Objective: To evaluate the effects of a 24-week home-based, remotely supervised strength exercise program combined with guideline-based aerobic physical activity modification on cognitive function and neuropsychiatric symptoms in Parkinson’s disease (PD), and to explore potential biological mechanisms using exercise-related plasma biomarkers.

Background: Although physical exercise has been proposed as a non-pharmacological intervention that may improve cognitive and neuropsychiatric outcomes in PD, the effects of different exercise modalities and delivery formats remain unclear.

Method: In this single-blinded randomized controlled trial, 64 patients with PD (Hoehn and Yahr stage ≤3, age 50–80 years) were randomly assigned to an exercise group (n=32) or a control group (n=32). The intervention consisted of four weeks of face-to-face training followed by 20 weeks of remotely supervised strength training via videoconferencing twice weekly, combined with individualized aerobic physical activity modification. Controls maintained usual activities. The primary outcome was change in Dementia Rating Scale-2 (DRS-2). Secondary outcomes included Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Apathy Scale (AS), and Movement Disorder Society Unified PD Rating Scale (MDS-UPDRS) Part 3. Exploratory outcomes included DRS-2 subdomains and exercise-related plasma biomarkers (BDNF, myostatin, VEGF, and IGF-1).

Results: Of the 64 participants, 62 completed the study, with two dropout in the control group. After 24 weeks, there were no significant between-group differences in changes in the DRS-2 total (p=0.401) or subdomain scores. However, the exercise group showed greater improvements than the control group in BDI (−1.5 [−2.0 to 1.0] vs. 1.0 [−2.8 to 2.0]; p=0.008), AS (−2.0 [−5.8 to 1.8] vs. 0.0 [−2.0 to 3.8]; p=0.026), and MDS-UPDRS Part 3 (−3.0 [−5.0 to 0.0] vs. 2.0 [−1.0 to 4.0]; p<0.001) scores. BAI score changes did not differ between the groups (p=0.481). In exploratory analyses, plasma BDNF and IGF-1 levels increased significantly in the exercise group compared with the control group.

Conclusion: A 24-week exercise program did not improve cognitive performance in patients with PD but improved depressive symptoms, apathy, and motor function, and increased circulating neurotrophic factors.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/cognitive-and-neuropsychiatric-effects-of-home-based-remotely-supervised-strength-exercise-combined-with-guideline-based-aerobic-physical-activity-modification-in-parkinsons-disease-a-rando/