A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease

Abstract

The effects of progressive resistance exercise (PRE) on the motor signs of Parkinson's disease have not been studied in controlled trials. The objective of the current trial was to compare 6-, 12-, 18-, and 24-month outcomes of patients with Parkinson's disease who received PRE with a stretching, balance, and strengthening exercise program. The authors conducted a randomized controlled trial between September 2007 and July 2011. Pairs of patients matched by sex and off-medication scores on the Unified Parkinson's Disease Rating Scale, motor subscale (UPDRS-III), were randomly assigned to the interventions with a 1:1 allocation ratio. The PRE group performed a weight-lifting program. The modified fitness counts (mFC) group performed a stretching, balance, and strengthening exercise program. Patients exercised 2 days per week for 24 months at a gym. A personal trainer directed both weekly sessions for the first 6 months and 1 weekly session after 6 months. The primary outcome was the off-medication UPDRS-III score. Patients were followed for 24 months at 6-month intervals. Of 51 patients, 20 in the PRE group and 18 in the mFC group completed the trial. At 24 months, the mean off-medication UPDRS-III score decreased more with PRE than with mFC (mean difference, -7.3 points; 95% confidence interval, -11.3 to -3.6; P<0.001). The PRE group had 10 adverse events, and the mFC group had 7 adverse events. PRE demonstrated a statistically and clinically significant reduction in UPDRS-III scores compared with mFC and is recommended as a useful adjunct therapy to improve Parkinsonian motor signs. © 2013 Movement Disorder Society.

Keywords: Parkinson's disease; Unified Parkinson's Disease Rating Scale motor subscale; progressive resistance exercise; randomized controlled trial; strength training.

Figure 1. Trial Profile

* Patients who were matched for sex and off UPDRS-III score replaced the three patients who withdrew before six-month testing. Patients who withdrew after six months were not replaced. DBS = Deep Brain Stimulation.

Figure 2. Change from Baseline Scores for All Outcomes in the Two Exercise Groups

The mean (± SE) change from baseline in the off-medication UPDRS-III score (A), the levodopa equivalent dose (B), off-medication elbow flexion torque (C), off-medication elbow flexion velocity (D), off-medication modified Physical Performance Test (E), and Parkinson’s Disease Questionnaire – 39 (F) at 6, 12, 18, and 24 months. The dashed lines indicate the Modified Fitness Counts group (mFC), and the solid lines indicate the Progressive Resistance Exercise group (PRE). Negative change scores indicate improvement in UPDRS-III score, levodopa equivalent dose, and Parkinson’s Disease Questionnaire – 39. Positive change scores indicate improvement in elbow flexion torque, elbow flexion velocity, and Modified Physical Performance Test.