EXERCISE IN PARKINSON'S DISEASE: WHAT DOES THE DATA TELL US ABOUT NEUROPROTECTION AND...
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Transcript of EXERCISE IN PARKINSON'S DISEASE: WHAT DOES THE DATA TELL US ABOUT NEUROPROTECTION AND...
EXERCISE IN PARKINSON'S DISEASE: WHAT DOES THE DATA TELL US ABOUT NEUROPROTECTION AND NEURORESTORATION?
Christina MarciniakThe Rehabilitation Institute of Chicago and Northwestern University
AAPMR November 2014
DISCLOSURES
I have no relevant disclosures.
DISCLOSURES
OBJECTIVES
Discuss preclinical evidence for exercise as neuro-protection in PD
Review retrospective human studies suggesting exercise is neuro-protective in PD
Discuss human studies evaluating exercise effects in neuro-restoration in PD
CUMULATIVE RCT/CCTS OF PHYSICAL THERAPY IN PD
Cumulative number of randomized and controlled clinical trials on the efficacy of physical therapy in PD Parkinson Disease
Keus et al. Physical Therapy in Parkinson’s Disease: Evolution and Future Challenges.2009;Movement Disorders:24(1)
EXERCISE PROTECTS AGAINST TOXIN INDUCED PD IN ANIMAL MODELS.
Petzinger GM et al. Effects of treadmill exercise on dopaminergic transmission in 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse model of basal ganglia injury. L Neurosci 2007; 27:5291-300.
DURATION/INTENSITY OF EXERCISE DETERMINE TOXIN EFFECTS.
3 months of exercise, but not 1 or 2 months prior to MPTP administration provided complete protection from DA loss in mice.Protein changes related to energy regulation, cellular
metabolism, cytoskeleton, intracellular signaling even Gerecke. Brain Research 2010
Mice running unrestricted, but limited in distance or time lost DA cells
Faherty. Brain Research 2005
EXERCISE ELEVATES DOPAMINE D2 RECEPTOR IN A MOUSE MODEL OF PARKINSON'S DISEASE. IN VIVO
DEC 15;25(16):2777-84N CALIFORNIA, LOS ANGELES, CALIFORNIA, USA.
Marta G. Vučković, et al. Movement Disorders. 2010 December 15;25(16):2777-2784.
EXERCISE RESULTS IN ENHANCED CONNECTIVITY
EXERCISE APPEARS NEUROPROTECTIVE IN RETROSPECTIVE HUMAN STUDIES.
Moderate or vigorous levels of physical activity are associated with lower risk of developing PDChen H et al. Physical activity and the risk of Parkinson’s disease. Neurology
2005; 64:664-9.
Regular exercise delays the appearance of parkinsonian features in persons already diagnosed with PD.
Tsia CH et al. Environmental risk factors of young-onset Parkinson’s disease: a case-control study: Clin Neurol Neurosurg 2002;104:328-33
Xu, Q. et al. Neurology 2010;75:341-348
Exercise throughout adulthood decreases PD.
Odds Ratio 0.40
PARKINSON’S AND EXERCISE
After diagnosis, persons with PD decrease their physical activity levels. Only 12-15% are referred to physiotherapy.
Thacker EL et al. Recreational physical activity and risk of Parkinson’s disease. Movement Disorders
2008; 23:69-74
Only 7-57% report being treated by a physical therapist, though there are large differences in utilization.
Nijkrake MJ et al. Allied healthcare in Parkinson’s disease: referral, consultation, and professional expertise. Movement Disorders 2009; 24:282-6.
High Intensity exercise can normalize Corticomotor excitability in early PD
Fisher, Archives PMR 2008
Subjects with PD Hoehn and Yahr Stage 1-2 randomized to 3 groupsZero intensity exercise (education)Low intensity exercise (50%) – 24 sessions over 8 weeksHigh intensity exercise (75%)– 24 treadmill training over 8 weeks
High-intensity group subjects:Clinical outcomes: Post-exercise increases in:
Increases in gait speed, step and strike lengthHip and ankle joint excursion during self-selected fast gait Improved weight distribution during sit-to stand tasks
Outcome: Corticomotor excitability measured by Transcutaneous Mag Stim Silent Period
Neurorestoration: Are thereExercise effects in PD patients?
Cortical Silent Period effects With High intensity exercise
FORCED EXERCISE AND PD: RATE VS RESISTANCE
Tandem bike used to force patients to exercise 30 % greater than preferred rate
Control group exercised at preferred rate
Ridgel, Neurorehab and Neural Repair 2009
Jay L. Alberts, Susan M. Linder, Amanda L. Penko, Mark J. Lowe1, Micheal Phillip Exerc Sport Sci Rev. 2011;39(4):177-186.
“FORCED” EXERCISE IMPROVED PD MOTOR SCORE ON THE UPDRS.
BOTH GROUPS IMPROVED THEIR AEROBIC CONDITIONING
“FORCED” CYCLING IMPROVES HAND FXN
THREE HOURS OF AEROBIC EXERCISE/DAY INCREASES BDNF IN PERSONS WITH PD
NATIONAL PARKINSON FOUNDATION DATA REGISTRY STUDY OF EXERCISE IN PD
NEURO -PROTECTION AND NEURO -RESTORATIONContinuous, deficit-targeted, intensive training may confer
neuroprotection and thereby slow, stop or reverse the progression of the disease or promote neurorestoration through adaptation of compromised signaling pathways.
However, intensity, duration and task-specific paradigms are likely important.
Barriers PD patients encounter with exercise need to be addressed
.