# Exercise as it relates to Disease/Benefits of physical exercise in older people with Parkinson's

Benefits of Physical Exercise in Older People with Parkinson's
This Wikibooks fact sheet summarises, critiques and discusses the article, "Benefits of Physical Exercise on Executive Functions in Older People with Parkinson’s Disease".

## What is the background to this research?

Parkinson’s disease (PD) is a neurodegenerative disorder that affects the control and function of motor and non-motor features. The disease is the second most common progressive neurological disorder, after Alzheimer’s, and affects approximately 0.5-1% of 65-69 years of age and rises to 1-3% of those 80 years and older. Parkinson’s disease affects motor functions, but it has also been found through observation to exhibit cognitive and behavioural impairments..
The study explores the affect PD has on executive function (EF) in the body and how exercise can slow down or even reverse some of the effects of the disease. Executive function is generalised as the understanding of one’s conscious control of their thought and action. The research is conducted through using an aerobic multimodal exercise program to see if it influences executive function with those who suffer from Parkinson’s disease.

## Where is the research from?

The study was carried out at the Sao Paulo State University in Rio Claro, Brazil. The institution is Brazils most prestigious University and is amongst the top 100 universities in the world. The authors involved in the study were from:
    - UNESP, Sao Paulo State University at Rio Claro, SP, Brazil
    - Psychopharmacology Research Support Association (AFIP), SP, Brazil
    - Clinic in Geriatric Psychiatry, UNICAMP, State University of Campinas, SP, Brazil
The authors have been involved in many studies linked to Parkinson’s disease and have shown no evident conflicts of interest. There are no signs of bias in the study as the funding was from a third-party source run by the Brazilian government that is linked with the University. Although the study only focused on Brazilian patients, the research is still very relevant as Parkinson’s disease affects people from all over the world.

## What kind of research was this?

The study was a random controlled trial (RCT) that was clinically run to observe the improvements of quality of life through exercise in Parkinson’s disease patients. The study split the sample into two groups – the trained group and the control group.

## What did the research involve?

The study involved 20 older people (mean age of 65.4 years) with Parkinson’s Disease; who were encouraged to participate in the study by neurologists, gerontologists, psychiatrists and other physicians. To qualify for the sample, participants had to conform to the following:
    a) Present clinical diagnosis of PD in early stages
    b) No current signs of dementia
    c) Not been attending any other physical exercise program
    d) Minimum of 70% attendance to training sessions
The sample was then separated into two groups, a trained group (TG) and a control group (CG). The trained group was required to partake in the following; 60-minute sessions, three times a week for six months with progression every 12 sessions (1 month). The methodology may not have been the best approach in relation to using exercise. Heart rate was not measured because the exercise was said to have not reached the anaerobic threshold. This limits the ability to judge the intensity heavily, as patients were only monitored by three professionals. Without an actual statistical value, it makes it hard to judge 10 patients in one session with great accuracy.

## What were the basic results?

The results were interpreted through analysis of variance (ANOVA), as it provides a statistical test stating whether the groups are equal or not.
All tests showed no difference between the two groups for all the variables tested in the pre-intervention.
The post-intervention presented the following:
    - The exercise intervention was able to improve executive function in the patients as assessed in the Wisconsin Card Sorting Test (WCST), with the statistical analysis showing significant difference between the controlled and trained group.
    - The ‘Categories Completed’ and the ‘Preservative Errors’ observed a significant improvement in the trained group where the ‘Failure to Maintain Set’ displayed no benefits of exercise.
The results in relation to executive function are consistent with the method and the objectives of the study. The three other tests explained in the method; concentrated attention, anxiety and depressive symptoms were not discussed in the results. Thus, decreasing their importance to the outcome of the study.

## What conclusions can we take from this research?

* The generalised physical exercise program was able to maintain or improve executive function in patients with PD. Although multiple other studies, to name a few ("A Review of the Effects of Physical Activity and Exercise on Cognitive and Brain Functions in Older Adults". and "Ageing, fitness and neurocognitive function".), provide physical training; this program still demands aerobic metabolism which is a safer and more practical form of exercise for this age group and the brutality of the disease.
* As concentrated attention, anxiety and depressive symptoms play such a major role in the function of the brain. These three results and their direct link to executive function should have been discussed more.
* Exercise as a whole, physical and mental, will benefit the quality of life of those who suffer from PD.

## Practical Advice

Parkinson’s disease can be challenging to diagnose as there is no definitive test, only clinical criteria. This makes it difficult to have consistency in observing the different stages of the disease and where the patient is at in relation..
A study providing more specific stages and the optimal exercise intervention at that time of the disease would give the study more practical use.
The meta-analysis, "A Review of the Effects of Physical Activity and Exercise on Cognitive and Brain Functions in Older Adults" , provides a good source to gain ideas about what exercise would be needed in a patient. It discusses fourteen random controlled trials covering; physical functioning, health‐related quality of life, strength, balance and gait speed for people. This assists by showing the many benefits of exercise in PD patients rather than just executive function.
Warning should also be made that no cure is being trialled, just the aim of improving the quality of life.

## Further Information/Resources

The Wisconsin Card Sorting Test (WCST) used to observe executive function can be recorded using,"Wisconsin Card Sorting Test™: Computer Version 4"
Other very helpful resources:
* "Aerobic Exercise to Improve Executive Function in Parkinson Disease: A Case Series"
* "Exercise and Parkinson’s: benefits for cognition and quality of life"
* "Understanding Parkinson's Treatments"

## References

* 1 2 3 " Tanaka K, Quadros A, Santos R, Stella F, Gobbi L, Gobbi S. Benefits of physical exercise on executive functions in older people with Parkinson’s disease. Brain and Cognition. 2009;69(2):435-441.
* 1 2 " Jankovic J. Parkinson's disease: clinical features and diagnosis. Journal of Neurology, Neurosurgery & Psychiatry. 2008;79(4):368-376.
* ↑ Nussbaum R, Ellis C. Alzheimer's Disease and Parkinson's Disease. New England Journal of Medicine. 2003;348(14):1356-1364.
* ↑ Zelazo P, Moscovitch M, Thompson E. The Cambridge handbook of consciousness. Cambridge [England]: Cambridge University Press; 2007.
* 1 2 " Goetz C, Poewe W, Rascol O, Sampaio C, Stebbins G, Counsell C et al. MovementDisorder Society Task Force report on the Hoehn and Yahr staging scale: Status and recommendations The Movement Disorder Society Task Force on rating scales for Parkinson's disease. Movement Disorders. 2004;19(9):1020-1028.
* ↑ Bherer L, Erickson K, Liu-Ambrose T. A Review of the Effects of Physical Activity and Exercise on Cognitive and Brain Functions in Older Adults. Journal of Aging Research. 2013;2013:1-8.
* ↑ Kramer A, Hahn S, Cohen N, Banich M, McAuley E, Harrison C et al. Ageing, fitness and neurocognitive function. Nature. 1999;400(6743):418-419.
* 1 2 " Goodwin V, Richards S, Taylor R, Taylor A, Campbell J. The effectiveness of exercise interventions for people with Parkinson's disease: A systematic review and meta-analysis. Movement Disorders. 2008;23(5):631-640.