The best medicine? The influence of physical activity and inactivity on Parkinson's disease

Additive neurorestorative effects of exercise and docosahexaenoic acid intake in a mouse model of Parkinson's disease

JOURNAL/nrgr/04.03/01300535-202502000-00033/figure1/v/2024-05-28T214302Z/r/image-tiff There is a need to develop interventions to slow or reverse the degeneration of dopamine neurons in Parkinson's disease after diagnosis. Given that preclinical and clinical studies suggest benefits of dietary n-3 polyunsaturated fatty acids, such as docosahexaenoic acid, and exercise in Parkinson's disease, we investigated whether both could synergistically interact to induce recovery of the dopaminergic pathway. First, mice received a unilateral stereotactic injection of 6-hydroxydopamine into the striatum to establish an animal model of nigrostriatal denervation. Four weeks after lesion, animals were fed a docosahexaenoic acid-enriched or a control diet for the next 8 weeks. During this period, the animals had access to a running wheel, which they could use or not. Docosahexaenoic acid treatment, voluntary exercise, or the combination of both had no effect on (i) distance traveled in the open field test, (ii) the percentage of contraversive rotations in the apomorphine-induction test or (iii) the number of tyrosine-hydroxylase-positive cells in the substantia nigra pars compacta. However, the docosahexaenoic acid diet increased the number of tyrosine-hydroxylase-positive terminals and induced a rise in dopamine concentrations in the lesioned striatum. Compared to docosahexaenoic acid treatment or exercise alone, the combination of docosahexaenoic acid and exercise (i) improved forelimb balance in the stepping test, (ii) decreased the striatal DOPAC/dopamine ratio and (iii) led to increased dopamine transporter levels in the lesioned striatum. The present results suggest that the combination of exercise and docosahexaenoic acid may act synergistically in the striatum of mice with a unilateral lesion of the dopaminergic system and provide support for clinical trials combining nutrition and physical exercise in the treatment of Parkinson's disease.

The effect of multi-component exercise intervention in older people with Parkinson's disease and mild cognitive impairment: A randomized controlled study

A multimodal exercise training program might be the best way to improve motor and cognitive function in patients with Parkinson's disease (PD), but this has yet to be fully proven in PD patients with mild cognitive impairment (MCI). This study aims to examine the feasibility and effectiveness of a theory-based, multi-component exercise intervention in older people with PD-MCI. Participants were randomized into an intervention group (n=23) and an active control group (n=23), receiving the theory-based multi-component exercise intervention and Parkinson's health exercises, respectively. All participants performed 60-minute exercise training sessions three times a week over a 12-week period. The retention rate at post-intervention was 95.7% (42/46) for the entire cohort. The attendance rates were 99.6% in the intervention group and 99.5% in the control group. No adverse events occurred. The intervention group showed significantly greater improvements than the control group in global cognitive function, executive function, physical motor function, balance and gait, depression, and quality of life. This study indicates that the theory-based multi-component exercise intervention demonstrates high feasibility in promoting exercise adherence and is an effective treatment option for older adults with PD-MCI.

10 weeks low intensity treadmill exercise intervention ameliorates motor deficits and sustains muscle mass via decreasing oxidative damage and increasing mitochondria function in a rat model of Parkinson's disease

AIMS

Parkinson's disease (PD) is characterized by loss of dopamine neurons in the brain, which leads to motor dysfunction; excessive inflammation induces neuronal death. This study aimed to determine the most effective exercise modality to improve motor dysfunction in PD by comparing three different exercise regimens (low-intensity treadmill, high-intensity treadmill, and swimming).

MATERIALS AND METHODS

The rat model for PD was established through stereotaxic surgery, inducing unilateral 6-OHDA (6-hydroxydopamine) lesions. The low-intensity treadmill regimen exerted better protective effects on neurological and motor functions in a rat model of unilateral 6-OHDA-induced PD compared to high-intensity treadmill and swimming. The most suitable exercise regimen and the optimal duration of daily exercise (15 or 30 min) on motor activity and oxidative stress parameters were evaluated.

KEY FINDINGS

Comparison of 15 and 30 min low-intensity treadmill regimens (10 m/min) revealed 30 min daily exercise was the optimal duration and had more favorable impacts on neurological and motor function. Furthermore, we assessed the neuroprotective effects of exercising for 15 and 30 min per day for either four or ten weeks; 30 min of daily exercise for ten weeks improved mitochondrial function, the antioxidant defense system, neurotrophic factors, and muscle mass, and thereby provided protection against dopaminergic neuron loss, and motor dysfunction in rats with 6-OHDA-induced PD.

SIGNIFICANCE

30 min of daily low-intensity treadmill exercise over 10 weeks resulted in heightened mitochondrial function in both muscle and brain tissues, therefore, yielded a neuroprotective effect against the loss of dopaminergic neurons and motor dysfunction in PD rats.

Motor dysfunction in Parkinson's patients: depression differences in a latent growth model

Objective

This study aims to utilize latent growth model (LGM) to explore the developmental trajectory of motor dysfunction in Parkinson's disease (PD) patients and investigate the relationship between depression and motor dysfunction.

Methods

Four-year follow-up data from 389 PD patients were collected through the Parkinson's Progression Marker Initiative (PPMI). Firstly, a univariate LGM was employed to examine the developmental trajectory of motor dysfunction in PD patients. Subsequently, depression levels were introduced as covariates into the model, and depression was further treated as a parallel growth latent variable to study the longitudinal relationship between motor dysfunction and depression.

Results

In the trajectory analysis of motor dysfunction, the fit indices for the quadratic growth LGM model were χ2 = 7.419, df = 6, CFI = 0.998, TLI = 0.997, SRMR = 0.019, and RMSEA = 0.025, indicating that the growth trend of motor dysfunction follows a quadratic curve rather than a simple linear pattern. Introducing depression symptoms as time-varying covariates to explore their effect on motor dysfunction revealed significant positive correlations (β = 0.383, p = 0.026; β = 0.675, p < 0.001; β = 0.385, p = 0.019; β = 0.415, p = 0.014; β = 0.614, p = 0.003), suggesting that as depression levels increase, motor dysfunction scores also increase. Treating depression as a parallel developmental process in the LGM, the regression coefficients for depression intercept on motor dysfunction intercept, depression slope on motor dysfunction slope, and depression quadratic factor on motor dysfunction quadratic factor were 0.448 (p = 0.046), 1.316 (p = 0.003), and 1.496 (p = 0.038), respectively. These significant regression coefficients indicate a complex relationship between depression and motor dysfunction, involving not only initial level associations but also growth trends over time and possible quadratic effects.

Conclusion

This study indicates a quadratic growth trajectory for motor dysfunction in PD, suggesting a continuous increase in severity with a gradual deceleration in growth rate. The relationship between depression and motor dysfunction is complex, involving initial associations, evolving trends over time, and potential quadratic effects. Exacerbation of depressive symptoms may coincide with motor function deterioration.

Measuring Physical Functioning Using Wearable Sensors in Parkinson Disease and Chronic Obstructive Pulmonary Disease (the Accuracy of Digital Assessment of Performance Trial Study): Protocol for a Prospective Observational Study

BACKGROUND

Physical capacity and physical activity are important aspects of physical functioning and quality of life in people with a chronic disease such as Parkinson disease (PD) or chronic obstructive pulmonary disease (COPD). Both physical capacity and physical activity are currently measured in the clinic using standardized questionnaires and tests, such as the 6-minute walk test (6MWT) and the Timed Up and Go test (TUG). However, relying only on in-clinic tests is suboptimal since they offer limited information on how a person functions in daily life and how functioning fluctuates throughout the day. Wearable sensor technology may offer a solution that enables us to better understand true physical functioning in daily life.

OBJECTIVE

We aim to study whether device-assisted versions of 6MWT and TUG, such that the tests can be performed independently at home using a smartwatch, is a valid and reliable way to measure the performance compared to a supervised, in-clinic test.

METHODS

This is a decentralized, prospective, observational study including 100 people with PD and 100 with COPD. The inclusion criteria are broad: age ≥18 years, able to walk independently, and no co-occurrence of PD and COPD. Participants are followed for 15 weeks with 4 in-clinic visits, once every 5 weeks. Outcomes include several walking tests, cognitive tests, and disease-specific questionnaires accompanied by data collection using wearable devices (the Verily Study Watch and Modus StepWatch). Additionally, during the last 10 weeks of this study, participants will follow an aerobic exercise training program aiming to increase physical capacity, creating the opportunity to study the responsiveness of the remote 6MWT.

RESULTS

In total, 89 people with PD and 65 people with COPD were included in this study. Data analysis will start in April 2024.

CONCLUSIONS

The results of this study will provide information on the measurement properties of the device-assisted 6MWT and TUG in the clinic and at home. When reliable and valid, this can contribute to a better understanding of a person's physical capacity in real life, which makes it possible to personalize treatment options.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05756075; https://clinicaltrials.gov/study/NCT05756075.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/55452.

Effects of Group Exercise on Motor Function and Mobility for Parkinson Disease: A Systematic Review and Meta-Analysis

OBJECTIVE

Parkinson disease (PD) is associated with a predictable decline in motor function and mobility that is commonly managed with exercise. There is a limited understanding of the effects of group exercise compared to individual exercise (IE) and usual care (UC) on motor function and mobility. Our purpose was to investigate the effects of group exercise compared to IE and UC on motor function and mobility for people with PD.

METHODS

A systematic review and meta-analysis was performed with randomized control trials that investigated the effects of group compared with IE and UC on motor function and mobility for people with PD. A systematic search was performed in PubMed, EBSCO, and Science Direct databases. Methodological quality was assessed using the Cochrane Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

Twenty-three studies assessed at least 1 mobility-related outcome measure, met our inclusion criteria, and were included in quantitative analysis. There was no significant difference on motor function and mobility between group exercise and IE for all standardized outcome assessment meta-analyses. Motor function and mobility were significantly improved with group exercise compared to UC in 9 of 11 standardized outcome assessment meta-analyses. Results were based upon low to moderate quality of evidence.

CONCLUSION

Based upon low to moderate quality of evidence, group exercise has a similar to larger effect as IE and UC on improving motor function and mobility for people with PD. When used in combination with skilled physical therapy, group exercise may be an appropriate adjunct to individualized physical therapy to maximize mobility and function.

IMPACT

Long-term adherence to exercise is essential to maintain mobility and motor function for people with PD. Our study suggests group exercise is as effective as IE and may be an appropriate option to encourage long-term adherence related to increased access, socialization, and accountability.

Exercise as medicine in Parkinson's disease

Parkinson's disease (PD) is an incurable and progressive neurological disorder leading to deleterious motor and non-motor consequences. Presently, no pharmacological agents can prevent PD evolution or progression, while pharmacological symptomatic treatments have limited effects in certain domains and cause side effects. Identification of interventions that prevent, slow, halt or mitigate the disease is therefore pivotal. Exercise is safe and represents a cornerstone in PD rehabilitation, but exercise may have even more fundamental benefits that could change clinical practice. In PD, the existing knowledge base supports exercise as (1) a protective lifestyle factor preventing the disease (ie, primary prevention), (2) a potential disease-modifying therapy (ie, secondary prevention) and (3) an effective symptomatic treatment (ie, tertiary prevention). Based on current evidence, a paradigm shift is proposed, stating that exercise should be individually prescribed as medicine to persons with PD at an early disease stage, alongside conventional medical treatment.

Physical activity and sleep pattern in relation to incident Parkinson's disease: a cohort study

BACKGROUND

How physical activity (PA) and different sleep traits and overall sleep pattern interact in the development of Parkinson's disease (PD) remain unknown.

OBJECTIVE

To prospectively investigate the joint associations of PA and sleep pattern with risk of PD.

METHODS

Included were 339,666 PD-free participants from the UK Biobank. Baseline PA levels were grouped into low (< 600 MET-mins/week), medium (600 to < 3000 MET-mins/week) and high (≥ 3000 MET-mins/week) according to the instructions of the UK Biobank. Healthy sleep traits (chronotype, sleep duration, insomnia, snoring, and daytime sleepiness) were scored from 0 to 5 and were categorized into "ideal sleep pattern" (≥ 3 sleep scores) and "poor sleep pattern" (0-2 sleep scores). Hazard ratios (HRs) and 95% confidence intervals (CIs) of PD were estimated by Cox proportional hazards models.

RESULTS

During a median of 11.8 years of follow-up, 1,966 PD events were identified. The PD risk was lower in participants with high PA (HR = 0.73; 95% CI: 0.64, 0.84), compared to those with low PA; and participants with ideal sleep pattern also had a lower risk of PD (HR = 0.78; 95% CI: 0.69, 0.87), compared to those with poor sleep pattern. When jointly investigating the combined effect, participants with both high PA and ideal sleep pattern had the lowest risk of incident PD (HR = 0.55; 95% CI: 0.44, 0.69), compared to those with low PA and poor sleep pattern; notably, participants with high PA but poor sleep pattern also gained benefit on PD risk reduction (HR = 0.74; 95% CI: 0.55, 0.99).

CONCLUSIONS

Both high PA and ideal sleep pattern were independently associated with lower risk of developing PD, and those with both high PA level and ideal sleep pattern had the lowest risk. Our results suggest that improving PA levels and sleep quality may be promising intervention targets for the prevention of PD.

Fish oil supplementation, physical activity and risk of incident Parkinson's disease: results of longitudinal analysis from the UK Biobank

Objective

Evidence on the individual and combined relationship of physical activity (PA) and fish oil supplement use on the incidence of Parkinson's disease (PD) risk remains lacking.

Materials and methods

This UK population-based prospective cohort study, involving 385,275 UK Biobank participants, collected PA and fish oil supplement data via touchscreen questionnaires. Using Cox proportional hazards models and restricted cubic splines to examined the associations between use of fish oil supplements, PA and PD risk.

Results

During a median 12.52-year follow-up, 2,131 participants incident PD. Analysis showed that fish oil supplement users had a lower PD risk [hazard ratio (HR), 0.89; 95% confidence interval (CI), 0.82-0.98]. The adjusted HRs for the PD incidence were 0.96 (95% CI, 0.95-0.98) for total PA; 0.93 (95% CI, 0.90-0.96) for moderate PA; 0.95 (95% CI, 0.91-0.99) for vigorous PA and 0.93 (95% CI, 0.89-0.98) for walking activity. Significant interactions were found between fish oil supplement use and total PA (P for interaction = 0.011), moderate PA (P for interaction = 0.015), and walking activity (P for interaction = 0.029) in relation to PD incidence.

Conclusion

Both fish oil supplement use and PA were associated with a reduced risk of PD, and the effect of PA in reducing the risk of PD was more pronounced when fish oil supplement was used.

Association of allergic disease with Parkinson's disease: A nationally representative retrospective cohort study

BACKGROUND

The association of allergic diseases such as allergic rhinitis, asthma, and atopic dermatitis with Parkinson's disease (PD) risk is yet unclear. In the few preceding studies, a short follow-up duration was followed for a relatively small study population, and lifestyle behaviors were not adjusted for. Therefore, there is a need for large-scale observation studies on the association of allergic disease with PD risk after considering lifestyle behaviors.

METHODS

The study population consisted of 398,936 participants aged 40 years or older who underwent health screening before 1 January 2005 from the Korean National Health Insurance Service database. Starting from 1 January 2005, all participants were followed up until the date of PD event, death, or 31 December 2019. The adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the risk of PD were calculated using multivariable Cox proportional hazards regression.

RESULTS

Compared to non-allergic disease participants, allergic disease patients had a higher risk for PD (aHR 1.18, 95% CI 1.07-1.30) and especially, allergic rhinitis patients had a higher risk for PD (aHR 1.14, 95% CI 1.00-1.29). Allergic disease was associated with a higher risk for PD (aHR 1.24, 95% CI 1.01-1.52) among participants who were never smokers, did not consume alcohol, and exercised regularly.

CONCLUSIONS

Allergic rhinitis was associated with a higher risk for PD compared to participants without allergic rhinitis. This risk-increasing association of allergic rhinitis with PD was preserved even among people with healthy lifestyle behaviors.

Association of accelerometer-measured physical activity intensity, sedentary time, and exercise time with incident Parkinson's disease

Evidence regarding the association between physical activity and Parkinson's disease (PD) risk is generally limited due to the use of self-report questionnaires. We aimed to quantify the separate and combined effects of accelerometer-measured light physical activity (LPA), moderate-to-vigorous physical activity (MVPA), sedentary time and exercise timing with incident PD. 96,422 participants without prior PD and with usable accelerometer data were included from UK Biobank. Time spent in sedentary activity, LPA, MVPA, and exercise timing were estimated using machine learning models. The study outcome was incident PD. Over a median follow-up duration of 6.8 years, 313 participants developed PD. There was a L-shaped association for LPA and MVPA, and a reversed L-shaped association for sedentary time, with the risk of incident PD (all P for nonlinearity < 0.001). Similar trends were found across three time-windows (morning, midday-afternoon, and evening). Compared with those with both low LPA (<3.89 h/day) and low MVPA (<0.27 h/day), the adjusted HR (95% CI) of PD risk was 0.49 (0.36-0.66), 0.19 (0.36-0.66) and 0.13 (0.09-0.18), respectively, for participants with high MVPA only, high LPA only, and both high LPA and high MVPA. Moreover, participants with both low LPA and high sedentary time (≥9.41 h/day) (adjusted HR, 5.59; 95% CI: 4.10-7.61), and those with both low MVPA and high sedentary time (adjusted HR, 3.93; 95% CI: 2.82-5.49) had the highest risk of incident PD. In conclusion, regardless of exercise timing (morning, midday-afternoon, and evening), there was an inverse association for accelerometer-measured MVPA and LPA, and a positive association for sedentary time, with incident PD.

Muscle strength and spatiotemporal gait parameters in people with Parkinson´s disease. A pilot study

INTRODUCTION

Muscle weakness in persons with Parkinson disease (PD) has been frequently recognized as a nonspecific symptom. In other neurological conditions, lower limb weakness, specifically quadriceps weakness, is the factor that causes greater gait disability. Little research has evaluated the relationship between lower limb muscle strength, using objective tools, in PD persons and gait performance. The aim of this study was to analyze the correlation between lower limb muscle strength, using an isokinetic dynamometer, and the spatiotemporal gait parameters in PD, compared with age- and sex- matched healthy controls.

SUBJECTS AND METHODS

The study was conducted with 7 persons with PD -Hoehn and Yahr (HY) between II-III- and 7 healthy controls. Isokinetic knee and ankle tests at 60 and 120°/s and the 10-meter walking test at comfortable and fast walking speed, were performed on all recruited subjects.

RESULTS

Significant differences in lower limb strength-related measures and gait parameters were observed between persons with PD and controls. Gait parameters showed excellent correlations (rho = 0.7) for both lower limb: ankle plantar flexion work/body wearing at 180°/s with number of steps (indirect) and stride (direct) at both speeds, and between the ankle plantar flexion peak torque/ body wearing at 180°/s with number of steps (indirect) and stride (direct) at maximum speed; and between knee extension work/body wearing at 60°/s) with stride (direct) at self-selected speed.

CONCLUSIONS

Persons with PD (HY II-III stages) lower limb muscle strength correlates excellently with gait pattern, showing lower isokinetic strength than healthy subjects of the same age and sex. This protocol showed safety to be performed in a larger sample.

Association of Physical Activity and Parkinson Disease in Women: Long-term Follow-up of the E3N Cohort Study

BACKGROUND AND OBJECTIVES

Previous cohort studies reported that a single measure of physical activity (PA) assessed at baseline was associated with lower Parkinson disease (PD) incidence, but a meta-analysis suggested that this association was restricted to men. Because of the long prodromal phase of the disease, reverse causation could not be excluded as a potential explanation. Our objective was to study the association between time-varying PA and PD in women using lagged analyses to address the potential for reverse causation and to compare PA trajectories in patients before diagnosis and matched controls.

METHODS

We used data from the Etude Epidémiologique auprès de femmes de la Mutuelle Générale de l'Education Nationale (1990-2018), a cohort study of women affiliated with a national health insurance plan for persons working in education. PA was self-reported in 6 questionnaires over the follow-up. As questions changed across questionnaires, we created a time-varying latent PA (LPA) variable using latent process mixed models. PD was ascertained using a multistep validation process based on medical records or a validated algorithm based on drug claims. We set up a nested case-control study to examine differences in LPA trajectories using multivariable linear mixed models with a retrospective timescale. Cox proportional hazards models with age as the timescale and adjusted for confounders were used to estimate the association between time-varying LPA and PD incidence. Our main analysis used a 10-year lag to account for reverse causation; sensitivity analyses used 5-, 15-, and 20-year lags.

RESULTS

Analyses of trajectories (1,196 cases and 23,879 controls) showed that LPA was significantly lower in cases than in controls throughout the follow-up, including 29 years before diagnosis; the difference between cases and controls started to increase ∼10 years before diagnosis (p interaction = 0.003). In our main survival analysis, of 95,354 women free of PD in 2000, 1,074 women developed PD over a mean follow-up of 17.2 years. PD incidence decreased with increasing LPA (p trend = 0.001), with 25% lower incidence in those in the highest quartile compared with the lowest (adjusted hazard ratio 0.75, 95% CI 0.63-0.89). Using longer lags yielded similar conclusions.

DISCUSSION

Higher PA level is associated with lower PD incidence in women, not explained by reverse causation. These results are important for planning interventions for PD prevention.

Natural Walking Intensity in Persons With Parkinson Disease

BACKGROUND AND PURPOSE

Few persons with Parkinson disease (PD) appear to engage in moderate-intensity walking associated with disease-modifying health benefits. How much time is spent walking at lower, yet still potentially beneficial, intensities is poorly understood. The purpose of this exploratory, observational study was to describe natural walking intensity in ambulatory persons with PD.

METHODS

Accelerometer-derived real-world walking data were collected for more than 7 days at baseline from 82 participants enrolled in a PD clinical trial. Walking intensity was defined according to the number of steps in each active minute (1-19, 20-39, 40-59, 60-79, 80-99, or ≥100 steps). Daily minutes of walking and duration of the longest sustained walking bout were calculated at each intensity. Number of sustained 10 to 19, 20 to 29, and 30-minute bouts and greater at any intensity also were calculated. Values were analyzed in the context of physical activity guidelines.

RESULTS

Most daily walking occurred at lower intensities (157.3 ± 58.1 min of 1-19 steps; 81.3 ± 32.6 min of 20-39 steps; 38.2 ± 21.3 min of 40-59 steps; 15.1 ± 11.5 min of 60-79 steps; 7.4 ± 7.0 min of 80-99 steps; 7.3 ± 9.6 min of ≥100 steps). The longest daily sustained walking bout occurred at the lowest intensity level (15.9 ± 5.2 min of 1-19 steps). Few bouts lasting 20 minutes and greater occurred at any intensity.

DISCUSSION AND CONCLUSIONS

Despite relatively high daily step counts, participants tended to walk at remarkably low intensity, in bouts of generally short duration, with relatively few instances of sustained walking. The findings reinforced the need for health promotion interventions designed specifically to increase walking intensity.Video Abstract available for more insight from authors (see the Video, Supplemental Digital Content 1 available at: http://links.lww.com/JNPT/A426 ).

Effects of non-invasive brain stimulation on walking and balance ability in Parkinson's patients: A systematic review and meta-analysis

Objective

To investigate and contrast the effects of non-invasive brain stimulation (NIBS), including repeated transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), on walking and balance ability in patients with Parkinson's disease (PD).

Methods

The PubMed, Embase, Medline, Cochrane, CNKI, and Chinese WanFang databases were searched up to June 2022. Quality assessment was performed using the Cochrane Collaboration's risk-of-bias guidelines, and the standardized mean differences (SMD) or mean differences (MD) for each outcome were calculated.

Results

Among 32 eligible studies, including 1,586 participants were analyzed in this meta-analysis. The results of the meta-analysis showed that NIBS was effective in improving UPDRS-III scores (MD = -2.07; 95% CI, -2.62 to -1.53; P < 0.00001; I 2 = 6%) and variables associated with the ability of walk such as step width (SMD = 0.35; 95% CI, 0.16-0.55; P = 0.0005; I 2 = 38%), cadence (SMD = 0.3; 95% CI, 0.05 to 0.55; P = 0.02; I 2 = 25%), and 6MWT (MD = 62.86; 95% CI, 39.43-86.29; P < 0.00001; I 2 = 0%). In subgroup analyses across intervention types, UPDRS-III scores (rTMS: MD = -2.54; 95% CI, -3.16 to -1.92; P < 0.00001; I 2 = 0%; tDCS: MD = -1.20; 95% CI, -1.99 to -0.40; P = 0.003; I 2 = 0%) and TUGT time (rTMS: MD = -4.11; 95% CI, -4.74 to -3.47; P < 0.00001; I 2 = 0%; tDCS: MD = -0.84; 95% CI, -1.48 to -0.21; P = 0.009; I 2 = 0%) significantly improved. Moreover, our results also showed that compared to tDCS, rTMS was more significant in improving UPDRS-III scores and TUGT time (p < 0.05).

Conclusion

NIBS benefits some walking ability variables but not balance ability in 36 patients with PD. The rTMS significantly improved UPDRS-III scores and TUGT time compared to tDCS. Further studies are needed to determine the optimal protocol and to illuminate effects based on the ideal target brain regions, stimulation intensity, timing, and type of intervention.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42022350782.

Objective and subjective measures of daily physical activity in persons with Multiple Sclerosis beginning a rehabilitation regime: A cross-sectional study

INTRODUCTION

Fatigue, and balance and gait disorders can impact on physical activity (PA) levels in persons with Multiple Sclerosis (pwMS). To date, several studies have examined PA in pwMS during daily life, but little is known about PA levels in pwMS during a rehabilitation period. The present study investigated PA levels (daily steps, light physical activity (LPA), and moderate-vigorous physical activity (MVPA)) in inpatient and outpatients with MS during their rehabilitation period and described the relationship between objectively measured PA and levels of disability, quality of life, fatigue, and self-efficacy.

METHODS

In this exploratory cross-sectional study, we examined 40 pwMS during their inpatient or outpatient rehabilitation regime. Participants included in the study (N = 34) wore a Fitbit Versa tracker for one week recording daily steps, minutes of LPA, and minutes of MVPA (primary outcomes). They underwent a clinical assessment of physical activity levels (Godin Leisure-Time Exercise Questionnaire(GLTEQ)), fatigue (Fatigue Severity Scale(FSS)), walking ability (10 Meter Walk Test(10MWT), 2-Min Walk Test(2MWT), 12-item Multiple Sclerosis Walking scale(MSWS-12)), quality of life (12-Item Short Form Survey (SF-12)), and self-efficacy (Self-Efficacy in Multiple Sclerosis scale (SEMS)) (secondary outcomes). Multiple linear regressions (MLR) models were used to test whether the demographic difference between the two groups influenced the estimation of objective variables measured by Fitbit. Finally, correlations between objectively measured physical activity and subjective clinical scales were estimated with Spearman correlations.

RESULTS

Our sample consisted of 21 females and 13 males with a mean (interquartile range) age of 52 (20) years and an Expanded Disability Status scale(EDSS) score of 6.0 (1.50) points; baseline characteristics of inpatients (N = 18) and outpatients (N = 16) differed statistically only in EDSS levels (p-value = 0.008) and use of assistive devices (p=0.007). The whole sample performed (mean±standard deviation) 3969±2190 steps per day, with no significant difference between inpatients (3318±1515) and outpatients (4660±2606). No statistical difference was found between the groups in LPA (p-value=0.064). A significant difference in MVPA (p-value < 0.001) was found between inpatients and outpatients, 1.52±3.98 and 14.69±11.56 min per day, respectively. Significant correlations were found between FSS and MVPA both in the whole sample (r(32)= -0.62, p < 0.001) and in the outpatients group (r(14) = -0.66, p = 0.005), and between 10MWT and daily steps (whole sample:(r(32) = 0.48, p = 0.005), outpatients:(r(14)= -0.51, p = 0.05)).

CONCLUSIONS

PwMS in our study overall engaged in reduced and less intense levels of daily PA with respect to the guidelines with inpatients performing almost no vigorous activities. Considering the importance of PA in improving physical and mental well-being, clinicians and researchers should develope strategies to increase daily PA of PwMS during their rehabilitation programs and daily life.

Molecular and Cellular Interactions in Pathogenesis of Sporadic Parkinson Disease

An increasing number of the population all around the world suffer from age-associated neurodegenerative diseases including Parkinson’s disease (PD). This disorder presents different signs of genetic, epigenetic and environmental origin, and molecular, cellular and intracellular dysfunction. At the molecular level, α-synuclein (αSyn) was identified as the principal molecule constituting the Lewy bodies (LB). The gut microbiota participates in the pathogenesis of PD and may contribute to the loss of dopaminergic neurons through mitochondrial dysfunction. The most important pathogenetic link is an imbalance of Ca²⁺ ions, which is associated with redox imbalance in the cells and increased generation of reactive oxygen species (ROS). In this review, genetic, epigenetic and environmental factors that cause these disorders and their cause-and-effect relationships are considered. As a constituent of environmental factors, the example of organophosphates (OPs) is also reviewed. The role of endothelial damage in the pathogenesis of PD is discussed, and a ‘triple hit hypothesis’ is proposed as a modification of Braak’s dual hit one. In the absence of effective therapies for neurodegenerative diseases, more and more evidence is emerging about the positive impact of nutritional structure and healthy lifestyle on the state of blood vessels and the risk of developing these diseases.

Parkinson's Disease: Risk Factor Modification and Prevention

The global burden of Parkinson's disease (PD) has increased from 2.5 to 6.1 million since the 1990s. This is expected to rise as the world population ages and lives longer. With the current consensus on the existence of a prediagnostic phase of PD, which can be divided into a preclinical stage and a prodromal stage, we can better define the risk markers and prodromal markers of PD in the broader context of PD pathogenesis. Here, we review this pathogenetic process, and discuss the evidence behind various heritability factors, exposure to pesticides and farming, high dairy consumption, and traumatic brain injuries that have been known to raise PD risk. Physical activity, early active lifestyle, high serum uric acid, caffeine consumption, exposure to tobacco, nonsteroidal anti-inflammatory drugs, and calcium channel blockers, as well as the Mediterranean and the MIND diets are observed to lower PD risk. This knowledge, when combined with ways to identify at-risk populations and early prodromal PD patients, can help the clinician make practical recommendations. Most importantly, it helps us set the parameters for epidemiological studies and create the paradigms for clinical trials.

Systematic review for the prevention and management of falls and fear of falling in patients with Parkinson's disease

OBJECTIVE

To synthesize recent empirical evidence for the prevention and management of falls and fear of falling in patients with Parkinson's disease (PD).

DATA SOURCE

Database from PubMed, Cochrane Library, and EMBASE.

STUDY DESIGN

Systematic review.

DATA COLLECTION

We searched the PubMed, Cochrane Library, and EMBASE databases for studies published from inception to February 27, 2021. Inclusion criteria were nonreview articles on prevention and management measures related to falls and fall prevention in Parkinson's disease patients.

PRINCIPAL FINDINGS

We selected 45 articles and conducted in-depth research and discussion. According to the causes of falls in PD patients, they were divided into five directions, namely physical status, pre-existing conditions, environment, medical care, and cognition. In the cognitive domain, we focused on the fear of falling. On the above basis, we constructed a fall prevention model, which is a tertiary prevention health care network, based on The Johns Hopkins Fall Risk Assessment Tool to provide ideas for the prevention and management of falling and fear of falling in PD patients in clinical practice CONCLUSIONS: Falls and fear of falls in patients with Parkinson's disease can be reduced by effective clinical prevention and management. Future studies are needed to explore the efficacy of treatment and prevention of falls and fear of falls.

Association of Diet and Physical Activity With All-Cause Mortality Among Adults With Parkinson Disease

IMPORTANCE

Greater diet quality and physical activity level are associated with a lower risk of developing Parkinson disease (PD). However, information regarding the association between lifestyle behaviors and survival after PD diagnosis remains limited.

OBJECTIVE

To examine the association of prediagnosis and postdiagnosis overall diet quality and physical activity with all-cause mortality among individuals with PD.

DESIGN, SETTING, AND PARTICIPANTS

This population-based cohort study analyzed male participants in the Health Professionals Follow-up Study from 1986 to 2012 and female participants in the Nurses' Health Study from 1984 to 2012. Participants who were diagnosed with PD and had complete baseline dietary assessment data were included. Data were analyzed from January 2021 to February 2022.

EXPOSURES

Prediagnosis diet quality, assessed by the Alternative Healthy Eating Index (AHEI), and physical activity, assessed by metabolic equivalent task (MET) hours per week reported on questionnaires, were the primary exposures of interest to minimize reverse causation.

MAIN OUTCOMES AND MEASURES

Mortality, which was followed up until 2018, was the primary outcome. Cox proportional hazards regression models were used to estimate the association of diet and physical activity with mortality individually and jointly, and the models were adjusted for age, total energy intake, caffeine intake, and other lifestyle risk factors.

RESULTS

The sample comprised 1251 individuals with PD, which included 652 men (52.1%) with a median (IQR) age at diagnosis of 73.4 (67.5-78.7) years. During the 32 to 34 years of follow-up, 942 participants died. The adjusted hazard ratio (HR) comparing the highest vs the lowest AHEI quartile was 0.69 (95% CI, 0.56- 0.85) for prediagnosis analyses and 0.57 (95% CI, 0.42-0.78) for postdiagnosis analyses. Similar results were obtained for cumulative mean MET hours per week in the prediagnosis analyses (HR, 0.71; 95% CI, 0.57-0.87) and postdiagnosis analyses (HR, 0.47; 95% CI, 0.35-0.63). The inverse association persisted for PD-specific mortality (postdiagnosis AHEI: HR, 0.52 [95% CI, 0.33-0.80]; postdiagnosis physical activity: HR, 0.37 [95% CI, 0.25-0.55]). In the joint analyses of diet quality and physical activity before the PD diagnosis, the adjusted HR was 0.51 (95% CI, 0.36-0.73) for individuals in the highest vs lowest tertiles for both variables. The HR for diet quality and physical activity after the diagnosis was 0.35 (95% CI, 0.23-0.52).

CONCLUSIONS AND RELEVANCE

Results of this study showed that a healthy dietary pattern and an active lifestyle were associated with a lower rate of all-cause mortality among individuals with PD. Consuming a healthy diet and engaging in physical activity or exercise could be targeted to improve PD outcomes.

Parkinson's disease and intensive exercise therapy - An updated systematic review and meta-analysis

In 2015, Uhrbrand et al. published the first review on Parkinson´s disease (PD) and exercise entirely based on randomized controlled trials (RCT) applying strict exercise definitions. The present review aimed to update the PD literature by assessing the effects of different intensive exercise modalities: resistance training (RT), endurance training (ET), and other intensive exercise modalities (OITM). An updated systematic literature search identified 33 new RCTs. Qualitative and quantitative analyses were performed. A total of 18 RT, 14 ET, and 1 OITM studies were identified (adding to the 8 RT, 6 ET, and 4 OITM studies identified by Uhrbrand et al. in 2015). RT, ET, and OITM were feasible, safe, and did not worsen PD symptoms. Furthermore, RT, ET, and OITM may positively affect functional outcomes (e.g., balance) and depressive symptoms in PD but inconsistencies across these findings warrant cautious conclusions. Meta-analyses showed that RT had a positive impact on muscle strength (standardized mean difference (SMD) = 0.83 [95% CI;0.54, 1.12]), functional capacity (Timed Up and Go Test (TUG): SMD = -0.62 [-1.01, -0.24]), and quality of life (SMD = -0.41 [-0.72, -0.09]), while ET had a positive impact on cardiorespiratory fitness (SMD = 0.27 [0.07, 0.47]) and functional capacity (TUG: SMD = -0.21 [-0.46, 0.04], 6-Min Walk Test: SMD = 0.89 [0.17, 1.62]), and a potentially positive impact on "on-medication" UPDRS-III (SMD = -0.15 [-0.38, 0.09]) and "off-medication" UPDRS-III (SMD = -0.19 [-0.41, 0.04]). In conclusion, RT, ET, and OITM all represent safe, feasible, and beneficial adjunct rehabilitation strategies in PD, with particularly RT and ET showing solid effects.

A theoretical framework for addressing fear of falling avoidance behavior in Parkinson's disease

Postural instability in Parkinson's disease (PD) is associated with several downstream consequences that ultimately lead to a greater risk of falling. Among the prominent downstream consequences is fear of falling (FOF), which is both common and problematic in PD. It can lead to a vicious cycle of FOF avoidance behavior that results in more sedentary behavior, physical deconditioning, and weakening of already impaired balance systems. This, in turn, may make the person with PD more susceptible to a future fall even with benign daily tasks. While FOF activity avoidance can be adaptive (appropriate), it can also be maladaptive (inappropriate or exaggerated). When this adaptive and maladaptive FOF avoidance behavior is contextualized to gait/balance performance, it provides a theoretical framework that can be used by clinicians to match patterns of behavior to a concordant treatment approach. In the theoretical framework proposed in this perspective, four different patterns related to FOF avoidance behavior and gait/balance performance are suggested: appropriate avoiders, appropriate non-avoiders, inappropriate avoiders, and inappropriate non-avoiders. For each of the four FOF avoidance behavior patterns, this paper also provides suggested treatment focuses, approaches and recommendations.

Six-Month Community-Based Brisk Walking and Balance Exercise Alleviates Motor Symptoms and Promotes Functions in People with Parkinson's Disease: A Randomized Controlled Trial

BACKGROUND

In Parkinson's disease (PD), sustained aerobic exercise is a promising therapy in delaying motor disability. Brisk walking is a moderate intensity aerobic training, which could be translated to community practice at low cost, but its effects on motor symptoms remains unclear.

OBJECTIVE

To determine the effectiveness of a six-month brisk walking and balance program in alleviating motor symptoms, and promoting functional, gait, and balance performance in people with PD.

METHODS

Seventy individuals with mild to moderate PD were randomly assigned to a brisk walking (BW) group or an active control (CON) group. BW group received ten 90-minute supervised brisk walking and balance exercise for six months (weeks 1-6: once/week, weeks 7-26: once/month). CON group received upper limb training. Both groups performed 2-3 self-practice sessions weekly. Primary outcome was Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score. Secondary outcomes were fast gait speed (FGS), timed-up-and-go (TUG) time, six-minute walk distance (6MWD), and Mini-Balance Evaluation Systems Test (Mini-BEST) score.

RESULTS

Sixty-four participants (33 BW/31 CON) completed training. BW group showed greater significant decreases from baseline than CON group in MDS-UPDRS motor score after six weeks (-5.5 vs -1.6, p < 0.001) and 6 months (-6.0 vs -1.4, p < 0.001) of training. BW group also showed greater significant improvement from the baseline than CON group for TUG time, FGS, 6MWD, and mini-BEST score (all p < 0.05).

CONCLUSION

The six-month brisk walking and balance program alleviates motor symptoms, promotes functional and gait performance, walking capacity, and dynamic balance in people with mild to moderate PD.

Neural Suppression Elicited During Motor Imagery Following the Observation of Biological Motion From Point-Light Walker Stimuli

Introduction: Advantageous effects of biological motion (BM) detection, a low-perceptual mechanism that allows the rapid recognition and understanding of spatiotemporal characteristics of movement via salient kinematics information, can be amplified when combined with motor imagery (MI), i.e., the mental simulation of motor acts. According to Jeannerod's neurostimulation theory, asynchronous firing and reduction of mu and beta rhythm oscillations, referred to as suppression over the sensorimotor area, are sensitive to both MI and action observation (AO) of BM. Yet, not many studies investigated the use of BM stimuli using combined AO-MI tasks. In this study, we assessed the neural response in the form of event-related synchronization and desynchronization (ERD/S) patterns following the observation of point-light-walkers and concordant MI, as compared to MI alone. Methods: Twenty right-handed healthy participants accomplished the experimental task by observing BM stimuli and subsequently performing the same movement using kinesthetic MI (walking, cycling, and jumping conditions). We recorded an electroencephalogram (EEG) with 32 channels and performed time-frequency analysis on alpha (8-13 Hz) and beta (18-24 Hz) frequency bands during the MI task. A two-way repeated-measures ANOVA was performed to test statistical significance among conditions and electrodes of interest. Results: The results revealed significant ERD/S patterns in the alpha frequency band between conditions and electrode positions. Post hoc comparisons showed significant differences between condition 1 (walking) and condition 3 (jumping) over the left primary motor cortex. For the beta band, a significantly less difference in ERD patterns (p < 0.01) was detected only between condition 3 (jumping) and condition 4 (reference). Discussion: Our results confirmed that the observation of BM combined with MI elicits a neural suppression, although just in the case of jumping. This is in line with previous findings of AO and MI (AOMI) eliciting a neural suppression for simulated whole-body movements. In the last years, increasing evidence started to support the integration of AOMI training as an adjuvant neurorehabilitation tool in Parkinson's disease (PD). Conclusion: We concluded that using BM stimuli in AOMI training could be promising, as it promotes attention to kinematic features and imitative motor learning.

A Systematic Review on Physical Health Education Interventions for People with Parkinson's Disease: Content, Impact, and Implementation Considerations Across the Parkinson's Trajectory

BACKGROUND

Educational interventions promoting the role of physical activity (PA) aim to address knowledge, poor exercise self-efficacy, and low outcome expectations, which are well-researched barriers to PA participation in healthy and in people with chronic conditions. However, little is known about the effectiveness of educational interventions in addressing these barriers in people with Parkinson's (PwP).

OBJECTIVE

To examine the content of education interventions that promote PA behavior in PwP, and to assess their effectiveness on physical and psychosocial outcomes.

METHODS

An electronic search (12/2021) of MEDLINE, EMBASE, CINAHL, PubMed PsycINFO, the Web of Science and the Cochrane Library was conducted from 1990 to 2021. Education interventions, alone or combined with other strategies, promoting PA in PwP were included. Quality was assessed using the Johanna Briggs Institute and National Institute of Health quality assessment tools. A narrative synthesis was performed.

RESULTS

Six studies were identified. Five interventions were comprised of education and exercise sessions. Improvement in physical and psychosocial outcomes were suggested but delineating the exact impact of education was impeded due to lack of assessment.

CONCLUSION

Few interventions exist that provide knowledge, and skills promoting PA participation, and fewer are addressed towards newly diagnosed PwP. There is lack of assessment over the effectiveness of education as a tool to facilitate PA participation in PwP. Lack of assessment poses the risk of potentially disregarding effective interventions or adopting ineffective approaches without the evidence. Education interventions can boost PA engagement by increasing factors such as exercise self-efficacy, but further interventions are required to assess this model of relationship.

High-intensity training induces non-stoichiometric changes in the mitochondrial proteome of human skeletal muscle without reorganisation of respiratory chain content

Mitochondrial defects are implicated in multiple diseases and aging. Exercise training is an accessible, inexpensive therapeutic intervention that can improve mitochondrial bioenergetics and quality of life. By combining multiple omics techniques with biochemical and in silico normalisation, we removed the bias arising from the training-induced increase in mitochondrial content to unearth an intricate and previously undemonstrated network of differentially prioritised mitochondrial adaptations. We show that changes in hundreds of transcripts, proteins, and lipids are not stoichiometrically linked to the overall increase in mitochondrial content. Our findings suggest enhancing electron flow to oxidative phosphorylation (OXPHOS) is more important to improve ATP generation than increasing the abundance of the OXPHOS machinery, and do not support the hypothesis that training-induced supercomplex formation enhances mitochondrial bioenergetics. Our study provides an analytical approach allowing unbiased and in-depth investigations of training-induced mitochondrial adaptations, challenging our current understanding, and calling for careful reinterpretation of previous findings.

Association of Physical Activity, Including Amount and Maintenance, With All-Cause Mortality in Parkinson Disease

Importance

The protective effects of physical activity (PA) against Parkinson disease (PD) development have been suggested; however, the association of PA with mortality in PD has rarely been investigated.

Objective

To evaluate the association between PA and mortality in individuals with PD and determine how the amount and maintenance of PA are associated with mortality.

Design, Setting, and Participants

This nationwide population-based cohort study used Korean National Health Insurance System data. Participants were included from January 1, 2010, and December 31, 2013, and were followed up until December 31, 2017. Data were analyzed from September 2020 to March 2021. Individuals who were newly diagnosed with PD were selected using the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision code G20 and registration code V124 in the program for rare intractable diseases in 2010 through 2013. Individuals who underwent health checkups within 2 years before and after the PD diagnosis were enrolled. Those aged younger than 40 years or with missing data were excluded.

Exposures

Physical activity levels were collected using self-reported questionnaires.

Main Outcomes and Measures

All-cause mortality.

Results

A total of 45 923 individuals were identified; 10 987 were enrolled, and 34 individuals younger than 40 years and 254 with missing data were excluded. A total of 10 699 individuals with PD were included; 4925 (46%) were male and 5774 (54%) were female, and the mean (SD) age was 69.2 (8.8) years. During the 8-year follow-up period, there were 1823 deaths (17%). The mortality rate was lower among individuals who were physically active vs inactive at all PA intensities (vigorous: hazard ratio [HR], 0.80 [95% CI, 0.69-0.93]; moderate: HR, 0.66 [95% CI, 0.55-0.78]; light: HR, 0.81 [95% CI, 0.73-0.90]). There was a significant inverse dose-response association between the total amount of PA and mortality (HRs: vigorous, 0.80 [95% CI, 0.69-0.93]; moderate, 0.66 [95% CI, 0.55-0.78]; light, 0.81 [95% CI, 0.73-0.90]; P < .001). Moreover, maintenance of PA was associated with the mortality rate. Individuals with PD who were physically active both before and after the PD diagnosis had the greatest reduction in mortality rate across all PA intensities (HRs: vigorous, 0.66 [95% CI, 0.50-0.88]; moderate, 0.49 [95% CI, 0.32-0.75]; light, 0.76 [95% CI, 0.66-0.89]). Individuals who started PA after receiving the PD diagnosis had a lower mortality rate than those who remained physically inactive (HRs: vigorous, 0.82 [95% CI, 0.70-0.97]; moderate, 0.69 [95% CI, 0.57-0.83]; light, 0.86 [95% CI, 0.78-0.98]).

Conclusions and Relevance

This analysis found a dose-response association between PA and all-cause mortality in PD. Reverse causality may exist, and future prospective randomized clinical trials are warranted to determine the effect of PA on mortality in PD.

Running to save sight: The effects of exercise on retinal health and function

The benefits of exercise to human health have long been recognised. However, only in the past decade have researchers started to discover the molecular benefits that exercise confers, especially to the central nervous system (CNS). These discoveries include the magnitude of molecular messages that are communicated from skeletal muscle to the CNS. Despite these advances in understanding, very limited studies have been conducted to decipher the molecular benefits of exercise in retinal health and disease. Here, we review the latest work on the effects of exercise on the retina and discuss its effects on the wider CNS, with a focus on demonstrating the potential applicability and comparative molecular mechanisms that may be occurring in the retina. This review covers the key molecular pathways where exercise exerts its effects: oxidative stress and mitochondrial health; inflammation; protein aggregation; neuronal health; and tissue crosstalk via extracellular vesicles. Further research on the benefits of exercise to the retina and its molecular messages within extracellular vesicles is highly topical in this field.

The Neurologist as an Agent of Exercise Rehabilitation in Multiple Sclerosis

This review hypothesizes that the neurologist represents the linchpin of exercise behavior change within comprehensive multiple sclerosis (MS) care settings. This is based on a series of recent articles that developed actionable practice models for accomplishing such behavior change through the neurologist as the primary agent. This provides tangible, next steps for exercise promotion in MS.

Physical activity and risk of Parkinson's disease and parkinsonism in a prospective population-based study (NEDICES)

To investigate whether physical activity (PA) is a protective factor for the incidence of Parkinson's disease (PD) and parkinsonism after three years of follow-up. All participants of this study were obtained from the Neurological Disorders in Central Spain (NEDICES), a prospective population-based cohort survey of older subjects (≥65 years) that comprised 5278 census-based participants at baseline (1994-1995). A modified version of Rosow-Breslau questionnaire was applied to categorize PA into active versus sedentary group. The final diagnosis of PD and parkinsonism was made by an expert neurologist. Cox regression models (CRM) adjusted for several covariates (sex, age, education, alcohol consumption, tobacco, stroke, hypertension and body mass index) were used to calculate the association between PA (active group vs. sedentary) and risk of PD and parkinsonism after three years. 22 incident PD and 25 incident parkinsonism cases were identified among 2943 participants with available PA information (57.1% female; mean age = 73.28 ± 6.24 years) after three years of follow-up. The CRM showed that the active group (vs. sedentary) showed a lower risk of parkinsonism (Hazard ratio (HR) = 0.18; 95% CI [0.07-0.51]; p = 0.0001). However, this effect was restricted to men (HR = 0.34; 95% CI [0.11-0.99], p < 0.05) for incident PD. PA may be a protective factor for incident parkinsonism, whereas this effect was only significant for men in the case of PD. The mechanisms implicated for brain maintenance in active individuals and the neurophysiological differences behind the role of sex on PD are discussed.

Potentials of autophagy enhancing natural products in the treatment of Parkinson disease

Parkinson disease (PD) is a progressive neurodegenerative movement disorder characterized by motor and non-motor symptoms due to loss of striatal dopaminergic neurons and disruption of degradation signaling leading to the formation of Lewy bodies (aggregation of α-synuclein). Presently, there are no disease modifying therapy for PD despite improvement in the understanding of the disease pathogenesis. However, the drugs currently used in PD management provide symptomatic relieve for motor symptoms without significant improvement in non-motor complications, thus, a public health burden on caregivers and healthcare systems. There is therefore the need to discover disease modifying therapy with strong potential to halt the disease progression. Recent trend has shown that the dysfunction of lysosomal-autophagy pathway is highly implicated in PD pathology, hence, making autophagy a key player owing to its involvement in degradation and clearance of misfolded α-synuclein (a major hallmark in PD pathology). In this review, we described the current drugs/strategy in the management of PD including targeting the autophagy pathway as a novel approach that could serve as potential intervention for PD management. The discovery of small molecules or natural products capable of enhancing autophagy mechanism could be a promising strategy for PD treatment.

Potentials of autophagy enhancing natural products in the treatment of Parkinson disease

Parkinson disease (PD) is a progressive neurodegenerative movement disorder characterized by motor and non-motor symptoms due to loss of striatal dopaminergic neurons and disruption of degradation signaling leading to the formation of Lewy bodies (aggregation of α-synuclein). Presently, there are no disease modifying therapy for PD despite improvement in the understanding of the disease pathogenesis. However, the drugs currently used in PD management provide symptomatic relieve for motor symptoms without significant improvement in non-motor complications, thus, a public health burden on caregivers and healthcare systems. There is therefore the need to discover disease modifying therapy with strong potential to halt the disease progression. Recent trend has shown that the dysfunction of lysosomal-autophagy pathway is highly implicated in PD pathology, hence, making autophagy a key player owing to its involvement in degradation and clearance of misfolded α-synuclein (a major hallmark in PD pathology). In this review, we described the current drugs/strategy in the management of PD including targeting the autophagy pathway as a novel approach that could serve as potential intervention for PD management. The discovery of small molecules or natural products capable of enhancing autophagy mechanism could be a promising strategy for PD treatment.

A Single Session of Whole-Body Electromyostimulation Increases Muscle Strength, Endurance and proNGF in Early Parkinson Patients

Parkinson's disease (PD) patients lead a sedentary lifestyle, being unable or unwilling to exercise conventionally, due to physical and mental limitations. The aim of this study was to assess the acute effects of a single session of whole-body electromyostimulation (WB-EMS) on the physical performances and serum levels of the neurotrophic factors in PD patients. Ten subjects (aged 72.60 ± 6.82) underwent 20 min of physical activity with superimposed WB-EMS and, after four weeks, the same protocol with no WB-EMS. WB-EMS was conducted with intermittent stimulation, with 4 s WB-EMS/4 s rest, at 85 Hz, 350 μs. A physical fitness assessment and blood samples collection, to evaluate neurotrophic factors' levels (BDNF, FGF21, proNGF, mNGF), were collected before and after the intervention. The RM-ANOVA showed significant improvements in sit-to-stand (p < 0.01), arm curl (p < 0.01), handgrip (p < 0.01) and soda pop test (p < 0.01) after the WB-EMS intervention. Higher proNFG serum levels were observed in the WB-EMS condition compared to the no WB-EMS after 60 min post-intervention (p = 0.0163). The effect of WB-EMS confirmed the electrostimulation ability to modulate the proNGF quantity. The positive impact of the WB-EMS protocol on physical functioning, and eye-hand coordination, makes this intervention a promising strategy to improve motor and non-motor symptoms in PD patients.

Predictors of physical activity levels in individuals with Parkinson's disease: a cross-sectional study

BACKGROUND

To investigate whether modifiable predictors (depressive symptoms, impairment in behavior and mood, balance impairments, and knee extensor muscle strength) are determinants of the physical activity level in Parkinson's disease.

MATERIALS AND METHODS

A cross-sectional study with individuals diagnosed with idiopathic Parkinson's disease. Regression analysis of the data was used to investigate whether depressive symptoms, impairments in behavior and mood, balance impairments, or dominant knee extensor muscle strength are predictors of physical activity levels in Parkinson's disease.

RESULTS

A total of 50 individuals with mild to moderate Parkinson's disease participated in this study, with a mean age of 67 ± 8 years and 68% male. Balance impairments explained 29% of the variation in the physical activity levels. The explained variance increased to 34% when depressive symptoms were included in the model.

CONCLUSION

Among the predictor variables investigated in our study, only balance impairments and depressive symptoms explained the variance in physical activity levels in individuals with Parkinson's disease.

Effects of Lee Silverman Voice Treatment BIG and conventional physiotherapy on non-motor and motor symptoms in Parkinson's disease: a randomized controlled study comparing three exercise models

Background:

Parkinson’s disease (PD) patients experience disabling motor dysfunctions as well as non-motor symptoms (NMSs) that can highly impact their perceived quality of life. Besides pharmacological treatment options, active intervention programs have set some attention in managing these symptoms. However, previous studies mainly assessed the effectiveness of active intervention programs on functional mobility and motor symptoms.

Objective:

This study aimed to investigate the effect of Lee Silverman Voice Treatment (LSVT) BIG, an intensified and personalized physiotherapy (INTENSIVE), and a conventional physiotherapy (NORMAL) on NMSs in PD.

Method:

Forty-four patients with mild to moderate PD were randomly assigned to one of the three treatment groups. LSVT BIG and INTENSIVE were delivered one-on-one in 16 1-hour sessions within 4 weeks (4×/week). Patients assigned to NORMAL received 16 individual 1-hour sessions within 8 weeks (2×/week). The primary outcome measure was the difference in change from baseline in the non-motor symptom assessment scale for Parkinson’s disease (NMSS) between treatment groups to follow up at week 8. Patients were blinded for the NMSS being the primary outcome, but not the different treatment groups.

Results:

ANCOVA (Analysis of Covariance) showed reduced NMSS scores for all groups, with INTENSIVE being superior to NORMAL (p = 0.033). For secondary outcome measures (stride length, gait velocity and chair rising test) LSVT BIG and INTENSIVE were both superior to NORMAL.

Conclusions:

The study provides evidence that all three exercise programs are effective techniques to improve NMSs as well as motor function in PD.

DRKS registration number:

DRKS00008732

Aquatic exercise associated or not with grape juice consumption-modulated oxidative parameters in Parkinson disease patients: A randomized intervention study

Parkinson's disease (PD) is a neurodegenerative disorder with significant motor disabilities and cognitive decline. Importantly, the imbalance of oxidative stress is related to PD physiopathology and progression. This study aimed to evaluate the impact of grape juice consumption associated with an aquatic exercise protocol on oxidative stress parameters and cognitive function in individuals with PD. The participants were randomized into two groups: grape juice group (GJG) and control group (CG) and were submitted to 4 weeks of an aquatic intervention (twice a week, approximately 60 minutes/session). The GJG also consumed 400 ml of grape juice per day (integral and conventional) during this period. Cognitive function was assessed by the Montreal Cognitive Assessment (MoCa) questionnaire. For the analysis of oxidative stress markers, specifically lipid oxidative damage (TBARS), proteins (Carbonil), acid uric and the activity of antioxidant enzymes (superoxide dismutase, glutathione peroxidase and catalase), blood collection were done before and after intervention. No changes were observed in cognitive function after intervention in both groups. Regarding biomarkers, a reduction of antioxidant enzymes, thiobarbituric acid reactive substances (TBARS) and uric acid was observed in both groups. However, only the GJG showed a significant reduction on protein oxidation levels after intervention. In conclusion, the consumption of grape juice associated with an aquatic exercise protocol might be consider an effective alternative to reduce the oxidative damage in PD, reinforcing the importance of this intervention in promoting beneficial impact in this population.

Osteoporosis and the Risk of Parkinson's Disease: A Nationwide, Propensity Score-Matched, Longitudinal Follow-up Study

CONTEXT

Osteoporosis and Parkinson's disease (PD) often co-occur, and even patients with early-stage PD may have reduced bone-mineral density levels. This may imply that osteoporosis is associated with a higher risk of PD.

OBJECTIVES

This work aimed to determine whether patients with osteoporosis are at a higher risk of subsequently developing PD.

DESIGN AND SETTING

A retrospective cohort study was conducted using Taiwan's National Health Insurance Research Database.

PARTICIPANTS

A total of 23 495 individuals age 50 to 80 years who had osteoporosis between 2002 and 2006 were enrolled in the osteoporosis group. The comparison group comprised 23 495 propensity score-matched patients without osteoporosis. Their propensity scores were computed using a logistic regression model that included age, sex, comorbid conditions, and socioeconomic status.

RESULTS

The hazard ratio (HR) of PD for the osteoporosis group was 1.31 times larger than that of the comparison group (95% CI, 1.13-1.50, P < .001). The PD-free survival rate of the osteoporosis group was also significantly lower than that of the comparison group (P < .001). The analyses stratified by sex showed that women with osteoporosis appeared to have a higher magnitude of PD HR (HR 1.50; 95% CI, 1.27-1.77, P < .001) than their male counterparts (HR 1.23; 95% CI, 0.93-1.64, P = .15).

CONCLUSIONS

The present study's results suggest that osteoporosis is related to an increased risk of PD, especially among women.

Gait parameters of Parkinson's disease compared with healthy controls: a systematic review and meta-analysis

We systematically reviewed observational and clinical trials (baseline) studies examining differences in gait parameters between Parkinson’s disease (PD) in on-medication state and healthy control. Four electronic databases were searched (November-2018 and updated in October-2020). Independent researchers identified studies that evaluated gait parameters measured quantitatively during self-selected walking speed. Risk of bias was assessed using an instrument proposed by Downs and Black (1998). Pooled effects were reported as standardized mean differences and 95% confidence intervals using a random-effects model. A total of 72 studies involving 3027 participants (1510 with PD and 1517 health control) met the inclusion criteria. The self-selected walking speed, stride length, swing time and hip excursion were reduced in people with PD compared with healthy control. Additionally, PD subjects presented higher cadence and double support time. Although with a smaller difference for treadmill, walking speed is reduced both on treadmill (.13 m s⁻¹) and on overground (.17 m s⁻¹) in PD. The self-select walking speed, stride length, cadence, double support, swing time and sagittal hip angle were altered in people with PD compared with healthy control. The precise determination of these modifications will be beneficial in determining which intervention elements are most critical in bringing about positive, clinically meaningful changes in individuals with PD (PROSPERO protocol CRD42018113042).

Applying available knowledge and resources to alleviate familial and sporadic neurodegenerative disorders

Here I present the scientific rationale and implementation strategies for elimination of early-onset neurodegenerative disorders (EONDD) from future generations, and for risk reduction and treatments for the more common late-onset neurodegenerative disorders (LONDD). Young adults with a family history of an EONDD should be educated on the genetics and familial burden of EONDD. They can then be genotyped and, if positive for the mutation, counseled as to how they can ensure that none of their children will be affected by choosing either adoption or in vitro fertilization and preimplantation genetic testing. LONDD risk reduction will require education of physicians and patients on the benefits of regular intermittent bioenergetic and cognitive challenges (exercise, intermittent fasting, intellectual challenges and social engagement) for brain health, and on specific risk-reduction regimens. Regulations will be required to counteract the disease-promoting mercenary practices of the processed food and pharmaceutical industries. Clinical trials of pharmacological interventions should shift to small trials of agents that substantially mimic mechanisms of action of exercise and intermittent fasting to bolster neuronal bioenergetics and stress resistance.

Modulation of the Microbiome in Parkinson's Disease: Diet, Drug, Stool Transplant, and Beyond

The gastrointestinal microbiome is altered in Parkinson's disease and likely plays a key role in its pathophysiology, affecting symptoms and response to therapy and perhaps modifying progression or even disease initiation. Gut dysbiosis therefore has a significant potential as a therapeutic target in Parkinson's disease, a condition elusive to disease-modifying therapy thus far. The gastrointestinal environment hosts a complex ecology, and efforts to modulate the relative abundance or function of established microorganisms are still in their infancy. Still, these techniques are being rapidly developed and have important implications for our understanding of Parkinson's disease. Currently, modulation of the microbiome can be achieved through non-pharmacologic means such as diet, pharmacologically through probiotic, prebiotic, or antibiotic use and procedurally through fecal transplant. Novel techniques being explored include the use of small molecules or genetically engineered organisms, with vast potential. Here, we review how some of these approaches have been used to date, important areas of ongoing research, and how microbiome modulation may play a role in the clinical management of Parkinson's disease in the future.

Comparison of efficacy and safety of complementary and alternative therapies for Parkinson's disease: A Bayesian network meta-analysis protocol

BACKGROUND

In recent years, the incidence of Parkinson's disease (PD) has been on the rise. However, the existing therapy of PD cannot fundamentally treat the disease. Meanwhile, the complementary and alternative therapies of PD have played a positive role in the treatment of PD. Traditional meta-analysis was only able to compare 2 interventions, while the efficacy and safety of many complementary and alternative therapies were not comparable. Therefore, this study compared the efficacy and safety of different complementary and alternative therapies through network meta-analysis (NMA).

METHODS

A comprehensive search of randomized controlled trials of complementary and alternative therapies for PD, as well as trials currently in progress, will be conducted until August 2020. Literature and data extraction were independently completed by two researchers. Through the meta-analysis of pairwise comparison and Bayesian NMA, all evidences are comprehensively evaluated. Use STATA15.0 and WinBUGS1.4.3 software for data processing and analysis, and use grading of recommendations assessment development and evaluation to classify the quality of evidence in the NMA.

RESULTS

The aim of this study is to obtain a ranking of efficacy and safety of different complementary and alternative therapies for PD.

CONCLUSION

Complementary and alternative therapies for PD have positive significance in improving the symptoms of PD, and can provide evidence support for clinicians and patients.

INPLASY REGISTRATION NUMBER

INPLASY202080079.

Exercise-Induced Neuroprotection in the 6-Hydroxydopamine Parkinson's Disease Model

Exercise exerts helpful effects in Parkinson's disease. In this study, the 6-hydroxydopamine (6-OHDA) injection was used to investigate the effect of exercise on apomorphine-induced rotation and neurorestoration. Rats (n = 32) were divided into four groups: (1) Saline+Noexercise (Sham); (2) 6-OHDA+Noexercise (6-OHDA); (3) Saline+Exercise (S+EXE), and (4) 6-OHDA+Exercise (6-OHDA+EXE). The rats were administered 8 μg 6-OHDA by injection into the right medial forebrain bundle. After 2 weeks, the exercise group was run (14 consecutive days, 30 min per day). One month after the surgery, following the injection of apomorphine, the 6-OHDA group displayed a significant increase in rotation and the 6-OHDA+EXE group showed a significant reduction of rotational asymmetry (P < 0.001). 6-OHDA injection reduced the mRNA and protein expression of the AMP-activated protein kinase, brain-derived neurotropic factor, and tyrosine hydroxylase in relation to the Sham group and exercise increased these levels. Expression of the silent information regulator 2 homolog 1 and peroxisome proliferator-activated receptor gamma coactivator 1-alpha was unexpectedly enhanced in the 6-OHDA groups in relation to the Sham group. These findings suggest that the 6-OHDA injection increased the neurodegeneration and mitochondrial and behavioral dysfunctions and the treadmill running attenuated these disorders in the ipsilateral striatum of the 6-OHDA+EXE group.

Chasing Protection in Parkinson's Disease: Does Exercise Reduce Risk and Progression?

Exercise may be the most commonly offered yet least consistently followed therapeutic advice for people with Parkinson's disease (PD). Epidemiological studies of prospectively followed cohorts have shown a lower risk for later developing PD in healthy people who report moderate to high levels of physical activity, and slower rates of motor and non-motor symptom progression in people with PD who report higher baseline physical activity. In animal models of PD, exercise can reduce inflammation, decrease α-synuclein expression, reduce mitochondrial dysfunction, and increase neurotrophic growth factor expression. Randomized controlled trials of exercise in PD have provided clear evidence for short-term benefits on many PD measurements scales, ranging from disease severity to quality of life. In this review, we present these convergent epidemiological and laboratory data with particular attention to translationally relevant features of exercise (e.g., intensity requirements, gender differences, and associated biomarkers). In the context of these findings we will discuss clinical trial experience, design challenges, and emerging opportunities for determining whether exercise can prevent PD or slow its long-term progression.

A review of possible therapies for Parkinson's disease

Parkinson's disease (PD) is a complex condition with a wide range of symptoms, like impaired movement, tremors, apathy and depression, and many other symptoms. The disease results from degeneration of dopaminergic neural cells. No cure at present but symptomatic some palliative treatments are available to slow down the disease progression. According to the Parkinson's Foundation every year in U.S., approximately 60,000 Americans diagnosed with PD. Nearly one million will be living with PD in the U.S. by 2020, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Amyotrophic Lateral Sclerosis (ALS). There is no diagnostic test for PD, yet, but this article will review all kinds symptomatic and disease-modifying therapy.

Possible therapies of Parkinson's disease: A review

Parkinson's disease (PD) is a complex condition with a wide range of symptoms, like impaired movement, tremors, apathy and depression, and many other symptoms. The disease results from degeneration of dopaminergic neural cells. No cure at present but symptomatic some palliative treatments are available to slow down the disease progression. According to the Parkinson's Foundation every year in U.S., approximately 60,000 Americans diagnosed with PD. Nearly one million will be living with PD in the U.S. by 2020, which is more than the combined number of people diagnosed with multiple sclerosis, muscular dystrophy and Amyotrophic Lateral Sclerosis (ALS). There is no diagnostic test for PD, yet, but this article will review all kinds symptomatic and disease-modifying therapy.

Aquatic exercise program-modulated oxidative stress markers in patients with Parkinson's disease

Parkinson’s disease is a neurodegenerative disease. Oxidative stress, i.e., the imbalance between the generation of reactive oxygen species and the antioxidant defense capacity of the body, plays an important role in the pathogenesis of this disease. Physical exercise can regulate oxidative stress. The purpose of this study was to analyze the short- and long-term effects of an aquatic exercise program on oxidative stress levels in patients with Parkinson’s disease. The aquatic exercise program was carried out during 1 month with two sessions per week (1 hour/session). Blood samples were collected at four different time points: pre-intervention, immediately, 48 hours, and 30 days after the first session of aquatic exercise program. Our results revealed that water-based programs modulated antioxidant enzyme activity, increased superoxide dismutase activity, reduced catalase activity, and increased the ratio of superoxide dismutase activity to catalase activity in patients with Parkinson’s disease. Compared with pre-intervention and 48 hours after the first session of aquatic exercise program, superoxide dismutase activity was higher and catalase activity was lower immediately and 30 days after the first session. Our results demonstrated that aquatic exercise program could modulate oxidative stress, mainly by the effect of antioxidant enzyme activity. These results could better help understand the target of oxidative stress in Parkinson’s disease. This study was approved by the Ethics Committee of Centro Universitário Metodista IPA (approval No. 1.373.911) on August 9, 2019 and registered with REBEC (registration number: RBR-6NJ4MK).

Exercise and Parkinson's Disease

Parkinson's disease (PD) is an aging-related neurodegenerative disorder characterized by progressive motor impairment.The etiology of PD is poorly understood but likely involves both genetic and environmental factors; the management of the disease is still with symptomatic therapy without any interference on the progression of neurodegeneration. In the past two decades, the results of a series of prospective cohort studies suggested that lifestyle factors likely modify the risk of developing PD. Among these, physical activity is known to reduce the risk of a wide range of diseases and conditions, including cardiovascular disease, stroke, and diabetes.Recently, a growing body of evidence has suggested that increased physical activity may also reduce the risk of PD and partly improve motor and non-motor symptoms during the disease course.Here we report the main findings on the effect of physical activity on both mobility and cognition either in animal models of PD or in people with PD. We also highlighted the structural and functional links between gait and cognition by reporting evidence from neuroimaging studies.

Prior exercise protects against oxidative stress and motor deficit in a rat model of Parkinson's disease

This study investigated if a prior long-term physical exercise protocol protects the substantia nigra and the striatum against oxidative stress and motor deficits in a Parkinson Disease model induced by 6-hydroxydopamine. Three animal treatment groups were included in the study: sham; 6-hydroxydopamine and 6-hydroxydopamine/exercise. Previously to the intrastriatal lesion by 6-hydroxydopamine, rats in the exercise groups performed a swimming program for 18 weeks. The rats were submitted to behavioral tests before and after intrastriatal 6-hydroxydopamine injection. The oxidative stress was analyzed by Thiobarbituric Acid Reactive Substances and Glutathione reductase activity methods. The exercise decreased lipid peroxidation and increased glutathione reductase activity in the substantia nigra. In contrast, in the striatum, exercise increased lipid peroxidation and decreased glutathione reductase activity. Exercise increased contralateral rotations and reduces immobility levels at 14 days post lesion. The exercise prior to 6-OHDA lesion had protective action only in substantia nigra against oxidative stress.