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Observational Study
. 2020;10(1):267-274.
doi: 10.3233/JPD-191762.

Delayed Clinical Manifestation of Parkinson's Disease Among Physically Active: Do Participants in a Long-Distance Ski Race Have a Motor Reserve?

Tomas T Olsson  1   2 , Martina Svensson  3 , Ulf Hållmarker  4   5 , Stefan James  4 , Tomas Deierborg  3
Affiliations
Observational Study

Delayed Clinical Manifestation of Parkinson's Disease Among Physically Active: Do Participants in a Long-Distance Ski Race Have a Motor Reserve?

Tomas T Olsson et al. J Parkinsons Dis. 2020.

Erratum in

Abstract

Background: Physical activity is associated with reduced risk of Parkinson's disease (PD). The explanations for this association are not completely elucidated. We use long-term PD-incidence data from long-distance skiers to study the relationship between exercise and PD.

Objective: We aimed to investigate if physical activity is associated with long-term lower risk of PD and if this association could be explained by physically active people being able to sustain more PD neuropathology before clinical symptoms, a motor reserve.

Methods: Using a prospective observational design, we studied whether long-distance skiers of the Swedish Vasaloppet (n = 197,685), exhibited reduced incidence of PD compared to matched individuals from the general population (n = 197,684) during 21 years of follow-up (median 10, interquartile range (IQR) 5-15 years).

Results: Vasaloppet skiers (median age 36.0 years [IQR 29.0-46.0], 38% women) had lower incidence of PD (HR: 0.71; 95 % CI 0.56-0.90) compared to non-skiers. When reducing risk for reverse causation by excluding PD cases within the first five years from race participation, there was still a trend for lower risk of PD (HR: 0.80; 95 % CI 0.62-1.03). Further, the PD prevalence converged between skiers and non-skiers after 15 years of follow-up, which is more consistent with a motor reserve in the physically active rather than neuroprotection.

Conclusions: A physical active lifestyle is associated with reduced risk for PD. This association weakens with time and might be explained by a motor reserve among the physically active.

Keywords: Parkinson’s disease; Physical activity; exercise; motor reserve.

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Conflict of interest statement

The authors have no conflict of interest to report.

Figures

Fig.1
Fig.1
Two possible mechanisms of protection. A) High cognitive/motor reserve where the brain can sustain more neuropathological damage before the onset of overt clinical symptoms. B) High brain resilience may delay onset of neuropathology and then slow the rate of decline.
Fig.2
Fig.2
Cumulative incidence of PD among skiers and non-skiers. A) Cumulative incidence of PD among all skiers and non-skiers. B) Cumulative incidence of PD among all Vasaloppet participants with exclusion of diagnoses set within the first five years after baseline. HR represents hazard ratios from an unadjusted cox regression.
Fig.3
Fig.3
Kaplan Meier plots of cumulative incidence of Parkinson’s disease in subgroups with different age at participation, 39–49 years (A), 49–59 year (B), 59–69 years (C) and 69–100 years (D). HR represents hazard ratios from an unadjusted cox regression. HR represents hazard ratios from an unadjusted cox regression.
Fig.4
Fig.4
Kaplan Meier plot of Parkinson’s disease prevalence among those with the longest follow-up time. HR represents hazard ratios from an unadjusted cox regression.
Fig.5
Fig.5
Cumulative incidence of Parkinson’s disease among skiers vs. non-skiers in men (A) and women (B) separately. HR represents hazard ratios from an unadjusted cox regression.
See this image and copyright information in PMC

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