The Davis Phinney Foundation has long promoted exercise as an intervention people with Parkinson’s can use to live well each day. Results recently published by a Davis Phinney Foundation funded researcher help substantiate the positive impacts of exercise and give people with Parkinson’s even more incentive to stay on track with exercise programs.
Dr. Margaret Schenkman of the University of Colorado School of Medicine is the lead author of this work, published in the Journal of the American Medical Association. The article outlines a phase 2 clinical trial of high-intensity treadmill exercise in people with Parkinson’s that was performed with colleagues at multiple sites, including Chicago, Denver and Pittsburgh.
Participants were invited to take part in the study if they did not exercise at moderate intensity more than three times per week, were not on dopaminergic medications and had been diagnosed within five years of the start of the study. The 128 individuals were randomized into three groups.
The high-intensity group was instructed to exercise on a treadmill four days a week at 80%-85% of their maximum heart rate.
A moderate-intensity group was instructed to exercise on a treadmill four days per week at 60%-65% of their maximum heart rate. The target for success was a frequency of three days per week.
The third group of individuals was comprised of a wait-list control group that received usual medical care but was not prescribed an exercise intervention.
After six months, the high-intensity exercise group had significantly lower reductions in motor ability scores than the control group, indicating a potential slowing of disease progression. The moderate-intensity group did not see sufficient benefit to warrant further study.
The study establishes that high-intensity treadmill exercise is safe for people with Parkinson’s and clinicians can safely prescribe this activity for people under their care. As with any motorized exercise equipment, it’s important to be aware of the chance of falling. Make sure you only use it if you feel safe. The study also sets the stage for a larger phase 3 trial to determine the efficacy and clinical benefits of high-intensity exercise.
Of course, it’s important to check with your own health care provider prior to beginning a new physical activity program, but Dr. Schenkman’s work suggests that you’re likely to experience benefits from becoming active.
Discussing her research, Dr. Schenkman told us,
“A growing body of work demonstrates the importance of exercise for living well today with Parkinson’s. Because people with Parkinson’s may have a number of different symptoms, the right exercise prescription for an individual may include some combination of endurance, strength and balance training. The findings of this investigation indicate that the endurance training should be at high-intensity to the extent possible.”
If you’d like to learn more about how exercise can help you live well today with Parkinson’s, request a copy of our Every Victory Counts® manual here.
When I was diagnosed with PD my neurologist recommended the addition of Tai Chi to my exercise regimen.
A tantalizing study the report of which is severely lacking in detail. The question that needs answering is “how long?” How long at 80-85% of maximum heart rate. I get there at least 5 days a week but it is not at 80-95% until late in the 30 minute treadmill routine (I do interval training).
Hi Jon, you bring up a very good point! The participants in the High Intensity group followed this exercise regimen:
Treadmill exercise was prescribed for 4 days per week for 26 weeks. This included 5 to 10 minutes of warm-up, 30 minutes of treadmill exercise at the targeted rate of 80% to 85% maximum heart rate then 5 to 10 minutes of cool down.
Has anyone done any research on the relationship of high intensity exercise with the cortisol/adrenaline response in elderly Parkinson’s patients? If so, what was surmised?
Martin, Thank you for bringing up this question! There has not been a good scientific study of the relationship between high intensity exercise and adrenaline or cortisol in Parkinson’s patients. We do fund innovative research focused on helping people with Parkinson’s live well and have the best possible quality of life. For example, we helped Dr. Jay Alberts establish the importance of physical activity as a therapy for Parkinson’s.
We hope that this type of good research will eventually lead to answering important questions such as the one you raise about the interactions of hormones, physical activity and Parkinson’s.
The best exercise is boxing. Please look into Rock Steady Boxing. It also contains different exercises as well. There are videos on YouTube.com where you can see the exercises.
Another issue that’s not addressed here is the effect of dopaminergic medications. I find it odd that a study would be done with people NOT on those drugs as I would guess most people ARE on those drugs. Do those drugs effect heart rates and should that be factored into hitting 80-85% of MHR?
Good question, Lynda! Scientific studies are very hard to do to ensure that your results are accurate. It is likely that this study was done without dopaminergic medications to eliminate one more variable that can change (different types of medication, different dosages, time of day a patient takes medication vs. time of exercise, patients who might skip or miss medication, how long a patient has been on a medication, etc). It would certainly be a good follow up study to assess the exercise levels as they work with different medications. For now, the practical answer is to work with your own physician and therapist to determine what works for you, your physical abilities and your medications.
Hi, I was a participant in this study and like to clarify that the requirement was that one wasn’t on dopaminergic medications at the start of the study. I myself started on meds during the study.
Thanks for clarifying, Susanne!
45 minutes of treadmilling at 80-85% for 1/2 hour?
Can this finding be translated to some other, equivalent exercise?
Hi Louis, the study likely chose exercise on treadmills because it is easily monitored and consistent across patients. An important take away is that exercising where your heart rate is at 80-85% of your maximum heart rate is beneficial. Other forms of exercise could get your heart rate to that level too, as long as your physician agrees that you are choosing an exercise regimen that is safe for you. Unfortunately, most research studies raise as many questions as they answer. Research studies also usually direct researchers to the next important questions to answer, like the good question you raised here!
Is the effect on symptoms vary gradually with respect to the intensity from moderate to high OR is there a sharp threshold below with zero effectiveness. In other words, what is the effectiveness from 70 to 80% HR?
Hi Shabbir, thank you for your question! The study had two groups, the moderate group exercised at 60-65% maximum heart rate and the high intensity group exercised at 80-85% maximum heart rate. The study did not report on a range of heart rates so they could not determine a slope of benefit. As a result, it would be inaccurate to guess the effectiveness of 70-80% maximum heart rate. Most health care professionals agree there is benefit from almost any exercise so it’s unlikely the effectiveness would be zero, however this study just couldn’t assess all levels. Obviously, there is more research that needs to be done to answer more questions like this!
Thx for your prompt reply Anna. I have been diagnosed PD in 2014. Over these years my right hand tremors have gotten worse and left hand just started.
I have been mod to extensively exercising most of my adult life. Mostly swimming (1 mile) and hiking (5 miles). For last several years, I swim x2, hike x2 and fitness x2. I have started using HR monitor and push myself.
My symptoms slowly gotten worse. If the exercise slows the slop, I wouldn’t know. I am not on any meds.
I would love to see more research on exercise and even sign up as subject.
Congratulations Shabbir on your great exercise routine. As Dr. Peter Wayne, one of our other funded researchers stated, “ . . . there is no doubt whatsoever that exercise remains one of the best therapies for preserving and enhancing quality of life.” We know there is more to learn about the effects of exercise and we recently announced that the priority topic for our 2018 grant cycle will be exercise (2018 Davis Phinney Research Grants). We will post information about new studies and will supply information about how to participate in those studies when possible.
Is intensity (80% target HR) enough or does the activity require “forced exercise” (as per Dr. Jay Albert)?
Dr. Schenkman’s study did not involve “forced exercise” as the study by Dr. Jay Alberts did, rather it used heart rate to determine the intensity level of their exercise. To date, research has not determined the ‘best’ exercise. That answer will likely be different for each individual based on their abilities, symptoms, etc. It is important to consult your physician and health care team to determine what exercise is best for you
What were the different statistical improvements for the three groups.
The study utilized the Unified Parkinson’s Disease Rating Scale, a standardized scale used to measure the progression of symptoms associated with Parkinson’s, which suggested people with Parkinson’s who participated in the exercise groups experienced a slower progression of motor symptoms when compared to usual care. Those who participated in high-intensity exercise experienced a progression of motor symptoms 90% less extreme than those who participated in usual care over a 6 month period. In the same time period, those who participated in high-intensity exercise experienced a progression of motor symptoms 37% less extreme than those who participated in usual care. Thanks for the question!
My husband is almost 82 and has a variety of Parkinson’s – without tremors of any kind. He walks, and does other exercises taught to him by a therapist. We will ask his neurologist, but are wondering what type of more vibrant exercise he might do that doesn’t require a treadmill. Thanks.
Hi Rita – we certainly recommend speaking to the neurologist about exercises he/she might recommend based on your husband’s unique experience with Parkinson’s. There are several other wonderful exercise classes that members of our community participate in, including Dance for Parkinson’s, Pedaling for Parkinson’s classes (depending on where you are located) or stationary cycling classes for Parkinson’s and Boxing. For exercises in your home, we also offer the Parkinson’s Exercise Essentials Video, which provides a range of exercise for the gym or home that can be modified for any fitness level.
I WAS DIAGNOSED WITH PD ABOUT ONE YEAR AGO. MY SYMPTOMS AREN’T TOO SERIOUS, MINOR RIGHT HAND TREMOR. BUT MY MENTAL OUTLOOK IS HORRIBLE. I’M 71 YEARS OLD AND I’M SO FRIGHTENED ABOUT MY FUTURE. I DON’T KNOW WHAT TO DO TO IMPROVE MY OUTLOOK. I’M SEEN APPROXIMATELY EVERY 3 TO 4 MONTHS BY A MOVEMENT SPECIALIST. SHE SAYS NO ONE WOULD KNOW BY LOOKING AT ME THAT I HAVE PD. I’M JUST REALLY AFRAID OF WHAT MY FUTURE MAY BE. I READ EVERYTHING & MY HUSBAND TELLS ME I’M DWELLING ON NEGATIVITY, WHEN IN FACT, I’M TRYING TO UNDERSTAND WHAT MAY BE IN STORE. I’VE ALSO BEEN DIAGNOSED WITH ISCHEMIC STROKES. I WOULD LOVE ANY POSITIVE FEEDBACK. I WISH I COULD FIND SOME KIND OF SUPPORT GROUP THAT COULD HELP ME. SORRY. I DIDN’T MEAN FOR THIS TO BE A NOVEL. THANKS FOR ANY INPUT YOU MAY PROVIDE.
Dear Kathy – Thank you for reading, and I’m sorry you are struggling right now. The uncertainty of progression of Parkinson’s is one of the most difficult aspects of it, and you are not alone in wondering and worrying about what it might mean for your future. It’s great that you are seeing a movement disorder specialist. Over time, she will be the best person to guide you on what to expect as she will be the one monitoring your progression. For some people, Parkinson’s progresses very slowly and they live an active and vibrant life with it for many years. For others, it progresses more quickly. It has been my experience that no matter what camp you fall in, that surrounding yourself with a positive Parkinson’s community is one of the best things you can do. Have you looked for support groups in your area? If you’ve been unable to find helpful resources, our Davis Phinney Foundation Ambassadors are an amazing group of people who have a wealth of knowledge to share, and they love speaking with people with Parkinson’s. You can learn more about them and how to contact them here: https://www.davisphinneyfoundation.org/resources/ambassadors-2/.
Wishing you well.
Kathy, I read your comment with interest and want you to know it touches my heart. It seems very common for folks to first react to the diagnosis like you did. I know I did, too, but HAD to focus on more positive things to move forward. I don’t know that what I have done will work for you, but here are a few ideas if they help. 1. Write down the facts and your responses as related to this diagnosis. I use a journal and started it the day my neurologist shared the news. A journal doesn’t require daily input, but sincerely helps me be objective. I keep track of how I’m doing, how I’m feeling. I log meds, my responses, and any changes in dosage, etc. over time. It allows me to write down fears, too, and think of ways to overcome them. AND I put in funny pictures and encouraging quotes. 2. Find a support group or start one. It took me a few months to find one locally and now I’m trying to help them become more visible so others don’t have as hard a time. I also started a four-person support group (once I knew three other people with PD) and we have lunch every other week. 3. Build a support network that already includes your MDS and your husband. Maybe there are trusted family members and close friends who are good listeners and encouragers. 4. I love that you’re reading. Me, too. Read more of the Moments of Victory (www.dpf.org) for an uplifting reprieve from negative thoughts. 5. And, certainly, as Melanie pointed out, contact an Ambassador. I suggest you start with Edie, but all of them would send you a reply and encourage you. 6. I don’t want this to sound trite, but I focus on joy. I have for decades, and I look forward to more years of the same (I’m a few years younger than you and was diagnosed two years ago). Reading about joy is simply uplifting so I seek joy, I choose joy, and I share joy.
This research study is interesting and helps us know what we already know and must act on – exercise is good. Do it! I hope even one of these ideas might get you out of the negative and into the positive scheme of things because all of us are striving to live well today. And like you said, didn’t mean to make this a novel. Blessings to you in the coming new year.
Hi Loraine – Thank you so much for your generous and thoughtful response to Kathy. A lot of times, just reminding people that they aren’t alone can make a big difference. I love your suggestions as well, and I’m glad you have found the support that works for you in your groups. Cheers to living well.
Even with training, it’s difficult for a healthy middle age person to do 30 minutes on a treadmill @ 85% max. heart rate, much less a 65 year old with P.D. Presumably there were partipants selected for the high intensity group in this study who were unable to attain the goal or reached the goal but were unable to complete the study because their disease had progressed. I’m not a scientist, but wouldn’t this distort the randomness of the sample? The attrition in the control group would be truly random, but the attrition in the high intensity group would self-select for only the healthiest participants.
Thank you for reading. Were you able to read the full article? That may provide some of the answers to your questions. Here it is again for your convenience: https://www.davisphinneyfoundation.org/download/1043792. You can also contact the author of the study here if you have further questions.
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