Exercise and dopaminergic therapy for early Parkinson’s disease

What type of exercise should patients diagnosed with early Parkinson’s disease do to improve their disease course before they need to take medication? And when they do need to take medication, which medication should they take? These were questions addressed by Professor Susan Fox, Toronto, Canada, in a presentation at MDS 2022.

Individualize treatment for each patient

"Parkinson’s disease (PD) affects men and women of all ages worldwide. When a patient is diagnosed with early PD, individualize treatment for each patient", said Professor Fox. "Focus on the patient in front of you".

Use evidence-based medicine recommendations, but adapt to the patient’s needs

"Evidence-based medicine is one factor contributing to nonpharmacologic and pharmacologic therapy decision-making", added Professor Fox. "Other factors include expert opinion, physician experience, patient preference, and local health resources and availability".

 

What type of exercise improves the symptoms and disease course?

Exercise needs to be sustained to be beneficial

"Exercise can be beneficial for patients with PD", said Professor Fox. Four weeks of gait training or 8 weeks of balance training have positive effects that persist for 3–12 months; and sustained strength training, aerobic training, tai chi, or dance therapy for at least 12 weeks can produce long-term benefits.1

"However, few clinical trials have been carried out on the effect of exercise on patients with early PD and not on medication", added Professor Fox, but the following studies provide some guidance:

Home-based aerobic exercise attenuates off-state motor signs

  • A phase 2 randomized clinical trial (RCT) involving 128 patients with PD and not on medication established that 80% to 85% and 60% to 65% exercise intensities are safe and feasible, and that high-intensity treadmill exercise is nonfutile2
  • An RCT involving 130 patients with mild PD and on stable dopaminergic medication, showed that home-based aerobic exercise attenuates off-state motor signs3
  • A retrospective study of 237 patients with early PD not on dopaminergic medication, revealed that regular physical activity and exercise were associated with an improved course of the disease

Regular physical activity and exercise are beneficial

 

Symptomatic motor therapies

"Any of the dopaminergic medications will reduce the motor symptoms of PD",5 said Professor Fox. These include levodopa, dopamine agonists, and monoamine oxidase B inhibitors, which are all recommended as first-line treatments by the National Institute for Health and Care Excellence for early PD.6

Any dopaminergic drug will reduce the motor symptoms of Parkinson’s disease

Choice of medication will depend upon a range of factors including:

  • The patient’s symptoms, comorbidities, current medication, lifestyle, preferences, needs, and goals6
  • The potential benefits and adverse effects of each treatment6
  • Local resources and availability

Many factors contribute to the choice of dopaminergic medication

Finally, Professor Fox highlighted the 147 ongoing clinical trials of drug therapies for PD,7 and suggested encouraging patients to take part in a clinical trial if appropriate." We must not let our patients lose hope", she said. "It’s important to take the positives and look forward".

 

MDS : International Parkinson and Movement Disorder Society
PD : Parkinson’s disease
RCT : randomized clinical trial  

BE-NOTPR-0238, approval date : 01.2023

Our correspondent’s highlights from the symposium are meant as a fair representation of the scientific content presented. The views and opinions expressed on this page do not necessarily reflect those of Lundbeck.

References
  1. Mak MK, Wong-Yu IS, Shen X, Chung CL. Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol. 2017;13(11):689–703.
  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):219–26.
  3. 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. Lancet Neurol. 2019 Nov;18(11):998–1008.
  4. Tsukita K, Sakamaki-Tsukita H, Takahashi R. Long-term effect of regular physical activity and exercise habits in patients with early Parkinson disease. Neurology. 2022;98(8):e859–71.
  5. Armstrong MJ, Okun MS. Diagnosis and treatment of Parkinson disease: A review. JAMA. 2020;323(6):548–60.
  6. National Institute for Health and Care Excellence (NICE) (2017) Parkinson’s disease in adults. NG71.
  7. McFarthing K, Rafaloff G, Baptista M, et al. Parkinson's disease drug therapies in the clinical trial pipeline: 2022 Update. J Parkinsons Dis. 2022;12(4):1073–82.
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