Category: Parkinson’s Disease: Clinical Trials
Objective: To examine the effect of aerobic exercise on motor symptoms, non-motor symptoms (NMS) and dopaminergic denervation, measured by I-123-ioflupane single photon emission computed tomography (DAT-SPECT), in Parkinson disease (PD).
Background: Exercise improves motor symptoms in PD and epidemiologic evidence suggests a role for aerobic exercise as a putative disease modifying therapy. However, the effects of exercise on non-motor symptoms and biomarkers of disease progression are less clear. Additionally, most studies of aerobic exercise have been short duration, observed protocols. The feasibility of PD patients to engage in aerobic exercise in the community over extended time periods has been less well-studied.
Method: We conducted a randomized controlled trial comparing aerobic walking (5 times per week in subjects’ neighborhoods or homes) to normal activity in early PD (H/Y≤2) over 1 year. Both recruitment and participation were limited by COVID19 and a total of 6 subjects (3 exercise(Ex), 3 control (Con) completed the study per protocol). The primary outcomes were between treatment group differences in the change in motor scores and semiquantitative regional DAT-SPECT over one year. Assessments included cardiovascular fitness (VO2max measured during a metabolic treadmill stress test), motor function (OFF UPDRS3), non-motor symptoms, quality of life (PDQ-8) and plasma biomarkers associated with exercise and/or PD risk (brain-derived neurotrophic factor-BDNF, ApoA1, uric acid). Semi-quantitative analysis of DAT-SPECT uptake in the caudate, anterior and posterior putamen, was performed using MIMNeuro.
Results: The cohort was 83% men with a mean age of 64.2±7.9 and UPDRS3 of 19.3±4.8. Groups were well-matched for baseline demographic, clinical and biomarker variables. Baseline age/sex-adjustedVO2max percentile was 4.1±4.1 (lower percentile indicating lower fitness). Changes in motor function favored the exercise group (Con: +10.5±10.6; Ex: -10.3±4.9, p=0.002). No significant between group differences were observed for NMS or biomarkers, though changes in DAT-SPECT tended to favor the exercise group.
Conclusion: Baseline levels of cardiovascular fitness were low in a small cohort of Veterans with early PD. Community-based aerobic exercise improved motor symptoms of PD. This study was likely underpowered to detect any small or moderate effects of exercise on NMS and biomarker outcomes.
To cite this abstract in AMA style:J. Morley, J. Dubroff, G. Cheng, B. Taylor, S. Wood, J. Duda. Effect of exercise on motor symptoms, non-motor symptoms and dopamine transporter imaging in Parkinson Disease [abstract]. Mov Disord. 2022; 37 (suppl 2). https://www.mdsabstracts.org/abstract/effect-of-exercise-on-motor-symptoms-non-motor-symptoms-and-dopamine-transporter-imaging-in-parkinson-disease/. Accessed September 21, 2023.
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MDS Abstracts - https://www.mdsabstracts.org/abstract/effect-of-exercise-on-motor-symptoms-non-motor-symptoms-and-dopamine-transporter-imaging-in-parkinson-disease/