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Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease.
JAMA Neurol. 2013 Feb; 70(2):183-90.JN

Abstract

OBJECTIVE

To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed, strength, and fitness for patients with Parkinson disease.

DESIGN

A comparative, prospective, randomized, single-blinded clinical trial of 3 types of physical exercise.

SETTING

The Parkinson's Disease and Movement Disorders Center at the University of Maryland and the Baltimore Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center.

PATIENTS

A total of 67 patients with Parkinson disease who had gait impairment were randomly assigned to 1 of 3 arms of the trial. INTERVENTIONS; (1) A higher-intensity treadmill exercise (30 minutes at 70%-80% of heart rate reserve), (2) a lower-intensity treadmill exercise (50 minutes at 40%-50% of heart rate reserve), and (3) stretching and resistance exercises (2 sets of 10 repetitions on each leg on 3 resistance machines [leg press, leg extension, and curl]). These exercises were performed 3 times a week for 3 months.

MAIN OUTCOME MEASURES

The primary outcome measures were gait speed (6-minute walk), cardiovascular fitness (peak oxygen consumption per unit time [$$ VO2], and muscle strength (1-repetition maximum strength).

RESULTS

All 3 types of physical exercise improved distance on the 6-minute walk: lower-intensity treadmill exercise (12% increase; P=.001), stretching and resistance exercises (9% increase; P<.02), and higher-intensity treadmill exercise (6% increase; P=.07), with no between-group differences. Both treadmill exercises improved peak $$ VO2 (7%-8% increase; P<.05) more than did the stretching and resistance exercises. Only stretching and resistance improved muscle strength (16% increase; P<.001).

CONCLUSIONS

The effects of exercise were seen across all 3 exercise groups. The lower-intensity treadmill exercise resulted in the greatest improvement in gait speed. Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness. Only the stretching and resistance exercises improved muscle strength. Therefore, exercise can improve gait speed, muscle strength, and fitness for patients with Parkinson disease. The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation.

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Authors+Show Affiliations

Shulman LM
University of Maryland School of Medicine, Department of Neurology, Baltimore,MD21201, USA. lshulman@som.umaryland.edu
Katzel LI
No affiliation info available
Ivey FM
No affiliation info available
Sorkin JD
No affiliation info available
Favors K
No affiliation info available
Anderson KE
No affiliation info available
Smith BA
No affiliation info available
Reich SG
No affiliation info available
Weiner WJ
No affiliation info available
Macko RF
No affiliation info available

MeSH

AdultAgedElectrocardiographyExerciseExercise TestFemaleGaitHumansMaleMiddle AgedMuscle Stretching ExercisesParkinson DiseaseProspective StudiesResistance TrainingSingle-Blind Method

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

23128427

Clinical Trial Links

Walking and mHealth to Increase Participation in Parkinson Disease
Effects of AMPS on Cardiovascular Variables in Patients With Parkinson's Disease

Citation

Shulman, Lisa M., et al. "Randomized Clinical Trial of 3 Types of Physical Exercise for Patients With Parkinson Disease." JAMA Neurology, vol. 70, no. 2, 2013, pp. 183-90.
Shulman LM, Katzel LI, Ivey FM, et al. Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. JAMA Neurol. 2013;70(2):183-90.
Shulman, L. M., Katzel, L. I., Ivey, F. M., Sorkin, J. D., Favors, K., Anderson, K. E., Smith, B. A., Reich, S. G., Weiner, W. J., & Macko, R. F. (2013). Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. JAMA Neurology, 70(2), 183-90. https://doi.org/10.1001/jamaneurol.2013.646
Shulman LM, et al. Randomized Clinical Trial of 3 Types of Physical Exercise for Patients With Parkinson Disease. JAMA Neurol. 2013;70(2):183-90. PubMed PMID: 23128427.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. AU - Shulman,Lisa M, AU - Katzel,Leslie I, AU - Ivey,Frederick M, AU - Sorkin,John D, AU - Favors,Knachelle, AU - Anderson,Karen E, AU - Smith,Barbara A, AU - Reich,Stephen G, AU - Weiner,William J, AU - Macko,Richard F, PY - 2012/11/7/entrez PY - 2012/11/7/pubmed PY - 2013/4/17/medline SP - 183 EP - 90 JF - JAMA neurology JO - JAMA Neurol VL - 70 IS - 2 N2 - OBJECTIVE: To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed, strength, and fitness for patients with Parkinson disease. DESIGN: A comparative, prospective, randomized, single-blinded clinical trial of 3 types of physical exercise. SETTING: The Parkinson's Disease and Movement Disorders Center at the University of Maryland and the Baltimore Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center. PATIENTS: A total of 67 patients with Parkinson disease who had gait impairment were randomly assigned to 1 of 3 arms of the trial. INTERVENTIONS; (1) A higher-intensity treadmill exercise (30 minutes at 70%-80% of heart rate reserve), (2) a lower-intensity treadmill exercise (50 minutes at 40%-50% of heart rate reserve), and (3) stretching and resistance exercises (2 sets of 10 repetitions on each leg on 3 resistance machines [leg press, leg extension, and curl]). These exercises were performed 3 times a week for 3 months. MAIN OUTCOME MEASURES: The primary outcome measures were gait speed (6-minute walk), cardiovascular fitness (peak oxygen consumption per unit time [$$ VO2], and muscle strength (1-repetition maximum strength). RESULTS: All 3 types of physical exercise improved distance on the 6-minute walk: lower-intensity treadmill exercise (12% increase; P=.001), stretching and resistance exercises (9% increase; P<.02), and higher-intensity treadmill exercise (6% increase; P=.07), with no between-group differences. Both treadmill exercises improved peak $$ VO2 (7%-8% increase; P<.05) more than did the stretching and resistance exercises. Only stretching and resistance improved muscle strength (16% increase; P<.001). CONCLUSIONS: The effects of exercise were seen across all 3 exercise groups. The lower-intensity treadmill exercise resulted in the greatest improvement in gait speed. Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness. Only the stretching and resistance exercises improved muscle strength. Therefore, exercise can improve gait speed, muscle strength, and fitness for patients with Parkinson disease. The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation. SN - 2168-6157 UR - https://www.unboundmedicine.com/medline/citation/23128427/full_citation L2 - https://jamanetwork.com/journals/jamaneurology/fullarticle/10.1001/jamaneurol.2013.646 DB - PRIME DP - Unbound Medicine ER -