Aerobic exercise can be recommended for patients with mild Parkinson’s disease because it can have symptom-modifying effects similar to that of pharmacotherapy, new research shows.
A randomised controlled exercise trial from the Netherlands compared the effects of a home-based high-intensity aerobic exercise with a non-aerobic active control intervention in 130 patients aged 30-75 years with mild Parkinson’s disease (Hoehn and Yahr stage ≤2).
Patients were eligible for inclusion if they were on stable dopaminergic medication and reported doing less than the recommended aerobic exercise for older adults.
The aerobic exercise group engaged in stationary cycling for three sessions a week for six months, which was enhanced with virtual reality and gamification techniques to encourage adherence. The target heart rate zone began at 50–70% heart rate reserve (HRR) and increased to a maximum of 80% HRR as fitness increased.
Researchers said they opted for cycling because this type of exercise is typically well accepted in patients with Parkinson’s disease, even in those with severe walking difficulties, and has a low risk of falling when patients exercise at home without physical supervision.
The active control group was instructed to do stretching, flexibility, and relaxation exercises three times per week for 30 min per session.
Both groups used a tablet-based motivational app and received remote coaching.
The primary outcome was a change in the Movement Disorders Society–Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) motor section at 6 months, tested during the off state, defined as 12 or more hours after the last dopaminergic medication.
Results revealed a significant and clinically meaningful difference in favour of aerobic exercise of 4·2 points (95% CI 1·6–6·9; p=0·0020) measured during a standardised ‘off state’ (12 h since last dopaminergic medication and, if applicable, deep brain stimulation switched off during measurements).
Researchers said the aerobic exercise had an effect similar to that of several conventional Parkinson drugs in patients with mild severity, noting the effect of levodopa initiated in early Parkinson’s disease ranges between 3·8 and 6·6 points depending on the prescribed dose.