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May delay progression of Parkinson’s, reduce the need for medications to be started or increased (Parkinson’s evidence)

Evidence Summary
Moderate quality RCTs and systematic reviews suggest regular physical activity (PA) particularly in early disease may delay progression of disease and modify needs to medicate [1 – 3].
Increased levels of brain derived neurotrophic factor (BDNF) are stimulated by intensive rehabilitation exercises improving Parkinson’s signs in early disease [1]. PA may decrease L-dopa levels in early-stage disease thereby slowing the motor decay, delay need for increased medication and provide some neuroprotective effect [2]. A patient from a community boxing programme is quoted: ‘Makes me reduce my medication’
However, all People with Parkinson’s should do individualised programme due to variability of medications and symptoms/capability at different stages of disease progression [4].
There is also evidence to show that upper and lower limb resistance training has more benefit in the early stages of Parkinson’s [5].
The rate of disease progression for motor and physical performance has been estimated as between 2-7% per year. A 5-year study showed annual progression rates were lower in these exercisers (<1%) but supported previous studies that suggested that older age at diagnosis is associated with more rapid progression.[6]

Quality of Evidence
B Moderate quality evidence from systematic reviews, RCTs, reviews and guidelines

Strength of Recommendation
1 – A consistent message from evidence: commencing intensive physical activity early after diagnosis may delay progression and reduce need for medication if sustained especially if designed for individual needs.

Conclusion
Intensive or vigorous PA may delay progression of Parkinson’s and reduce the need for starting or increasing doses of medication. Individualised programmes should be commenced as early as possible after diagnosis.

References
[1] Frazzitta et al. Intensive rehabilitation increases BDNF serum levels in Parkinsonian patients: A randomized study. Neurorehabilitation and Neural Repair; Feb 2014; vol. 28 (no. 2); p. 163-8
[2] Frazzitta G et al. Intensive rehabilitation treatment in early Parkinson’s disease: A randomized pilot study with a 2-year follow-up. Neurorehabilitation and Neural Repair; Feb 2015; vol. 29 (no. 2); p. 123-31
[3] Domingos J et al. Implementation of a Community-Based Exercise Program for Parkinson Patients: Using Boxing as an Example. Journal of Parkinson’s disease; 2019; vol. 9 (no. 3); p. 615-62
[4] Martignon C et al. Guidelines on exercise testing and prescription for patients at different stages of Parkinson’s Disease. Aging Clin Exp Res. 2020 Jun 8.
[5] Ellis T et al. Mobilizing Parkinson’s Disease: The Future of Exercise. Journal of Parkinson’s Disease 8 (2018) S95–S100
[6] Miller et al. Rate of Progression in Activity and Participation Outcomes in Exercisers with Parkinson’s Disease: A Five-Year Prospective Longitudinal Study. Parkinson’s Disease Volume 2019, Article ID 5679187, 9 pages
[7] Tollar J et al. A High-Intensity Multicomponent Agility Intervention Improves Parkinson Patients’ Clinical and Motor Symptoms. Archives of Physical Medicine and Rehabilitation; 2018; vol. 99 (no. 12); p. 2478

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