Two-Year Agility Maintenance Training Slows the Progression of Parkinsonian Symptoms.

Abstract

Parkinson's disease (PD) is a progressive neurodegenerative condition and it is unclear if long-term nonpharmaceutical interventions can slow the progression of motor and nonmotor symptoms and lower drug dose. In a randomized trial, after an initial 3-wk-long, 15-session supervised high-intensity sensorimotor agility exercise (E) program designed to improve postural instability, the exercise+maintenance (E + M, n = 19) group continued to exercise three times per week for 2 yr, whereas E (n = 16), and the no exercise and no maintenance control (C, n = 20) continued habitual living. Eight outcomes were measured before and after the 3-wk initial exercise program and then at 3, 6, 9, 12, 18, and 24 months in all patients. The group-time interactions (all P < 0.005) revealed robust and favorable effects of the initial 3-wk agility program on all six nonmotor (e.g., primary outcome Movement Disorder Society Unified Parkinson Disease Rating Scale, Motor Experiences of Daily Living, ~7 points; EuroQoL, ~9 points) and on each of the two motor outcomes (timed up and go test: ~6 s; posturography: up to 7 mm improvements in center of pressure path). E + M maintained but did not further improve the benefits produced by the initial 3-wk program. In E, the favorable effects of the 3-wk agility program lasted for 3 to 12 months. In C, patients declined steadily in all outcomes over 2 yr. By year 2, Leva-dopa equivalents increased by 99.4 mg·d (time main effect, P = 0.008). A high-intensity sensorimotor agility program with but not without a 2-yr maintenance program slowed the progression of parkinsonian symptoms.