# Exercise as it relates to Disease/The language and cognitive benefits of exercise for those with Parkinson's Disease

The language and cognitive benefits of exercise for those with Parkinson's Disease.
This is a page critiquing an article by J. Nocera, L. ALtmann, C Sapienza, M. Okun and C. Hass. Titled 'Can exercise improve language and cognition in Parkinson's disease? A case report.' DOI: 10.1080/13554790903559663

## What is the background to this research?[edit | edit source]

Parkinson’s disease (PD) is a slowly progressive neurodegenerative disorder. PD mainly interferes with a patients quality of life as tremors/ cognitive impairments interfere with most daily tasks. There is currently no known cure for PD, however, there are a few things, we as a society do know. We know that PD is caused by a lack of a chemical called dopamine; a neruotransimitter$^,$, controlling communication and movement conducted by the brain. Nerve cells in the substania nigra are responsible for the production of dopamine but when roughly 80% of these nerve cells are lost, the symptoms of PD start to severely impact the patient. The cause of the loss of nerve cells is unknown and further research is required to reach a conclusion in this area.
Existing knowledge in treating the cognitive and language impairments of PD is also inadequate, most research focused on pharmacotherapeutics do not address the cognitive impairments of those with PD. This research aimed to fill the gap in the cognitive therapies for Parkinson’s disease, compared to the research already carried out for motor movement improvements.
Dopaminergic therapy is said to significantly improve motor function and deep-brain stimulation has been found to have benefits to motor skills but adverse effects on cognitive function in PD patients. There is substantial evidence on the benefit of exercise on cognitive function of healthy older adults, the question proposed here is if this discovery can be reflective in PD patients. Specifically the introduction to the paper reads that, aerobic exercise has shown to precisely improve the areas of the brain that are associated with the cognitive function impairments of those with PD; exactly why this specific area of research is warranted.

## Where is the research from?[edit | edit source]

The participant was part of a randomised control trial and was recruited from the Movement Disorders Centre at the University of Florida. This is important as the Centre is a dedicated centre for movement impairments, research, care and treatment. The mission of the centre is “To provide the highest level of medical and surgical care to patients with Parkinson’s disease, tremor, dystonia and other movement disorders. To perform research that will lead to better treatments, and ultimately cures for Parkinson’s disease and other movement disorders.” This only proves the motivation and dedication of those involved with this study.
The authors all had extensive background knowledge and experience in multiple neurology, brain and physiology departments across America.
Three of the authors, Joe R. Nocera, Christine Sapienza and Chris J. Hass were all part of the Brain Rehabilitation Research Centre at Malcom Randall VAMC in Gainesville, Florida. J. Nocera and Michael S. Okun were apart of the Department of Neurology at the University of Florida. Lori J. P. Altmann and C. Sapienza were part of the Department of Communicative Disorders at the University of Florida. M. Okun was also part of the Department of Neurosurgery at the University of Florida and C. Hass was also part of the Department of Applied Physiology & Kinesiology at the University of Florida.

## What kind of research was this?[edit | edit source]

This research was a case report of a patient that was part of randomised control trial (RCT) comparing the effects of two forms of exercise training on locomotor performance in people with early to mid-staged PD. Case reports usually provide a low level of strong evidence however, their main role is to infer and suggest ideas rather than to all-out prove theories. This is mainly due to the small amount of data/subjects as the results may not be generalisable and findings may have only occurred to this participant.

## What did the research involve?[edit | edit source]

The participant completed two days of cognitive and language assessment prior to and following an 8 week aerobic exercise program. The exercise program consisted of 20mins of aerobic exercise three times a week, beginning at 50% of maximal heart rate reserve and increasing by 5% every week, to a maximum of 75% of maximum heart rate reserve. Each session was monitored by a clinical exercise physiologist. Measurements were taken from dual and single tasks assessed on different days to reduce mental and physical fatigue. These tasks included the Mini-Mental Health Status Examination, a picture description task and others, dual tasks were performed at the conclusion of 30s of pedalling on a stationary ergometer.
The participant was a 66 year old female diagnosed with idiopathic PD at stage 2 of the H&Y scale (Hoen & Yahr) and a score of 31 on the Unified Parkinson’s Disease Rating Scale (UPDRS), both reliable ratings of PD. She was chosen for this study due to scheduling she was unable to attend the RCT.
A factor to note is during the study the participant continued with prescribed medication for PD. This included 3x1.mg Mirapex and 3x25mg Sinemet daily, both dopaminomimetic drugs.
There was a criteria to meet to be included in the RCT. Patients had to be ambulate without assistance, were excluded if another disease limited their ability to exercise and if they had been participating in other regular exercise within the last year.

## What were the basic results?[edit | edit source]

This case study found that the exercise intervention improved almost all measures of cognitive function. Specifically, verbal fluency and working memory improved which correlated with evidence from research done in healthy older adult literature. In the dual task assessments, responses to picture descriptions were more concise and grammatical. Dysfluencies decreased in both single and dual task assessments. The dual task effect decreased, meaning the participants ability to perform dual tasks improved despite the stimulus of another task.
The researches seem confident that these results suggest an improvement in cognitive functioning can come from aerobic exercise. The paper states ‘Herein we provide novel evidence that cognitive and language function in individuals with PD may improve following an aerobic exercise intervention.’.
The researchers mention throughout the paper multiple other studies that agree with their findings. However, they also mention a study that disagrees with their results. This paper was published in 2008 by Melzer, Marx and Kurz and found that training did not improve stepping performance during dual task assessment in the elderly. Yet, this paper relied on self-reported levels of exercise rather than a specified exercise intervention.

## What conclusions can we take from this research?[edit | edit source]

In conclusion, based on the first meta-analysis published in 2010 (by F. Sofi et al.) that investigated the association between physical activity and risk of cognitive decline on all prospective studies, agrees that physical activity has an inverse relationship with cognitive decline and neurodegenerative diseases. The research results are undeniable.

## Practical advice[edit | edit source]

People diagnosed with PD should be assessed by a general practitioner (GP) prior to commencing any exercise regime. In conjunction with their GP the patient should be under the guidance of an accredited physiotherapist/exercise physiologist while gaining advice on the level and type of exercise that can be safely undertaken. This is due to the high level of falls and unilateral symptoms of PD and the dangers they pose.

## Further information/resources[edit | edit source]

Additional Resources:
- Exercise Tips for those with PD: https://www.parkinson.org/Understanding-Parkinsons/Treatment/Exercise
- Australian Peer Support Groups: https://www.parkinsonsvic.org.au/support-for-you/peer-support/
- Posture, Stretching and Flexibility: https://www.parkinsons.va.gov/NorthWest/Documents/Pt_ed_handouts/Exercise_for_PD_1-20-12.pdf

## References

* ↑ Videnovic A. How Long Can a Person Live With Parkinson's Disease? [Internet]. Agingcare.com. 2020 [cited 7 September 2021]. Available from: https://www.agingcare.com/articles/parkinsons-disease-how-long-can-a-person-live-after-diagnosis-123302.htm
* ↑ Christol H. What Is Dopamine? [Internet]. WebMD. 2021 [cited 7 September 2021]. Available from: https://www.webmd.com/mental-health/what-is-dopamine
* 1 2 Parkinson's disease - Causes [Internet]. nhs.uk. 2019 [cited 7 September 2021]. Available from: https://www.nhs.uk/conditions/parkinsons-disease/causes/
* 1 2 3 4 5 6 7 Nocera J, Altmann L, Sapienza C, Okun M, Hass C. Can exercise improve language and cognition in Parkinson's disease? A case report. Neurocase. 2010;16(4):301-306.
* ↑ Growdon J, Kieburtz K, McDermott M, Panisset M, Friedman J. Levodopa improves motor function without impairing cognition in mild non-demented Parkinson's disease patients. Neurology [Internet]. 1998 [cited 7 September 2021];50(5):1327-1331. Available from: https://n.neurology.org/content/50/5/1327.abstract
* ↑ About » Movement Disorders & Neurorestoration Program NORMAN FIXEL INSTITUTE for NEUROLOGICAL DISEASES » UF Health » University of Florida [Internet]. Movementdisorders.ufhealth.org. [cited 7 September 2021]. Available from: https://movementdisorders.ufhealth.org/about/
* ↑ Case Report - Study Design 101 [Internet]. Himmelfarb.gwu.edu. 2021 [cited 7 September 2021]. Available from: https://himmelfarb.gwu.edu/tutorials/studydesign101/casereports.cfm
* ↑ Standardised Mini-Mental State Examination (SMMSE) [Internet]. The Independent Hospital Pricing Authority. 2021 [cited 7 September 2021]. Available from: https://www.ihpa.gov.au/what-we-do/standardised-mini-mental-state-examination-smmse
* ↑ Melzer I, Marx R, Kurz I. Regular Exercise in the Elderly Is Effective to Preserve the Speed of Voluntary Stepping under Single-Task Condition but Not under Dual-Task Condition. Gerontology. 2008;55(1):49-57.
* ↑ Sofi F, Valecchi D, Bacci D, Abbate R, Gensini G, Casini A et al. Physical activity and risk of cognitive decline: a meta-analysis of prospective studies. Journal of Internal Medicine. 2010;269(1):107-117.
* ↑ Sweeney P. Parkinson's Disease [Internet]. Clevelandclinicmeded.com. 2013 [cited 13 September 2021]. Available from: https://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/neurology/parkinsons-disease/