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A High-Intensity Exercise Boot Camp for Persons With Parkinson Disease

A Phase II, Pragmatic, Randomized Clinical Trial of Feasibility, Safety, Signal of Efficacy, and Disease Mechanisms

Landers, Merrill R., PT, DPT, PhD, OCS; Navalta, James W., PhD; Murtishaw, Andrew S., PhD; Kinney, Jefferson W., PhD; Pirio Richardson, Sarah, MD

Journal of Neurologic Physical Therapy: January 2019 - Volume 43 - Issue 1 - p 12–25
doi: 10.1097/NPT.0000000000000249
Research Articles

Background and Purpose: The feasibility, safety, and efficacy of a high-intensity multimodal exercise program (aerobic, strengthening, and balance training) have not been well vetted in persons with Parkinson disease (PD). Thus, the primary aim was to determine whether a high-intensity multimodal exercise boot camp (HIBC) was both feasible and safe in persons with PD. The secondary aim was to determine whether the program would produce greater benefit than a usual care, low-intensity exercise program (UC). An exploratory aim was to determine whether these programs affected putative disease-modifying mechanisms.

Methods: Twenty-seven participants (19 men and 8 women) were randomized into 8 weeks of either the HIBC or UC supervised by physical therapists. For feasibility, participation, and meeting, Centers for Disease Control and Prevention (CDC) exercise guidelines were assessed. For safety, adverse events were monitored. For efficacy, the following outcome domains were assessed before and after participation: balance, motor activity, endurance and fatigue, strength, mental health, and quality of life. For disease-modifying mechanisms, circulating brain-derived neurotrophic factor (BDNF) and its genotype, superoxide dismutase, and cytokines (tumor necrosis factor-α, interleukin-6, and interleukin-10) were monitored.

Results: The HIBC was better at attaining CDC guidelines (P = 0.013) and spent more minutes in higher-intensity exercise per week (P < 0.001). There were no differences in adverse events (P = 0.419). The HIBC experienced significant improvements in 7/31 outcomes versus 3/31 in the UC arm. BDNF improved significantly for both groups from pre- to posttests (Ps ≤ 0.041) and an improved anti-inflammatory was observed for both groups.

Discussion and Conclusions: A high-intensity multimodal exercise boot camp was feasible and safe in persons with PD. Compared with usual care, there were no differences in adverse events. Moreover, the high-intensity multimodal exercise program produced more improvement across more domains than usual care. Our results also suggest a possible link between improvement in outcomes and an improved anti-inflammatory milieu.

Video Abstract available for more insights from the authors (see Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A244).

Departments of Physical Therapy (M.R.L.), Kinesiology and Nutritional Sciences (J.W.N.), and Psychology (J.W.K.), University of Nevada, Las Vegas; Alzheimer's Association, Chicago, Illinois (A.S.M.); and Department of Neurology, University of New Mexico and New Mexico VA Healthcare System, Albuquerque, New Mexico (S.P.R.).

Correspondence: Merrill R. Landers, PT, DPT, PhD, OCS, Department of Physical Therapy, University of Nevada, Las Vegas, 4505 Maryland Pkwy, Box 453029, Las Vegas, NV 89154 (merrill.landers@unlv.edu).

Results presented at:

Landers MR, Navalta J. A phase II, pragmatic, randomized clinical trial on a high-intensity exercise and fall prevention boot camp for Parkinson's disease: signal of efficacy. 4th World Parkinson Congress, Portland, Oregon, USA, September 20-23, 2016.

Landers MR, Navalta J. A phase II, pragmatic, randomized clinical trial on a high-intensity exercise and fall prevention boot camp for Parkinson's disease: feasibility and safety. 4th World Parkinson Congress, Portland, Oregon, USA, September 20-23, 2016.

This trial was funded by a Mountain West Clinical Translational Research-Infrastructure Network (CTR-IN) Pilot Study Grant, NIGMS, NIH, Grant U54GM104944-01A1. It was also partially funded through an Institutional Development Award (IDeA) from the National Institute of General Medical Sciences of the National Institutes of Health under grant number P20GM109025.

Ethical approval was received from the University of Nevada, Las Vegas Biomedical Institutional Review Board.

ClinicalTrials.gov Identifier: NCT02230267

The authors declare no conflict of interest.

Supplemental digital content is available for this article. Direct URL citation appears in the printed text and is provided in the HTML and PDF versions of this article on the journal's Web site (www.jnpt.org).

© 2019 Academy of Neurologic Physical Therapy, APTA