Long-term effect of regular physical activity and exercise habits in patients with early parkinson disease

Objective: Owing to the lack of long-term observations and/or
comprehensive adjustment for confounding factors, reliable conclusions
regarding long-term effects of exercise and regular physical activity in
Parkinson’s disease (PD) have yet to be drawn. Here, using data from the
Parkinson’s Progression Markers Initiative study that includes
longitudinal and comprehensive evaluations of many clinical parameters, we
examined the long-term effects of regular physical activity and exercise
habits on the course of PD. Methods: In this observational cohort study,
we primarily used the multivariate linear mixed-effects models to analyze
the interaction effects of their regular physical activity and
moderate-to-vigorous exercise levels, measured through the Physical
Activity Scale for the Elderly questionnaire, on the progression of
clinical parameters, after adjusting for age, sex, levodopa-equivalent
dose, and disease duration. We also calculated bootstrapping 95%
confidence intervals (CIs), and conducted sensitivity analyses using the
multiple imputation method and subgroup analyses using the propensity
score matching to match for all baseline background factors. Results: 237
early PD patients [median (interquartile range); age, 63.0 (56.0–70.0)
years; Male, 69.2%; follow-up duration, 5.0 (4.0–6.0) years] were
included. Regular physical activity and moderate-to-vigorous exercise
levels at the baseline did not significantly affect the subsequent
clinical progression of PD. However, average regular overall physical
activity levels over time were significantly associated with slower
deterioration of postural and gait stability [standardized fixed-effects
coefficients of the interaction term (βinteraction) = -0.10 (95% CI, -0.14
to -0.06)], activities of daily living [βinteraction = 0.08 (95% CI, 0.04
to 0.12)], and processing speed [βinteraction = 0.05 (95% CI, 0.03 to
0.08)] in PD patients. Moderate-to-vigorous exercise levels were
preferentially associated with slower decline of postural and gait
stability [βinteraction = -0.09 (95% CI, -0.13 to -0.05)] and work-related
activity levels were primarily associated with slower deterioration of
processing speed [βinteraction = 0.07 (95% CI, 0.04 to 0.09)]. Multiple
imputation and propensity score matching confirmed the robustness of our
results. Conclusions: In the long-term, the maintenance of high regular
physical activity levels and exercise habits was robustly associated with
better clinical course of PD, with each type of physical activity having
different effects.