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Walking may ease Parkinson’s symptoms, study suggests

By Kathryn Doyle

NEW YORK (Reuters Health) – Going for regular brisk walks may improve symptoms among people with Parkinson’s disease and boost their quality of life, according to a preliminary study.

“Exercise is medicine for Parkinson’s,” Jay Alberts, from the Cleveland Clinic Lerner Research Institute in Ohio, told Reuters Health.

“This shows it doesn’t necessarily have to be super high-intensity exercise,” Alberts said. He studies motor function in Parkinson’s disease but wasn’t involved in the new research.

The study included 60 people with mild to moderate Parkinson’s disease who could walk independently without a cane or walker and had no other serious medical problems.

Researchers had the participants walk briskly, at an average pace of 2.9 miles per hour, three times a week for six months. Each walking session lasted 45 minutes. Participants kept diaries of each session and had trainers to help choose walking routes and collect the diaries.

When researchers compared results from a battery of tests conducted before and after the six months of regular walks, they found participants’ motor function, fitness, mood, tiredness, memory and thinking abilities all improved during the study, on average.

At first some participants also tried interval training - alternating every three minutes between slower and faster speeds - but researchers started assigning all new participants to continuous speed walking when knee pain became a problem in the interval group. There were no such side effects in the continuous speed group, according to results published in Neurology.

“We observed seven to 15 percent improvement in various symptoms that appeared to be clinically meaningful,” Dr. Ergun Uc told Reuters Health in an email. He led the study at the University of Iowa in Iowa City.

This was only a preliminary study, called a phase I/II trial, but Uc said he has applied for phase III trial funding to continue the research.

One limitation of the current study is that it didn’t include a group of patients who did not walk regularly for comparison.

It’s hard to compare the effectiveness of medications to that of exercise since they probably work in different ways, Uc said. He prefers to think of exercise as supplemental to medical treatment, which patients can explore with guidance from their doctors.

With a doctor’s permission, certain patients may be able to follow the aerobic component of physical activity guidelines from the U.S. Department of Health and Human Services, which recommend 150 minutes of aerobic exercise, which should feel “somewhat hard,” per week, he said.

Uc added that people with Parkinson’s disease may be discouraged from exercising due to poor general health, lack of knowledge and appreciation of the benefits of exercise, time constraints, lack of an appropriate exercise environment, depression or fear of injury and falls.

“This is probably one of the hottest topics in Parkinson’s research right now,” said Beth Fisher, who studies exercise and Parkinson’s disease at the University of Southern California in Los Angeles. She was not part of the new research.

Researchers tend to focus on the physical symptoms of Parkinson’s, like tremor, but non-motor effects are important too, Alberts said.

“This should 100 percent be a part of the treatment program,” he said. “As long as they can do these things in a safe manner and don’t have any other orthopedic reasons (not to exercise), I’m not sure there’s any reason not to recommend exercise.”

“Even if there aren’t motor benefits, there are improvements in mood, fatigue, aerobic fitness - all of these things,” he said.

There will always be debate about the optimal type, amount and intensity of exercise, he said, and researchers will probably never have a precise answer because every person is different. But the aerobic component seems to be the important part, he said.

“I always say, what do you love doing and what can you scale up in difficulty?” Fisher told Reuters Health. “If you love walking and you’re doing it from point A to point B every day outside for x amount of time, how about doing it in less time?”

SOURCE: http://bit.ly/NwhhyY Neurology, online July 2, 2014.

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