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Walking Beats Rigorous Exercise in Parkinson's

Wednesday April 20, 2011

Michael Smith

Medpage Today - Moderate walking on a treadmill was better for Parkinson's patients than a pulse-pounding high-intensity workout, a researcher said here.

On a standard six-minute walk test, patients doing the low-intensity workout improved their six-minute walk distance significantly, according to Lisa Shulman, MD, of the University of Maryland School of Medicine in Baltimore.

But patients assigned to a more vigorous workout did not, Shulman reported at the annual meeting of the American Academy of Neurology.

Surprisingly, patients assigned to stretching and resistance training also improved significantly on the six-minute walk test, Shulman said before her late-breaking poster session here.

Newly diagnosed patients "understandably want to know what can I do for myself, besides taking pills from a bottle," Shulman told MedPage Today.

Exercise is one answer but she said doctors have not been able to say what sort of exercise is best.

To help fill the gap, she and colleagues randomly assigned patients to three different exercise models, looking for changes in gait, mobility, cardiovascular fitness, and a range of non-motor aspects of the disease.

In the high-intensity model, patients started with 15 minutes walking on a treadmill and were asked to increase their speed, time, and incline, in order to reach a 30-minute walk at 70% to 80% of their heart rate reserve.

In the low-intensity model, patients again started at 15 minutes and were asked to increase the time of their walk by five minutes a week -- but not the speed or incline -- to reach a target of 50 minutes and 40% to 50% of the heart rate reserve.

Patients assigned to stretching and resistance were given exercises to strengthen their lower body, using weight machines, as well as upper and lower body stretches. Weight was increased as tolerated, Shulman reported.

They exercised three times a week for three months, she said.

The researchers found:

•Patients in both treadmill groups had significant improvements in gait and mobility, and both groups improved their maximum speed.

•Improvement on the six-minute walk test was significant for those in the low-intensity group and the stretching and resistance group (at P<0.001 and P<0.02, respectively) but not for the high-intensity group (P=0.066).

•Cardiovascular fitness improved significantly for both treadmill groups but not for the stretching and resistance group.

•Only the stretching and resistance group had a significant improvement on the motor scale of the Unified Parkinson's Disease Rating Scale.

It would make sense, Shulman told MedPage Today, for patients to combine a low-intensity workout with stretching and resistance training.

But she cautioned that the workout has to be disciplined and regular. "These patients were walking 50 minutes without stopping and this is different than going to the mall," she said.

The findings are not surprising, mainly because so little is understood about the effects of exercise on disease, according to Kathleen Shannon, MD, of Rush University Medical Center in Chicago.

"Basically, every form of exercise works," she said, and the problem for researchers and clinicians is trying to tease out which form works better.

She cautioned that the findings might be difficult to translate to the real world. In the study, Shannon told MedPage Today, patients had "built-in adherence to the protocol" with personal trainers and a supervised program.

"The real challenge for clinicians is to get people to embrace exercise and to do it regularly," she said.

"I tell my patients just move 30 minutes a day -- dance, take yoga, take tai chi, walk, bike -- whatever it is," she said. Like Shulman, however, she emphasized that the exercise has to be consistent and disciplined.

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