http://www.uab.edu/news/latest/item/...nsons-patients

To put some perspective on this, the paper referenced says that:

"Study participants showed significant improvement of six points on average on a measure called the Unified Parkinson’s Disease Rating Scale."

The full UPDRS test is marked out of 199. See:
http://www.epda.eu.com/en/parkinsons...-scales/updrs/

So, this therapy gives only a 3% improvement. That's better than nothing, but still rather disappointing. It would be interesting to know how this compared with the placebo effect.

John

If your score was 12 it would be a 50 percent improvment after only 16 weeks. Impressive to say the least. These cats had moderate PD not end stage!

If you gain three to four points a year. (52 weeks) In 16 weeks you can go backwards 1.5 years!!! Imagine the health impliations and possibilities. These people were doing...A sit-to-stand test showed that, after strength training, participants dropped from requiring 90 percent of maximum muscle recruitment to rise to a standing position to just 60 percent, which put them on par with their same-age, non-Parkinson’s peers.

You're right. A six point decline in UPDRS is huge. You can't just look at the top possible score, which is basically someone at the end of the line. Typical scores for early stage PwP would be 15 - 25 range. Next stage would be 26 - 40. As most of PwP will progress over time, 6 points attributed to an intervention is huge. Also keep in mind that this measure is not based on a linear scale. It's a subjective test based on both your answers to questions and a doctors observance of you motor abilities. A 6 point change for someone at a level of 20 is totally different than a similar change for someone at 80.

badboy99 and Tupelo3 thank you for correcting my mistake. The 3% figure I gave would only be correct if all the participants were totally disabled by PD. This was not the case.

My mistake raises yet again the importance of metrics. They need to be accurate. They need to be understandable. They need to communicate to the extent that they inform action.

Put to one side, for now, statistical factors, the degree of blindedness of the trial, the subjective nature of some of the assessments, the placebo effect and all other confounding factors. Take the results as given. On that basis we should be able to make an informed answer to the question: Should we start this form of exercise today?

Unfortunately, the original paper is behind a pay wall, but the abstract is available and this gives some clues as to the size of the therapy's benefit. In it Kelly et al. write [1]:

"... Fifteen participants with PD (Hoehn & Yahr stage 2-3) completed 16 wk of high-intensity exercise training designed to simultaneously challenge strength, power, endurance, balance, and mobility function. ... These adaptations were accompanied by a host of functional and clinical improvements (p<0.05): total body strength (+30-56%); leg power (+42%); single leg balance (+34%); sit-to-stand motor unit activation requirement (-30%); 6-min walk (+43m), Parkinson's Disease Quality of Life Scale (PDQ-39, -7.8pts); Unified Parkinson's Disease Rating Scale (UPDRS) total (-5.7pts) and motor (-2.7pts); and fatigue severity (-17%). ..."

The measure that I find it easiest to get to grips with is the "6-min walk (+43m)". This would represent about a 6% improvement for me. But my walking is very good, so you can't take this as representative for all PwP. It's a pity that they don't give side-to-side tap test results which would give an indication of upper body mobility.

It should be pointed out that since the disease is progressive, without intervention one would have expected things to have got worse over the 16 weeks of the study. Thus, the true size of the benefit is higher than the raw figure.

I'm convinced of the benefit of exercise for PwP. The important thing is that we can measure its impact on PD in such a way that we can optimise its effectiveness.

References:

[1] "NOVEL, HIGH-INTENSITY EXERCISE PRESCRIPTION IMPROVES MUSCLE MASS, MITOCHONDRIAL FUNCTION, AND PHYSICAL CAPACITY IN INDIVIDUALS WITH PARKINSON'S DISEASE"
Neil A. Kelly1, Matthew P. Ford1, David G. Standaert1, Ray L. Watts1, C. Scott Bickel2, Douglas R. Moellering1, Steven Craig Tuggle2, Jeri Y. Williams3,Laura Lieb1, Samuel T. Windham2, and Marcas M. Bamman1,*
Journal of Applied Physiology, January 9, 2014
http://jap.physiology.org/content/ea....2013.abstract

John

On that basis we should be able to make an informed answer to the question: Should we start this form of exercise today?

high-intensity exercise training designed to simultaneously challenge strength, power, endurance, balance, and mobility function

It is the high intensity bit that gets me. If you are currently unable to walk much or have significant mobility problems this programme is not likely to be talking to you. My challenges are getting highly fatigued with any kind of activity, and there is dispute over the cause, which could be PD or other deficiency. At the moment the other is winning for the culprit prize, and I guess that many PwP have co-existing conditions. We know that exercise is good, we are not neccessarily sedentary people by nature, I know I personally loved walking being outdoors, and being active and am unable to do much now.

While studies with high intensity exercise continue to gain attention as preventing deterioration in the still mobile and active,the rest of us are left in limbo with no programmes that offer real help. Graded programmes that offer intensive exercise according to ability would address this. i.e. what is intensive for you may be impossible for me, but I am still worth the rehabilitation effort otherwise my care costs will spiral astronomically while me condition continues to deteriorate. So please give me some kind of programme that will help me help myself without exhausting me to the point that it may take days to recover or possibly never. (I am joking with the last, but tbh an hour on some of the programmes I have seen would probably finish me off.)

maybe they could hypnotize patients and "convince" them they got exercise to see what the placebo affect was but if that works, then using the placebo affect is just as valid as exercising, the researchers probably were hoping the "anticipation" of positive results would add to the result. in the final analysis we'll take what benefit we can get.

i think what's really important is researching different exercise regimes and finding the underlying biochemical changes that result in improvement so that can be measured quickly to estimate benefit rather than the more qualitative measures found thru observation, then put that into a pill. might be pie in the sky. and of course trying to find out if there are any permanent changes to the brain.

all i can say is everyone with pd may benefit, even advanced pd'ers, if treatments for less advanced pd'er are found that lets them work longer and/or save money by taking fewer drugs. my hypothesis is it frees up more funds for us advanced pd'ers. only a theory. same for a "cure" or progression slowing treatment that only works up to stage 3 pd, it frees up funds and manpower for other research? dunno.
but i'd be very happy if biomarkers were found that could predict pd way before visible symptoms so neuroprotective treatments could be tested, i wouldn't benefit directly but indirectly, i think so.
not pushing this but there is some research on power assisted bicycles that can at least force your legs to spin faster and at least in the U.S. there are exercise programs for more advanced pd'ers.

[QUOTE=lindylanka;1

While studies with high intensity exercise continue to gain attention as preventing deterioration in the still mobile and active,the rest of us are left in limbo with no programmes that offer real help. QUOTE]

I think that every study I've read on the benefits of exercise and activity for helping PwP has been positive, no matter what the form. It may be true that we don't know yet which regime is best. However, I believes it's pretty conclusive that any regime is better than nothing. So, if you can't do a high intensity exercise, you can continue your walking. There was a study published last week (I will look for the link) that showed distance walking as the best regime, even more so that fast treadmill walking. There are also plenty of studies supporting Tai Chi, Quigong, dancing, chair dancing, or chair stretching exercises. My point is, unless you are totally immobile, there is a routine for you that will work and provide some benefit to PD symptoms.