematic review. Movement Disorders, 22(13), 1839–1851.
27.
Rafferty,M. R., Schmidt,P. N., Luo,S. T., Li,K., Marras,C., Davis,T. L.,... Simuni,T. (2017). Regular exercise, quality of life, and mobility in Parkinson’s disease: A longitudinal analysis of National Parkinson Foundation Quality Improvement Initiative data. Journal of Parkinson’s Disease, 7(1), 193–202. doi:10.3233/JPD-160912
.
28.
Raggi,A., Leonardi,M., Ajovalasit,D., Carella,F., Soliveri,P., Albanese,A., & Romito,L. (2011). Disability and profiles of functioning of patients with Parkinson’s disease described with ICF classification. International Journal of Rehabilitation Research, 34(2), 141–150. doi:10.1097/MRR.0b013e328344ae09
.
29.
Rose,M. H., Løkkegaard,A., Sonne-Holm,S., & Jensen,B. R. (2013). Improved clinical status, quality of life, and walking capacity in Parkinson’s disease after body weight-supported high-intensity locomotor training. Archives of Physical Medicine and Rehabilitation, 94(4), 687–692. doi:10.1016/j.apmr.2012.11.025
.
30.
Samson,M. M., Crowe,A., de Vreede,P. L., Dessens,J. A., Duursma,S. A., & Verhaar,H. J. (2001). Differences in gait parameters at a preferred walking speed in healthy subjects due to age, height and body weight. Aging, 13(1), 16–21.
31.
Schaubert,K. L., & Bohannon,R. W. (2005). Reliability and validity of three strength measures obtained from community-dwelling elderly persons. Journal of Strength & Conditioning Research, 19(3), 717–720.
32.
Schrag,A., Dodel,R., Spottke,A., Bornschein,B., Siebert,U., & Quinn,N. P. (2007). Rate of clinical progression in Parkinson’s disease. A prospective study. Movement Disorders, 22(7), 938–945.
33.
Shults,J., Sun,W., & Tu,X. (2009). A comparison of several approaches for choosing between working correlation structures in generalized estimating equation analysis of longitudinal binary data Statistics in Medicine, 28(18), 2338–2355. doi:10.1002/sim.3622
.
34.
Singh,N. A., Quine,S., Clemson,L. M., Williams,E. J., Williamson,D. A., Stavrinos,T. M.,... Singh,M. A. F. (2012). Effects of high-intensity progressive resistance training and targeted multidisciplinary treatment of frailty on mortality and nursing home admissions after hip fracture: A randomized controlled trial. Journal ofthe American Medical Directors Association, 13(1), 24–30. doi:10.1016/j.jamda.2011.08.005
.
35.
Steffen,T., & Seney,M. (2008). Test-retest reliability and minimal detectable change on balance and ambulation tests, the 36-item short-form health survey, and the unified Parkinson disease rating scale in people with parkinsonism. Physical Therapy, 88(6), 733–746.
36.
Steffen,T. M., Hacker,T. A., & Mollinger,L. (2002). Age- and gender-related test performance in community-dwelling elderly people: Six-Minute Walk Test, Berg Balance Scale, Timed Up & Go Test, and gait speeds. Physical Therapy, 82(2), 128–137.
37.
Toy,W. A., Petzinger,G. M., Leyshon,B. J., Akopian,G. K., Walsh,J. P., Hoffman,M. V.,... Jakowec,M. W. (2014). Treadmill exercise reverses dendritic spine loss in direct and indirect striatal medium spiny neurons in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP) mouse model of Parkinson’s disease. Neurobiology of Disease, 63, 201–209. doi:10.1016/j.nbd.2013.11.017
.
38.
Uc,E. Y., Doerschug,K. C., Magnotta,V., Dawson,J. D., Thomsen,T. R., Kline,J. N.,... Darling,W. G. (2014). Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting. Neurology, 83(5), 413–425. doi:10.1212/WNL.0000000000000644
.
39.
Velseboer,D. C., Broeders,M., Post,B., vanGeloven, N., Speelman,J. D., Schmand,B.,... de Bie,R. M. A. (2013). Prognostic factors of motor impairment, disability, and quality of life in newly diagnosed PD. Neurology, 80(7), 627–633. doi:10.1212/WNL.0b013e318281cc99
.
40.
Vučković,M. G., Li,Q., Fisher,B., Nacca,A., Leahy,R. M., Walsh,J. P.,... Petzinger,G. M. (2010). Exercise elevates dopamine D2 receptor in a mouse model of Parkinson’s disease: in vivo imaging with [18F]fallypride. Movement Disorders, 25(16), 2777–2784. doi:10.1002/mds.23407
.
41.
Yorke,A. M., Curtis,A. B., Shoemaker,M., & Vangsnes,E. (2015). Grip strength values stratified by age, gender, and chronic disease status in adults aged 50 years and older. Journal of Geriatric Physical Therapy, 38(3), 115–121. doi:10.1519/JPT.0000000000000037
.
42.
Zhao,Y. J., Wee,H. L., Chan,Y.-H., Seah,S. H., Au,W. L., Lau,P. N.,... Tan,L. C. S. (2010). Progression of Parkinson’s disease as evaluated by Hoehn and Yahr stage transition times. Movement Disorders, 25(6), 710–716. doi:10.1002/mds.22875
.
