Clinical Practice & Epidemiology in Mental Health




ISSN: 1745-0179 ― Volume 15, 2019

Effects of Chronic Exercise on Severity, Quality of Life and Functionality in an Elderly Parkinson’s Disease Patient: Case Report



Eduardo Lattari 1, Pedro Paulo Pereira-Junior 2, Geraldo Albuquerque Maranhão Neto 2, Murilo Khede Lamego 1, Antonio Marcos de Souza Moura 1, Alberto Souza de Sá 1, Ridson Rosa Rimes 1, João Paulo Manochio 1, Oscar Arias-Carrión 3, Gioia Mura 4, Antonio E Nardi 1, Sergio Machado 1, 2, *
1 Panic & Respiration Laboratory, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil; National Institute for Translational Medicine (INCT-TM), Brazil
2 Physical Activity Neuroscience, Physical Activity Postgraduate Program, Salgado de Oliveira University (UNIVERSO), Niterói - RJ, Brazil;
3 Unidad de Trastornos de Movimiento y Sueño, Hospital General Dr. Manuel Gea Gonzalez, Secretaria de Salud México DF, México
4 Department of Public Health, Clinical and Molecular Medicine. University of Cagliari, Italy

Abstract

Exercise produces potential influences on physical and mental capacity in patients with neuropsychiatric disorders, and can be made a viable form of therapy to treat Parkinson’s disease (PD). We report the chronic effects of a regular physical exercise protocol on cognitive and motor functions, functional capacity, and symptoms in an elderly PD patient without dementia. The patient participated of a program composed of proprioceptive, aerobic and flexibility exercises, during 1 hour, three days a week, for nine months. Patient used 600 mg of L-DOPA daily, and 1 hour prior to each exercise session. Assessment was conducted in three stages, 0-3, 3-6 and 6 to 9 months, using percentual variation to the scales Hoehn and Yahr, Mini-Mental State Examination (MMSE), Parkinson Activity Scale (PAS), Beck Depression Inventory (BDI), and Unified Parkinson's Disease Rating Scale (UPDRS-III). Reassessment showed clear changes in clinical parameters for Hoehn and Yahr (4 to 2.5), MMSE (14 to 22), PAS (13 to 29), BDI (9 to 7) and UPDRS-III (39 to 27) at the end of 9 months. According to our data, exercise seems to be effective in promoting the functional capacity and the maintenance of cognitive and motor functions of PD patients. Regular exercise protocols can be implemented as an adjunctive treatment for reducing the severity of PD.

Keywords: Exercise, functional capacity, Parkinson’s disease, severity..


Article Information


Identifiers and Pagination:

Year: 2014
Volume: 10
First Page: 126
Last Page: 128
Publisher Id: CPEMH-10-126
DOI: 10.2174/1745017901410010126

Article History:

Received Date: 1/7/2014
Revision Received Date: 13/7/2014
Acceptance Date: 13/7/2014
Electronic publication date: 14 /11/2014
Collection year: 2014

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© Lattari et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Brazil; E-mail: secm80@gmail.com




INTRODUCTION

Parkinson's disease (PD), a chronic neurodegenerative disease, is manifested by a loss of dopaminergic neurons from the substantia nigra pars compacta, affecting up to 70% of these cells [1Poewe W, Mahlknecht P. The clinical progression of Parkinson's disease. Parkinsonism Relat Disord 2009; 15 (Suppl 4 ): S28-32.]. PD prevalence is around 0.5-1% in people aged 65-69 years, increasing to 1-3% among individuals aged over 80 years [2Schneider SA, Obeso JA. Clinical and Pathological Features of Parkinson's Disease. Curr Top Behav Neurosci 2014; [Epub Ahead of Print]]. PD is associated with genetic, environmental, and behavioral features, resulting in the main symptoms, such as rigidity, postural instability, progressive bradykinesia, and tremor. These sensorimotor deficits are directly related to falls, reduction in functional independence and fatigue experienced by the patients [3Gazibara T, Pekmezovic T, Tepavcevic DK , et al. Circumstances of falls and fall-related injuries among patients with Parkinson's disease in an outpatient setting. Geriatr Nurs 2014; 35(5): 364-9.].

Currently available drugs for PD treatment just provide relief of symptoms and do not control or prevent the disease progression [4Tarazi FI, Sahli ZT, Wolny M, Mousa SA. Emerging therapies for Parkinson's disease From bench to bedside. Pharmacol Ther 2014; 144(2): 123-33.]. Although many of these drugs are very promising, searching for new alternative treatments is essential. One such novel therapeutic option is physical exercise. Exercise might help by protecting against the disease as well as an adjunctive treatment, with proved benefits in terms of maintenance of functional capacity and quality of life [5Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.]. A meta-analysis published by Lima et al. [6Lima LO, Scianni A, Rodrigues-de-Paula F. Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson's disease a systematic review. J Physiother 2013; 59(1 ): 7-13.] showed that strength training improved the functional capability of walking and increased strength. Other meta-analysis found that exercise was beneficial for physical function, quality of life, strength, balance and gait [7Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL. The effectiveness of exercise interventions for people with Parkinson's disease a systematic review and meta-analysis. Mov Disord 2008; 23(5): 631-40.]. According to Falvo et al. [8Falvo MJ, Schilling BK, Earhart GM. Parkinson's disease and resistive exercise rationale, review, and recommendations. Mov Disord 2008; 23(1): 1-11.], adaptive changes in neuromuscular functions due to strength training are very important because they are specific in PD patients, such as musculoskeletal weakness and are associated with negative changes elapsed by PD. Nevertheless, in a recent review [9Murray DK, Sacheli MA, Eng JJ, Stoessl AJ. The effects of exercise on cognition in Parkinson's disease a systematic review. Transl Neurodegener 2014; 3(1): 5.] evidence in favor of exercise were found, however still inconclusive in relation to its efficacy on the promotion of quality of life and the reduction of motor and cognitive deficits. Additionally, the duration of the protocols applied in these studies were mainly shorter than three months, which raises questions about the benefits of regular, prolonged exercise for PD patients.

We report the case of a 77-year old female patient, 8 years with PD and is currently in Hoehn and Yahr [10Goetz CG, Poewe W, Rascol O , et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale status and recommendations. Mov Disord 2004; 19(9): 1020-8.] stage 4, without dementia according to criteria established by Emre et al. [11Emre M, Aarsland D, Brown R , et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord 2007; 22(12): 1689-707.]. The patient engaged in a 1-hour exercise protocol comprising proprioceptive, flexibility and aerobic activities, 3 days per week, for 9 months. She was treated with 600 mg L-DOPA on a daily basis, as many before as during the 9-month exercise intervention, which at exercise days would be administered 1 hour before the start of the training session. Previously to the intervention, a moderate cognitive loss was detected by a score 14 in the Mini-Mental State Examination (MMSE) [12Folstein MF, Folstein SE, McHugh PR. "Mini-mental state".A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98.], as well as a moderate functional capacity, detected by a score 13 in the Parkinson Activity Scale (PAS) [13Nieuwboer A, De Weerdt W, Dom R, Bogaerts K, Nuyens G. Development of an activity scale for individuals with advanced Parkinson disease reliability and "on-off" variability. Phys Ther 2000; 80(11): 1087-96.]. A score 39 on the UPDRS III and a score of 9 was observed in BDI. Data from the re-evaluations conducted during the chronic exercise intervention show a clear reduction in the severity of the disease by the end of the 9-month period according to percentual variation (Fig. 1).

Fig. (1)

Percentual variation of disease evolution throughout exercise intervention.

Note: BDI: Beck Depression Inventory; MMSE: Mini Mental State Examination; PAS: Parkinson Activity Scale; UPDRS: Unified Parkinson's Disease Rating Scale.



It is well known that PD is associated with a number of motor and cognitive deficits [5Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.,9Murray DK, Sacheli MA, Eng JJ, Stoessl AJ. The effects of exercise on cognition in Parkinson's disease a systematic review. Transl Neurodegener 2014; 3(1): 5.]. Exercise seems to contribute to the protection of the central nervous system (CNS) against PD, and can be considered as an adjuvant treatment approach to the disease [9Murray DK, Sacheli MA, Eng JJ, Stoessl AJ. The effects of exercise on cognition in Parkinson's disease a systematic review. Transl Neurodegener 2014; 3(1): 5.]. Also, epidemiological studies suggest that exercise reduce the risk for PD [5Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.,9Murray DK, Sacheli MA, Eng JJ, Stoessl AJ. The effects of exercise on cognition in Parkinson's disease a systematic review. Transl Neurodegener 2014; 3(1): 5.]. Additionally, other studies have been investigating the efficacy of exercise on PD, especially in terms of motor performance, gait and activities of daily living [9Murray DK, Sacheli MA, Eng JJ, Stoessl AJ. The effects of exercise on cognition in Parkinson's disease a systematic review. Transl Neurodegener 2014; 3(1): 5.]. Thus, variables such as exercise intensity seem to positively modulate the neuroprotective effect, since more intense activities would be more strongly associated with the induction of neuroprotection [5Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.]. These studies showed that exercise is effective in the promotion of the quality of life and in the maintenance of motor and cognitive functions [5Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.,9Murray DK, Sacheli MA, Eng JJ, Stoessl AJ. The effects of exercise on cognition in Parkinson's disease a systematic review. Transl Neurodegener 2014; 3(1): 5.].

In fact, the enhancement of functional capacity, as consequence of strength [5Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.], proprioceptive and flexibility training [6Lima LO, Scianni A, Rodrigues-de-Paula F. Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson's disease a systematic review. J Physiother 2013; 59(1 ): 7-13.], may positively affect patients’ functionality and quality of life, which is not necessarily due to neurochemical alterations [5Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.]. In terms of cognition, it is known that exercise increases the synthesis and release of various neurotrophic factors, such as brain-derived neurotrophic factor (BDNF) and insulin-like growth factor (IGF-1), both of them are related to healthy cognitive functioning, neurogenesis and cerebral plasticity [5Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.,9Murray DK, Sacheli MA, Eng JJ, Stoessl AJ. The effects of exercise on cognition in Parkinson's disease a systematic review. Transl Neurodegener 2014; 3(1): 5.]. Although there are few studies showing that exercise in long term appears to be beneficial for PD patients [5Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.,9Murray DK, Sacheli MA, Eng JJ, Stoessl AJ. The effects of exercise on cognition in Parkinson's disease a systematic review. Transl Neurodegener 2014; 3(1): 5.], our results support the few evidences that have been published, especially in terms of cognition.

CONFLICT OF INTEREST

The authors confirm that this article content has no conflict of interest.

ACKNOWLEDGEMENTS

Declared none.

REFERENCES

[1] Poewe W, Mahlknecht P. The clinical progression of Parkinson's disease. Parkinsonism Relat Disord 2009; 15 (Suppl 4 ): S28-32.
[2] Schneider SA, Obeso JA. Clinical and Pathological Features of Parkinson's Disease. Curr Top Behav Neurosci 2014; [Epub Ahead of Print]
[3] Gazibara T, Pekmezovic T, Tepavcevic DK , et al. Circumstances of falls and fall-related injuries among patients with Parkinson's disease in an outpatient setting. Geriatr Nurs 2014; 35(5): 364-9.
[4] Tarazi FI, Sahli ZT, Wolny M, Mousa SA. Emerging therapies for Parkinson's disease From bench to bedside. Pharmacol Ther 2014; 144(2): 123-33.
[5] Matta MPE Cevada T, Sobral MR , et al. Neuroscience of exercise from neurobiology mechanisms to mental health. Neuropsychobiol 2013; 68(1 ): 1-14.
[6] Lima LO, Scianni A, Rodrigues-de-Paula F. Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson's disease a systematic review. J Physiother 2013; 59(1 ): 7-13.
[7] Goodwin VA, Richards SH, Taylor RS, Taylor AH, Campbell JL. The effectiveness of exercise interventions for people with Parkinson's disease a systematic review and meta-analysis. Mov Disord 2008; 23(5): 631-40.
[8] Falvo MJ, Schilling BK, Earhart GM. Parkinson's disease and resistive exercise rationale, review, and recommendations. Mov Disord 2008; 23(1): 1-11.
[9] Murray DK, Sacheli MA, Eng JJ, Stoessl AJ. The effects of exercise on cognition in Parkinson's disease a systematic review. Transl Neurodegener 2014; 3(1): 5.
[10] Goetz CG, Poewe W, Rascol O , et al. Movement Disorder Society Task Force report on the Hoehn and Yahr staging scale status and recommendations. Mov Disord 2004; 19(9): 1020-8.
[11] Emre M, Aarsland D, Brown R , et al. Clinical diagnostic criteria for dementia associated with Parkinson's disease. Mov Disord 2007; 22(12): 1689-707.
[12] Folstein MF, Folstein SE, McHugh PR. "Mini-mental state".A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975; 12(3): 189-98.
[13] Nieuwboer A, De Weerdt W, Dom R, Bogaerts K, Nuyens G. Development of an activity scale for individuals with advanced Parkinson disease reliability and "on-off" variability. Phys Ther 2000; 80(11): 1087-96.

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