Exercise May Cut Fall Risk for Some Parkinson's Patients

Benefit strongest for those with milder symptoms, study finds

Wednesday, December 31, 2014

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WEDNESDAY, Dec. 31, 2014 (HealthDay News) -- Exercises that focus on balance and leg strengthening may help some people with Parkinson's disease avoid falls, according to a new clinical trial.

The study, reported online Dec. 31 in Neurology, found that the benefits were limited to people with milder Parkinson's symptoms. The exercise program -- done mostly at home -- cut their risk of falling by about 70 percent over six months.

But experts said that doesn't mean exercise is no help to people with more advanced Parkinson's.

It's possible they may need an exercise program with more supervision, said lead researcher Colleen Canning, an associate professor at the University of Sydney in Australia.

That possibility still needs to be studied, Canning added. But what seems clear, she said, is that "one size does not fit all" when it comes to exercise therapy for Parkinson's.

Parkinson's disease is a chronic movement disorder that causes tremors, stiffness in the limbs, and problems with balance and coordination, according to the Parkinson's Disease Foundation. About 60 percent of people with the disorder fall at least once a year, according to Canning's team -- and that can have consequences ranging from serious injury to fear of being active.

Yet physical activity is important for people with Parkinson's, said Dr. Roy Alcalay, a neurologist and medical advisor to the Parkinson's Disease Foundation in New York City.

That's partly because people with Parkinson's -- who are typically older than 50 -- should exercise for the sake of their cardiovascular health and mental well-being, explained Alcalay, who was not involved in the study.

"So we usually recommend exercise, just like we do for the general population without Parkinson's," said Alcalay.

Plus, he added, there is evidence that exercise could provide particular benefits for people with Parkinson's. In lab animals, physical activity seems to shield brain cells from some of the damage seen in Parkinson's, Alcalay noted.

And recent studies of Parkinson's patients have found that cardiovascular exercise, such as walking, can help ease physical and mental symptoms -- including stiffness, balance problems and depression.

"This study provides a couple new pieces," Alcalay said. "One is that for people with less severe Parkinson's, exercise does reduce falls. For people with more severe disease, though, this minimal-supervision program probably doesn't apply."

For the study, Canning's team randomly assigned 231 Parkinson's patients to either stick with their usual care or add an exercise program. That group took a monthly class with a physical therapist, where they learned balance and leg-strengthening exercises.

But most of the time, Canning said, the exercisers were on their own; they were told to fit in 40 to 60 minutes of exercise, three times a week -- with some of those sessions guided by a therapist who visited them at home.

After six months, the researchers found, there was no clear benefit for the study group as a whole. The picture looked different, however, when they focused on the 122 patients with milder Parkinson's symptoms.

Among those patients, 52 percent of exercisers had a fall over six months. That compared with 76 percent of those who did not exercise.

"This large effect was achieved with only 13 percent of exercise sessions supervised by a physical therapist," Canning said. "The results of our study suggest that early intervention for people with Parkinson's disease should be extended to include minimally supervised balance and strengthening exercises as a falls-prevention strategy."

"Early" is the key word, according to Canning. "We should not be waiting until the person has already fallen," she said.

Only an association was found between exercise and risk of falling among Parkinson's patients; the study did not prove cause and effect.

Alcalay noted that in the United States, the "minimal supervision" approach is typically how physical therapy works: Insurers pay for a limited number of sessions, where therapists teach people exercises they should continue at home.

Canning said more research is needed to know whether a program with closer supervision can help prevent falls among people with more advanced Parkinson's.

"Patients with Parkinson's disease should engage in exercise for better health outcomes," said Dr. Ergun Uc, a neurologist at the University of Iowa Hospitals & Clinics in Iowa City. Uc also recently led a study that found brisk walking can help improve Parkinson's symptoms.

"However," he added, the current study's "exercise regimen has to be tailored to [patients'] abilities, to maximize benefit and prevent injury from exercise itself."

Uc agreed that it would be worthwhile to study the effects of a closely supervised program for people with more severe Parkinson's.

SOURCES: Colleen Canning, Ph.D., associate professor, physiotherapy, University of Sydney, Faculty of Health Sciences, Sydney, Australia; Roy Alcalay, M.D., medical advisor, Parkinson's Disease Foundation, associate professor, neurology, Columbia University Medical Center, New York City; Ergun Uc, M.D., associate professor, neurology, University of Iowa Hospitals & Clinics, Iowa City; Neurology online, Dec. 31, 2014

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