Parkinson's disease progression can be slowed with vigorous exercise, study shows

Dec. 11--His friends noticed the tremor before he did. It started in his left hand, Geoffrey Rogers said, but before long the trembling affected his right too.

The cause, doctors found, was Parkinson's disease.

At Rush University Medical Center, where Rogers, then 64, received a second opinion, the father of three learned he could join a new clinical trial for those with the neurodegenerative condition.

A team of researchers at Northwestern Medicine and the University of Colorado School of Medicine wanted to find out whether high- or moderate-intensity exercise was safe for patients with Parkinson's disease. Would it help with the disease's symptoms, the progressive loss of muscle control, tremors, stiffness?

Five years later, those scientists have an answer: Yes. Increasing disease severity in early-stage Parkinson's disease patients can be slowed with a few days of exercise weekly. The results of their trial, published Monday in JAMA Neurology, found vigorous exercise is a safe way to potentially delay the progression of Parkinson's disease.

"The real question is: Is there any disease or any disorder for which exercise is not good?" said Daniel Corcos, one of the lead authors of the study and a professor of physical therapy and human movement sciences at Northwestern'sFeinberg School of Medicine. "I haven't found any."

About 1 million Americans live with Parkinson's disease, according to the Parkinson's Foundation, which funded the study. That's more than the total number diagnosed with muscular dystrophy, Lou Gehrig's disease and multiple sclerosis, the organization says. Sixty thousand are diagnosed across the U.S. each year.

Parkinson's disease is the result of impaired or dying cells in the part of the brain responsible for movement. As in Rogers' case, most with Parkinson's disease see symptoms begin slowly. Balance, posture, walking and talking can progressively become more difficult, leading to disability in many cases.

The onset of symptoms can be distressing for families, especially because the causes of Parkinson's disease are not fully understood.

The news of his diagnosis scared his family, said Rogers, who founded and ran a general contracting company in Chicago for decades. His siblings wanted to know if the condition ran in the family. Even his youngest son, who was 13, was concerned his condition was more like Alzheimer's disease, he recalled.

"He was afraid I wouldn't recognize him," Rogers said.

While prior studies have examined the effect of endurance exercise on motor symptoms, this one is the first to look at the effects of high-intensity regimens. Previously, some medical professionals believed rigorous exercise was too physically demanding for those with Parkinson's disease, researchers said. And though another clinical trial is needed to conclusively establish the efficacy of such workouts on Parkinson's disease, Corcos, who holds a doctorate in kinesiology, said improved blood flow to the brain because of exercise might explain the results.

For Rogers, now 69, the results were pronounced: after a high-intensity workout, his tremors appeared to calm down. In the years since he began the workout regimen, the benefits have not changed, he said. He's experienced no side effects either.

"I can't speak as a researcher or as an authority on this," Rogers said, "But the cumulative effect was that the tremor was less intense going forward. When I finished with a workout, the tremor would be under control, I wouldn't be going crazy with it. And that would last 20 minutes, an hour."

Rogers and the other 127 participants in the exploratory study, which was also funded by grants from the National Institutes of Health, were broken into three groups: those who, like Rogers, followed a vigorous weekly workout regimen for six months, those who followed a moderate one for the same duration and a control group that did not exercise. None was taking any medication for the condition at the time, and all who exercised used a treadmill only.

Researchers based symptom severity on a scale and measured on average how much better or worse the groups got.

Symptoms of the disease did not change or improve significantly for most of those who took part in high-intensity exercise. Participants in the moderate-intensity exercise group saw their symptoms worsen by 7.5 percent, while researchers observed symptoms of those in the control group worsen by 15 percent.

"Several lines of evidence point to a beneficial effect of exercise in Parkinson's disease," said Dr. Codrin Lungu, a program director at the National Institute of Neurological Disorders and Stroke, in a Monday statement.

Still, Parkinson's disease has no cure. Medicines that stimulate dopamine are currently standard treatment but can cause unwanted, uncontrolled movements, called dyskinesia, as the disease progresses.

Corcos said he believes the exploratory study's findings reinforce the notion that "exercise is medicine." But, just like a pill, he said, consistency is critical to seeing and retaining benefits.

"It has to be a sustained lifetime commitment," he said.

Roughly five years since his diagnosis and participation in the study, Rogers, who has since moved to New Buffalo, Mich., is still working out and now taking medicine to manage his condition.

Though Parkinson's is a "big part" of his daily life, Rogers and his family are optimistic, a departure from the fear they felt after his diagnosis.

"It's there, it's there every day and it doesn't go away," Rogers said. "It isn't like we know that three months from now there will be a procedure that will cure it. But my family's been extremely supportive," he said. "I guess that says it all."

eolumhense@chicagotribune.com

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