Exercise May Cut Fall Risk for Some Parkinson's Patients

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, 2014, 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 the lead researcher at the University of Sydney in Australia.

That possibility still needs to be studied. But what seems clear, 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 the research 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.

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.

So clinicians usually recommend exercise, just like they do for the general population without Parkinson's.

Plus, 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.

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. 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,the research 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, 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. 

The results of this 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 researchers. We should not be waiting until the person has already fallen.

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

The research team 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.

The researchers 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.

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

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

REFERENCES: 

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