Walking impairment is a characteristic of functional decline in patients with PD. Current treatments are insufficient at maintaining mobility as PD develops and worsens. There appears to be increasing interest in the use of exercise to better mobility and function.
Previous research has shown that physical therapy can be a great partner to medication therapy in PD patients. Physical therapy can improve areas such as gait speed, balance, and a clinician-rated disability scale.
Lisa M. Shulman, M.D., of the University of Maryland School of Medicine, Baltimore, and her team of researchers performed a randomized clinical trial of three kinds of physical exercise to compare the effectiveness of using a treadmill, resistance exercises, and stretching in bettering walking manner, fitness, and strength for all people with PD.
The study had 67 PD patients with walking manner impairment, and each one was randomly given one of three workout plans: a high intensity treadmill workout (30 minutes at 70 to 80 percent of heart rate reserve), a low intensity treadmill workout (50 minutes at 40 to 50 percent of heart rate reserve), or stretching and resistance exercises (two sets of ten repetitions on each leg on three different machines). Participants did their exercises three times a day for three months.
The authors explain:
"The effects of exercise were seen across all three 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."
Results showed that all three types of exercise improved distance of a 6-minute walk in patients. The low-intensity workout increased the distance by 12 percent, the resistance and stretching training increased it by 9 percent, and the high-intensity exercise saw a 6 percent increase.
Both groups completing treadmill training also had better cardiovascular fitness, while stretching and resistance did not result in this outcome. The only group that showed muscle strength improvement was stretching and resistance.
The authors conclude:
"The fact that the lower-intensity treadmill exercise is the most feasible exercise for most patients with PD has important implications for clinical practice. Although treadmill and resistance training are beneficial for gait, fitness and muscle strength, these benefits were not accompanied by improvements in disability and quality of life."
The authors recommend further studies concentrating on combinations of exercise types, longer periods of training, and examination of the use of exercise on the progression of PD over time.
In an editorial, Liana S. Rosenthal, M.D., and E. Ray Dorsey, M.D., M.B.A., of The Johns Hopkins University School of Medicine, Baltimore, Md., write, "This research adds to the evidence regarding the value of interventions for PD beyond medications and surgery and offers an opportunity for patients to be active participants in their care."
They go on to suggest that putting the patient at the center of his or her care, not medication, is where patients want to be and where they should be.
Written by Kelly Fitzgerald