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Low-Intensity Exercise, Drug Combo Can Help Parkinson's Patients, Studies Show
Date:4/13/2011

By Maureen Salamon
HealthDay Reporter

TUESDAY, April 12 (HealthDay News) -- The difficulties with walking, movement and coordination that Parkinson's patients struggle with might be partially offset by a new drug combination and a different approach to exercise, researchers suggest.

Parkinson's patients may achieve the greatest improvements in gait and mobility from lengthy, low-intensity training such as brisk walking, scientists said. This runs counter to prior advice that vigorous exercise helps Parkinson's patients the most.

Additionally, a drug known as safinamide shows promise in reducing involuntary movements in some mid- or late-disease patients when paired with an established medication called levodopa. Safinamide has not yet been approved by the U.S. Food and Drug Administration.

About 500,000 Americans have been diagnosed with Parkinson's disease, according to the U.S. National Institutes of Health. The findings are to be presented Tuesday at the American Academy of Neurology annual meeting in Honolulu.

In the exercise research, scientists from the University of Maryland randomly assigned 67 Parkinson's patients who had trouble walking to three types of exercise: high-intensity treadmill (with greater speed and shorter duration); low-intensity treadmill (lower speed, longer duration); or stretching and resistance training, which included leg presses, extensions and curls.

Participants who did the low-intensity treadmill training performed better than the other two groups on distance and speed tests, and experienced the most consistent improvements in gait and mobility, study author Dr. Lisa Shulman said. But only stretching and resistance training improved scores on a standardized Parkinson's rating scale, probably because that type of exercise improved flexibility, researchers said.

Researchers said that an exercise routine that includes low-intensity walking, as well as stretching and resistance training, might help Parkinson's patients the most.

"There has been quite a bit of media attention regarding high-intensity exercise as key, but our research showed low-intensity exceeded its efficacy," said Shulman, a professor of neurology at University of Maryland School of Medicine. "What was very significant was it was not necessary to increase intensity of walking . . . [and] we can say that virtually everyone at all stages of the disease can achieve some benefit."

The safinamide study was the first randomized, long-term clinical trial to show the drug reduced dyskinesia, or involuntary movements, when taken with levodopa. Levodopa increases levels of dopamine in the brain to help ease the stiffness, tremors and poor muscle control of Parkinson's, which is incurable.

Over a two-year period, researchers split 669 patients with mid- to late-stage Parkinson's who were already taking levodopa into groups that were given either 50 milligrams (mg) or 100 mg per day of safinamide, or a placebo.

Overall, the study found no significant improvements in their dyskinesia or other movement problems among patients taking the drug vs. the placebo.

But among a subset of participants suffering from severe dyskinesia, those taking 100 mg of safinamide per day experienced an average 24 percent reduction in movement problems, according to the study, which was funded by Newron Pharmaceuticals in Italy.

"It is a nice amount of improvement -- not dramatically life-changing, but real and interesting," said Dr. Michael Kaplitt, leading Michael Stern Parkinson's Research Foundation researcher and vice chairman for research in the department of neurological surgery at Weill Cornell Medical College in New York City.

"I think it's promising, to the extent that Parkinson's patients always need new therapies to come out," Kaplitt added. "It definitely warrants further study."

Kaplitt noted that the exercise study made walking long distances "almost like self-physical therapy" for Parkinson's patients because the regimen essentially helps train their brains to walk in a more stable manner.

He and Shulman agreed that Parkinson's patients should take these findings to heart and integrate long, brisk walks into their daily routines.

"Patients understandably want to know how they can slow the progression of the disease and unfortunately we don't have any medication proven to [do that]," said Shulman, also a fellow at the American Academy of Neurology. "But people who remain more active . . . can improve in terms of gait and mobility, and they're highly likely to delay their progression over time."

Because these studies were presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

The National Parkinson Foundation has more on the symptoms of Parkinson's.

SOURCES: Lisa Shulman, M.D., professor, neurology, University of Maryland School of Medicine, and fellow, American Academy of Neurology; Michael Kaplitt, M.D., Ph.D., leading Michael Stern Parkinson's Research Foundation researcher, and vice chairman, research, Department of Neurological Surgery, Weill Cornell Medical College, New York City; April 12, 2011, presentations, American Academy of Neurology annual meeting, Honolulu


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