Objective: This novel study tests the hypothesis that 16 weeks of high-intensity exercise rehabilitation combining resistance training plus body-weight interval training, compared with a sleep hygiene control, will improve the slow-wave sleep activity (SWA) during non-rapid eye movement stage 3 (N3) sleep in patients with Parkinson’s disease (PD).

Background: SWA (<4 Hz) during N3 has been linked with age-related neural plasticity and PD cognition(1). Physical exercise has become the standard of care as a non-pharmacological intervention for improving motor symptoms of PD(2), and we have previously shown that exercise increases N3 in PD(3). However, it remains to be determined if exercise enhances SWA during N3 sleep.

Method: We conducted a quantitative post hoc analysis evaluating absolute delta spectral power on 55 patients with PD. Participants were randomized to a supervised 3x/week exercise group (n=27) or in-person sleep hygiene counseling with monthly phone calls, no exercise control (n=28). Polysomnography (PSG) was performed in all the participants at baseline and post-intervention. PSG included EEG, from which we analyzed delta frequency (1-4 Hz) spectral power in frontal leads (F3 or F4) in artifact-free 30-second epochs using the fast Fourier transformation (Matlab pwelch function).

Results: We did not find any significant group differences in disease duration, age, levodopa-equivalent dose (LED), or dopamine agonist LED in baseline demographics. Individual group level descriptive statistics showed mean+/-SD frontal absolute delta power during N3 in exercise group 81.8+/-61.2 microV²/Hz (pre-intervention) and 102.9+/-62.9 microV²/Hz (post-intervention). In sleep hygiene group it was 73.0 +/- 47.4 microV²/Hz (pre-intervention) and 58.2 +/- 49.3 microV²/Hz (post-intervention). Overall, the exercise group showed significant improvement in sex-adjusted absolute N3 delta power compared with the sleep hygiene group (group x time interaction: F = 4.07, P=0.0493).

Conclusion: High-intensity exercise rehabilitation increases absolute N3 delta power in PD. Because SWA is essential for PD’s cognition, our findings demonstrate a crucial step in identifying exercise as an effective non-pharmacological treatment. Future research should evaluate the beneficial effects of exercise on other quantitative objective sleep measures to elucidate mechanisms underlying the beneficial effects of exercise on PD sleep.

References: 1. Wood KH, Memon AA, Memon RA, Joop A, Pilkington J, Catiul C, et al. Slow Wave Sleep and EEG Delta Spectral Power are Associated with Cognitive Function in Parkinson’s Disease. J Parkinsons Dis. 2020. 2. van der Kolk NM, King LA. Effects of exercise on mobility in people with Parkinson’s disease. Mov Disord. 2013;28(11):1587-96. 3. Amara AW, Wood KH, Joop A, Memon RA, Pilkington J, Tuggle SC, et al. Randomized, Controlled Trial of Exercise on Objective and Subjective Sleep in Parkinson’s Disease. Mov Disord. 2020;35(6):947-58.

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