Allison Fisher - Parkinson’s disease - retiring from professional competition

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More physical activity was linked to slower decline

In the new study, researchers followed 294 people with mild-to-moderate Parkinson’s disease for five years to track changes in cognitive function, and up to seven years for changes in motor symptoms. Participants estimated how much time they spent doing moderate and vigorous physical activity. Brisk walking, light cycling, doubles tennis and household chores such as vacuuming, mopping and mowing the lawn were categorized as moderate activity; vigorous activity included jogging, fast cycling, singles tennis and aerobics.

Researchers divided the participants into three groups based on their total physical activity: up to four hours per week, four to eight hours or more than eight hours. Then they tracked their movement symptoms and cognitive function over time while adjusting for age, sex, education, body mass index and disease duration and severity.

Overall, people who were more physically active showed slower declines both physically and mentally.

Cognitive function was measured using a 30-point test that looks at several aspects of thinking and memory. People in the least physically active group lost about 0.48 points per year, compared with 0.09 points in the middle group and virtually no decline (0.007 points) in the most active group during the study period.

While those numbers seem small, they represent a meaningful difference in the daily lives for people with Parkinson’s, Ryu said.

“That means the ability to go to a restaurant and calculate a tip. That means the ability to be part of a conversation, take something in and remember it a few minutes later, to find the word that you want in a conversation,” Fleisher said.

The researchers saw a similar pattern with movement. They measured participants using a standard Parkinson’s assessment that evaluates walking, posture, stiffness and slowness. The most active group had less worsening of those motor symptoms than the least active group.

“It may mean that the stiffness that a person feels, the slowness that a person feels, is progressing more slowly, which translates potentially into less medication to try to combat that,” Fleisher said. “What I think a lot of us see in practice, is that people who are more physically active can stave off needing to take more and more medications over time.”

The new findings add to a large body of evidence showing that exercise is beneficial for people with Parkinson’s. But much of that research has focused only on the ability to move. There’s been considerably less evidence about whether physical activity is associated with long-term changes in thinking and memory.

That’s part of what makes the new study interesting, Fleisher said. “This is going that extra level to say it’s more than just mobility.”
 
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Any amount of exercise is good

When researchers separated exercise intensity from the amount of time people were active, they found that total activity time was associated with changes in movement or cognition, but vigorous activity wasn’t.

“Consistency is the secret sauce,” Fleisher said.

That doesn’t mean vigorous exercise isn’t beneficial. Other research has found that higher-intensity workouts can improve cardiovascular fitness and some Parkinson’s motor symptoms. Fleisher encourages her patients to up the frequency, resistance or intensity of their activity as their fitness improves.

The study also doesn’t suggest that people with Parkinson’s should suddenly aim to get eight hours of physical activity each week. Researchers used those cutoffs to compare groups; they were not testing a specific exercise prescription. That amount may be completely unrealistic for many people, especially someone with a neurological disorder like Parkinson’s.

But you don’t need to move that much to benefit. Other research supports aiming for at least 150 minutes of moderate physical activity per week, though someone who is currently doing very little should aim to slowly work up to that (or as much as they can) so they can sustain it, be consistent and hopefully enjoy it, Fleisher said.
 
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How exercise affects your brain

The study can’t tell us why physical activity was associated with slower cognitive and motor decline, but scientists have several theories about how the brain benefits from exercise, said Ryu.

“It’s just bringing more blood flow to the brain, which means that the brain can enhance neuroplasticity,” Fleisher said. Neuroplasticity is the brain’s ability to learn and analyze new information, and adapt to challenges.

Scientists have proposed several other mechanisms, including reduced inflammation in the brain, the release of molecules produced during exercise that may affect brain function, and an increase in a hormone that may play a role in the development of new neurons.

Exercise may also indirectly support the brain in other ways, Ryu said. Trouble sleeping, for example, is common in Parkinson’s, and exercise can improve sleep. Fitness classes can also provide routine, accountability and social interaction, potentially helping counter the isolation and apathy some people with Parkinson’s experience, Fleisher said.

“There’s so much that contributes to brain health, to well-being,” Fleisher said.

What this study means for people with Parkinson’s

The study shows a correlation between more exercise and slower Parkinson’s progression, but it does not prove that exercise can stop or slow the disease. And there are several limitations: Participants reported their own physical activity rather than having it objectively measured by a device, and the study included people with mild-to-moderate Parkinson’s, so its findings may not apply to everyone with the disease.

The authors also note that reverse causation cannot be ruled out, meaning it’s possible that people with slower disease progression were more likely to keep up with exercise, not necessarily that the exercise kept them from progressing. However, baseline motor and cognitive measures were similar among participants in the new study, and the associations were still apparent after researchers adjusted for disease severity. Fleisher also noted that past studies have also shown that “people who’ve always been exercisers, regardless of the flavor of Parkinson’s that they develop, they tend to progress more slowly.”

Still, physical activity is one of the few modifiable behaviors that already has substantial evidence behind it for people with Parkinson’s. And this study suggests that its potential benefits may extend beyond improving symptoms today to being associated with how those symptoms change over time.

The practical message, Fleisher said, is not to obsess over finding the best Parkinson’s workout.

“Do the thing that you’ll actually stick with, and then we can put the scaffolding around that to say, well, how much and how often, and what should that intensity be,” she said.

The same principle applies to people whose Parkinson’s makes exercise difficult. Fleisher treats patients who are homebound or use wheelchairs and points them toward options such as chair yoga and seated exercise. Working with a physical therapist can help people figure out what is doable for them.

“Exercise is available to all, regardless of what your physical ability is,” she said. “Start from where you are and you build from there.”


 
westcoast said:
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How exercise affects your brain

The study can’t tell us why physical activity was associated with slower cognitive and motor decline, but scientists have several theories about how the brain benefits from exercise, said Ryu.

“It’s just bringing more blood flow to the brain, which means that the brain can enhance neuroplasticity,” Fleisher said. Neuroplasticity is the brain’s ability to learn and analyze new information, and adapt to challenges.

Scientists have proposed several other mechanisms, including reduced inflammation in the brain, the release of molecules produced during exercise that may affect brain function, and an increase in a hormone that may play a role in the development of new neurons.

Exercise may also indirectly support the brain in other ways, Ryu said. Trouble sleeping, for example, is common in Parkinson’s, and exercise can improve sleep. Fitness classes can also provide routine, accountability and social interaction, potentially helping counter the isolation and apathy some people with Parkinson’s experience, Fleisher said.

“There’s so much that contributes to brain health, to well-being,” Fleisher said.

What this study means for people with Parkinson’s

The study shows a correlation between more exercise and slower Parkinson’s progression, but it does not prove that exercise can stop or slow the disease. And there are several limitations: Participants reported their own physical activity rather than having it objectively measured by a device, and the study included people with mild-to-moderate Parkinson’s, so its findings may not apply to everyone with the disease.

The authors also note that reverse causation cannot be ruled out, meaning it’s possible that people with slower disease progression were more likely to keep up with exercise, not necessarily that the exercise kept them from progressing. However, baseline motor and cognitive measures were similar among participants in the new study, and the associations were still apparent after researchers adjusted for disease severity. Fleisher also noted that past studies have also shown that “people who’ve always been exercisers, regardless of the flavor of Parkinson’s that they develop, they tend to progress more slowly.”

Still, physical activity is one of the few modifiable behaviors that already has substantial evidence behind it for people with Parkinson’s. And this study suggests that its potential benefits may extend beyond improving symptoms today to being associated with how those symptoms change over time.

The practical message, Fleisher said, is not to obsess over finding the best Parkinson’s workout.

“Do the thing that you’ll actually stick with, and then we can put the scaffolding around that to say, well, how much and how often, and what should that intensity be,” she said.

The same principle applies to people whose Parkinson’s makes exercise difficult. Fleisher treats patients who are homebound or use wheelchairs and points them toward options such as chair yoga and seated exercise. Working with a physical therapist can help people figure out what is doable for them.

“Exercise is available to all, regardless of what your physical ability is,” she said. “Start from where you are and you build from there.”
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The article kind of implies that regular exercise will slow the disease which is really not supported by the science. You really need high intensity exercise for half an hour four times per week to slow progression. That's what SPARX3 aims to prove
 
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