Aerobic exercise stabilizes motor progression in Parkinson’s disease, helps cognition

Aerobic exercise stabilizes the progression of motor symptoms and improves cognitive function in people with Parkinson’s disease, according to additional data from the Park-in-Shape clinical trial.

Notably, these benefits were found to be associated with increased neural connectivity in areas of the brain controlling these functions and reduced brain atrophy (narrowing).

These findings build on previous Park-in-Shape findings highlighting the benefits of aerobic exercise in the progression of Parkinson’s disease and shedding light on underlying brain changes.

The study, “Aerobic exercise alters brain function and structure in Parkinson’s disease, a randomized controlled trial, ”Was published in the journal Annals of Neurology.

A growing body of evidence points to a link between physical activity and brain health, with regular exercise helping to delay brain aging and neurodegenerative diseases such as Parkinson’s disease.

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Notably, two independent clinical trials – SPARX (NCT01506479) in the United States and Park-in-Shape (NTR4743) in the Netherlands – have shown that aerobic exercise facilitates the progression of motor symptoms in Parkinson’s disease. Other studies also suggest that exercise may alleviate both motor and non-motor symptoms of Parkinson’s disease.

However, the neural mechanisms underlying these benefits remain unclear.

To address this issue, the researchers assessed the functional and structural changes in the brain in a subset of Park-in-Shape participants who also performed an additional cognitive control task.

Park-in-Shape involved 130 adults with mild Parkinson’s disease who were randomly assigned to undergo either 30- to 40-minute aerobic exercise sessions on a stationary bike at home or 30-minute sessions. stretching, flexibility and relaxation (active control exercises), three times a week for six months.

Participants in the aerobic exercise group were instructed to cycle in a target heart rate zone, which was gradually increased as participants became more fit. All participants had a motivational app with tips for optimal training, support from loved ones, and information to track progress.

An unselected subset of participants – 25 in the aerobic exercise group and 31 in the active control group – underwent functional and structural magnetic resonance imaging at rest, followed by a cognitive control task at the onset of study and at six months.

In this study, researchers investigated how aerobic exercise influences brain function and structure, particularly in regions known to be involved in motor and cognitive functions and affected by Parkinson’s disease.

In terms of motor function, the team was interested in the evolution of the cortico-striatal sensorimotor network involved in the emergence of motor deficits in Parkinson’s disease.

Previous studies have shown that cortical sensorimotor regions that normally communicate with the posterior putamen in healthy individuals are more dependent on the anterior putamen in patients with Parkinson’s disease. The putamen is a region of the brain involved in the control of motor function that is part of the striatum, and its posterior part is heavily affected in the onset of Parkinson’s disease.

The results showed that aerobic exercise, but not stretching, led to a shift in cortico-striatal sensorimotor connectivity to the anterior putamen, which is less affected by the disease.

An opposite increase in posterior putamen connectivity was detected in patients in the stretch group – the only Park-in-Shape group that showed worsening motor symptoms after six months.

These results suggest that aerobic exercise may strengthen a compensatory brain mechanism that increases connectivity between cortical sensorimotor regions and the anterior putamen, and stabilizes motor function.

Six months of aerobic exercise also improved patients’ cognitive control, which was associated with increased functional connectivity between two brain networks involved in such function. Notably, larger increases in this network connectivity have been associated with greater improvements in fitness in these patients.

Additionally, patients undergoing aerobic exercise had significantly reduced overall brain narrowing compared to those in the stretching group.

Combined with the results of the Park-in-Shape study, these results suggest that “aerobic exercise stabilizes motor progression and improves cognitive performance in people with [Parkinson’s] by stimulating functional and structural plasticity in cortico-striatal sensorimotor and cognitive control networks, ”the researchers wrote.

Neuroplasticity refers to the brain’s ability to make new connections in response to new information, stimuli, or developments.

“Our study suggests that a viable alternative to influence clinical decline may be to focus on maintaining cortico-striatal sensorimotor function against disease progression and enhancing compensatory cognitive processes,” the team wrote.

Larger studies are needed to confirm these results.


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