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Cited by 515Parkinson's Disease Mechanisms and TreatmentsBalance, Gait, and Falls PreventionPhysical Activity and Health

The DOI matches its Crossref record; 43 of the 45 references it cites were found in a registry or an index.

Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial

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Schenkman, Margaret, Moore, Charity G., Kohrt, Wendy M., Hall, Deborah A., Delitto, Anthony, Comella, Cynthia L., Josbeno, Deborah A., Christiansen, Cory L., Berman, Brian D., Kluger, Benzi M., Melanson, Edward L., Jain, Samay, Robichaud, Julie A., Poon, Cynthia, Corcos, Daniel M.·2018·JAMA Neurology
DOI 10.1001/jamaneurol.2017.3517PMC PMC5838616
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Abstract

Importance: Parkinson disease is a progressive neurologic disorder. Limited evidence suggests endurance exercise modifies disease severity, particularly high-intensity exercise. Objectives: To examine the feasibility and safety of high-intensity treadmill exercise in patients with de novo Parkinson disease who are not taking medication and whether the effect on motor symptoms warrants a phase 3 trial. Design, Setting, and Participants: The Study in Parkinson Disease of Exercise (SPARX) was a phase 2, multicenter randomized clinical trial with 3 groups and masked assessors. Individuals from outpatient and community-based clinics were enrolled from May 1, 2012, through November 30, 2015, with the primary end point at 6 months. Individuals with idiopathic Parkinson disease (Hoehn and Yahr stages 1 or 2) aged 40 to 80 years within 5 years of diagnosis who were not exercising at moderate intensity greater than 3 times per week and not expected to need dopaminergic medication within 6 months participated in this study. A total of 384 volunteers were screened by telephone; 128 were randomly assigned to 1 of 3 groups (high-intensity exercise, moderate-intensity exercise, or control). Interventions: High-intensity treadmill exercise (4 days per week, 80%-85% maximum heart rate [n = 43]), moderate-intensity treadmill exercise (4 days per week, 60%-65% maximum heart rate [n = 45]), or wait-list control (n = 40) for 6 months. Main Outcomes and Measures: Feasibility measures were adherence to prescribed heart rate and exercise frequency of 3 days per week and safety. The clinical outcome was 6-month change in Unified Parkinson's Disease Rating Scale motor score. Results: A total of 128 patients were included in the study (mean [SD] age, 64 [9] years; age range, 40-80 years; 73 [57.0%] male; and 108 [84.4%] non-Hispanic white). Exercise rates were 2.8 (95% CI, 2.4-3.2) days per week at 80.2% (95% CI, 78.8%-81.7%) maximum heart rate in the high-intensity group and 3.2 (95% CI, 2.8-3.6; P = .13) days per week at 65.9% (95% CI, 64.2%-67.7%) maximum heart rate in the moderate-intensity group (P < .001). The mean change in Unified Parkinson's Disease Rating Scale motor score in the high-intensity group was 0.3 (95% CI, -1.7 to 2.3) compared with 3.2 (95% CI, 1.4 to 5.1) in the usual care group (P = .03). The high-intensity group, but not the moderate-intensity group, reached the predefined nonfutility threshold compared with the control group. Anticipated adverse musculoskeletal events were not severe. Conclusions and Relevance: High-intensity treadmill exercise may be feasible and prescribed safely for patients with Parkinson disease. An efficacy trial is warranted to determine whether high-intensity treadmill exercise produces meaningful clinical benefits in de novo Parkinson disease. Trial Registration: clinicaltrials.gov Identifier: NCT01506479.

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  1. Fahn S, Elton RL. UPDRS Program Members. Unified Parkinson's Disease Rating Scale. In: Fahn S, Marsden CD, Goldstein M, Calne DB, eds. Recent Developments in Parkinson's Disease. Vol 2. Florham Park, NJ: Macmillan Healthcare Information; 1987:153-163, 293-304.
  2. Clarke CE, Patel S, Ives N, et al; PD REHAB Collaborative Group. Physiotherapy and occupational therapy vs no therapy in mild to moderate Parkinson disease. JAMA Neurol. 2016;73 (3):291-299.

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Metadata

Authors
Schenkman, M., Moore, C. G., Kohrt, W. M., Hall, D. A., Delitto, A., Comella, C. L., Josbeno, D. A., Christiansen, C. L., Berman, B. D., Kluger, B. M., Melanson, E. L., Jain, S., Robichaud, J. A., Poon, C., & Corcos, D. M.
Affiliations
  • University of Colorado Anschutz (US)
  • University of Pittsburgh (US)
  • VA Eastern Colorado Health Care System (US)
  • Rush University Medical Center (US)
  • University of Illinois Hospital & Health Sciences System (US)
  • Northwestern University (US)
Corresponding author
Schenkman, Margaret
ORCID
Venue
JAMA Neurology
Publisher
American Medical Association (AMA)
Published
2018-02-01
Volume
75
Issue
2
Pages
219
ISSN
2168-6149 (ISSN-L)
DOI
10.1001/jamaneurol.2017.3517
PMC
PMC5838616
OpenAlex
W2773186181
Cited by
515
References
45
Citations by year
2026: 59 · 2025: 72 · 2024: 82 · 2023: 71 · 2022: 66 · 2021: 70 · 2020: 38 · 2019: 33 · 2018: 24
FWCI
18.09
Type
journal article
Language
en
Open access
Locations
  • JAMA Neurology (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • Parkinson's Disease Foundation
  • National Institutes of Health
  • National Institute of Diabetes and Digestive and Kidney Diseases (P30DK048520)
Topics
  • Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
  • Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
Keywords
Parkinson's disease, high-intensity exercise, treadmill exercise, motor symptoms, exercise adherence, exercise safety, moderate-intensity exercise, early-stage Parkinson's disease
MeSH terms
High-Intensity Interval Training, Adult, Aged, Aged, 80 and over, Exercise Test, Exercise Therapy, Female, Humans, Longitudinal Studies, Male, Middle Aged, Parkinson Disease, Retrospective Studies, Treatment Outcome

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