All Parkinson’s patients reach a point in their disease where they begin to have trouble walking. Typically, a person starts to lean forward as they walk, their arms move stiffly with their strides, and they start to take shorter, shuffling steps.
This so-called gait impairment isn’t just disabling, it’s also disheartening since it is often the first time the disease becomes visible to the outside world.
Drugs and surgery may help for a time, but eventually they fail to make normal movement possible. So doctors have been testing whether exercise might help people walk and move more easily.
“There’s increasing evidence that people with Parkinson's disease who exercise do better than those who don’t, and that people who stop exercising do worse than those who continue to exercise,” says Ray Dorsey, MD, MBA, director of the Parkinson's Disease and Movement Disorders Center at Johns Hopkins University in Baltimore. Dorsey wrote an editorial on the study but was not involved in the research.
Testing Exercise in Parkinson's Disease
For the study, published in the Archives of Neurology, researchers recruited 67 people with Parkinson's disease who had begun to have trouble walking.
They randomly divided people in the study into three groups: The first group walked briskly on a treadmill, working up to 30 minutes at 70% to 80% of their maximum heart rates; the second group also walked on a treadmill, but they stuck to a normal pace, working up to 50 minutes at 40% to 50% of their maximum heart rates; and the third group stretched and did weight training exercises for their legs. All the groups worked out three times a week for three months.
At the end of the study, each had improved, but in different ways. Both types of treadmill training increased cardiovascular fitness. Resistance training increased muscle strength.
In addition, all types of exercise helped people pick up their walking pace.
The group that worked out at a lower intensity but for a longer time on the treadmill saw the biggest improvements in their walking speed. They were able to add an average of 161 feet -- about the width of a football field -- to the distance they could cover in six minutes.
People in the stretching/resistance training group also saw their walking speed improve. They added an average of 107 feet to the distance they could cover in six minutes.
Surprisingly, people who pushed themselves on the treadmill, walking at a brisk pace and on an incline, didn’t see as big a change in their walking pace as the other two groups. By the end of the study, they covered about 77 more feet in six minutes than they had when the study started.
In another surprise, better performance on the six-minute walking test didn’t translate to improvements in daily functioning at home or to less disability overall. Study researchers say they aren’t sure why people didn’t feel more of a difference in their daily lives, though they note that the tests they used might not have been able to capture the improvements.
“This data suggests that a combination of different types of exercise -- treadmill training and resistance training -- may achieve the greatest benefits,” says researcher Lisa Shulman, MD, professor of neurology at the University of Maryland School of Medicine in Baltimore.
Dorsey says he’s seen exercise work wonders for his own patients.
“I have patients who are probably more active now than they ever were before they were diagnosed,” he says. “And some of my patients look all for the world like they don’t have Parkinson’s disease. So this is really something that people can develop and own, and gain better control of a bad disease.”