Objective: To describe the effects of high intensity aerobic exercise in an individual with mild Parkinson’s disease (PD).

Background: Emerging evidence suggests high intensity aerobic exercise may attenuate PD progression.1,2 However, exercise programs tested to date were resource-intensive, fully supervised, or required expensive equipment. Therefore, they may not be easily accessible and translated into clinical practice.

Method: In a pilot single-group study, participants with mild PD (Hoehn & Yahr ≤ 2) completed high intensity aerobic exercise three times per week for 12 months. Participants could choose their exercise modality and location based on individual preferences. High intensity exercise was continuous (30 mins at 75 to 85% of maximal heart rate (HRmax) or interval training (4 x 4 mins at 85 to 95% of HRmax). Participants received support to exercise during the first six months, including therapist visits in the community and telephone health coaching to facilitate exercise self-management skills and adherence. The primary outcome was feasibility of the program. Secondary outcomes were clinical, physiological, and neuroimaging measures to quantify effects of the exercise, including the use of Total Body Positron Emitted Tomography (TB-PET) to explore potential disease-modifying effects. As the trial is ongoing, this case report presents results for one participant after the first six months of high intensity aerobic exercise.

Results: A 67-year-old male chose to do outdoor brisk walking in a hilly environment while wearing a weighted backpack. He completed 75 exercise sessions, averaging 39 mins of exercise per session, three times per week with no adverse events. Most (57%) of the exercise duration was at high intensity. Peak oxygen consumption improved by 25% from 26.4 ml/kg/min to 33.0 ml/kg/min. Disease severity remained stable with his “off” medication MDS-UPDRS motor score being relatively unchanged (20 to 21/132). His “off” medication dopamine transporter binding potential improved by 10% across the left and right striatum.

Conclusion: These preliminary results suggest individualized, community-based high intensity aerobic exercise may be feasible for people with mild PD, with encouraging signs of improved aerobic capacity and dopamine function. An adequately powered randomized controlled trial is needed to determine efficacy of this intervention.

References: 1. van der Kolk NM, de Vries NM, Kessels RPC, et al. Effectiveness of home-based and remotely supervised aerobic exercise in Parkinson’s disease: a double-blind, randomised controlled trial. The Lancet Neurology. 2019;18(11):998-1008.

2. Schenkman M, Moore CG, Kohrt WM, et al. Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial. JAMA Neurol. 2018;75(2):219-226.

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MDS Abstracts - https://www.mdsabstracts.org/abstract/potential-disease-modifying-effects-in-mild-parkinsons-disease-following-high-intensity-aerobic-exercise-a-case-report/