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Exercise and Parkinson's Disease
Abstract & Commentary
By Panida Piboolnurak, MD, Assistant Professor, Department of Neurology and Neuroscience, Weill Cornell Medical College. Dr. Piboolnurak reports no financial relationship relevant to this field of study.
Synopsis: Exercise is beneficial for frontal lobe based executive functions. Although this study did not show benefit of exercise on mood and quality of life, this could be due to a floor effect of data.
Source: Cruise KE, et al. Exercise and Parkinson's: Benefits for cognition and quality of life. Acta Neurol Scand 2010; March 1 (Epub ahead of print).
Depression and cognitive impairment are important predictors of the quality of life of patients with Parkinson's disease (PD). There is evidence suggesting benefit of exercise on mood disturbances and cognitive function, particularly on executive function. This study investigated the benefit of an exercise protocol on executive function and mood.
Patients with mild to moderate PD without significant cognitive impairment (MMSE < 24) were recruited. Patients with other neurological disorders, musculoskeletal diseases, or cardiovascular diseases that could inhibit them from exercise were excluded. Authors also excluded patients who had participated in regular resistance training in the previous 12 months. Thirty-five participants were selected and were allocated to either an immediate exercise program or delayed exercise group (control). Exercise program included resistance and aerobic exercises. Global cognitive function was assessed using MMSE and Australian National Adult Reading Test (AUSNART). Assessments specific to frontal (verbal fluency, spatial working memory and Stocking of Cambridge), fronto-temporal (spatial recognition memory), and temporal lobe (pattern recognition memory and semantic fluency) function were also obtained. Geriatric Depression Scale (GDS) was used for depression assessment. The Parkinson's Disease Questionnaire (PDQ-39) was used to evaluate the benefit of exercise on quality of life.
Exercise was shown to have a selective benefit for frontal lobe based executive function, but it did not show benefit on mood or quality of life. The authors explained that because 71% of participants were classified within the normal range for depression (GDS 0–4) and only two participants had very poor quality of life, exercise might not improve these areas beyond the normal range (floor effect). They also discussed that this study was limited by sampling bias because participants were recruited from PD support groups which likely involved people who are quite active at disease management. They suggested that this limitation be addressed by larger sample size and by recruiting participants from a clinic setting. Moreover, specifically screening participants for depression as an inclusion criterion would allow for more in depth assessment of the benefit of exercise on mood.
Many studies have suggested that exercise is beneficial for patients with Parkinson's disease. The benefit of exercise is not only for physical function, but also for cognition and mood. Although the mechanism of these effects are unknown, the animal studies using the MPTP model have shown that exercise improves motor function, enhances neuroplasticity in the basal ganglia and increases neurotrophic factors. Given current evidence, regular resistance and aerobic exercises should be recommended to patients with Parkinson's Disease.