Regular Exercise Linked to Lower All-Cause Mortality in PD

Patients with Parkinson disease (PD) who had the highest levels of physical activity after their diagnosis also had the lowest mortality rate from any reason, according to a study published last month.

The findings from the nationwide population-based cohort study were published in JAMA Neurology.

The authors noted that while the beneficial effects of exercise on various aspects of PD have been noted, the impact on mortality, including the amount and level, has not been thoroughly studied.

Using Korean National Health Insurance System data, researchers included participants who received a PD diagnosis between January 1, 2010, and December 31, 2013; follow-up continued unit December 31, 2017.

Individuals who underwent health checkups within 2 years before and after the PD diagnosis were enrolled. Through a self-reported questionnaire using the 7-day recall method, participants reported their physical activity 2 years before their PD diagnosis and then 2 years afterward.

After exclusions (including patients aged younger than 40 years or those with missing data), the researchers included 10,699 individuals with PD; 4925 (46%) were male and 5774 (54%) were female. The mean (SD) age was 69.2 (8.8) years. During the follow-up period, there were 1823 deaths (17%).

Participants were asked if they were physically active or not. If they responded that they were active, they were asked to quantify how many days per week they spent on each physical activity and at what level of intensity—light (such as walking), moderate (ie, fast walking or bike riding), or vigorous (running, aerobics).

Those who reported performing vigorous exercise 3 or more times a week or moderate/light exercise 5 or more times a week, were considered physically active. Otherwise, they were considered physically inactive.

The study found a reduction in mortality across the board for patients with PD engaging in exercise.

At all levels of exercise, patients with PD who were physically active had a significantly lower mortality rate compared with those who do not exercise:

• Vigorous: HR, 0.80 (95% CI, 0.69-0.93)
• Moderate: HR, 0.66 (95% CI, 0.55-0.78)
• Light: HR, 0.81 (95% CI, 0.73-0.90)

A higher total amount of exercise was also linked with a lower mortality rate (all P < .001):

• Vigorous: HR, 0.80 (95% CI, 0.69-0.93)
• Moderate: HR, 0.66 (95% CI, 0.55-0.78)
• Light: HR, 0.81 (95% CI, 0.73-0.90)

There was also a benefit for patients who did not begin to exercise until after their PD diagnosis, even if they were not active before, compared with patients who never took up exercising at all:

• Vigorous: HR, 0.82 (95% CI, 0.70-0.97)
• Moderate: HR, 0.69 (95% CI, 0.57-0.83)
• Light: HR, 0.86 (95% CI, 0.78-0.98)

Patients who were physically active both before and after the PD diagnosis had the greatest reduction in mortality rate across all exercise levels:

• Vigorous: HR, 0.66 (95% CI, 0.50-0.88)
• Moderate: HR,0.49 (95% CI, 0.32-0.75)
• Light: HR,0.76 (95% CI, 0.66-0.89)

The study had several limitations that randomized controlled trials should seek to address, the authors noted. It may have suffered from reverse causality and selection bias. In addition, information about motor symptoms and PD subtype were not included, nor were other lifestyle habits, which are known to influence PD.

An accompanying editorial noted that the challenge now will be for clincians and patients to figure out how to modify exercise as needed, as many patients with PD are faced with various barriers to vigorous and lengthy exercise.

Reference

Yoon SY, Suh JH, Yang SN, et al. Association of physical activity, including amount and maintenance, with all-cause mortality in Parkinson disease. JAMA Neurol. 2021;78(12):1446-1453. doi:10.1001/jamaneurol.2021.3926