Exercise and dopaminergic therapy for early Parkinson’s disease

Individualize treatment for each patient

Use evidence-based medicine recommendations, but adapt to the patient’s needs

Parkinson’s disease (PD) affects men and women of all ages worldwide. When a patient is diagnosed with early PD, individualize treatment for each patient, said Professor Fox. Focus on the patient in front of you.

Evidence-based medicine is one factor contributing to nonpharmacologic and pharmacologic therapy decision-making, added Professor Fox. Other factors include expert opinion, physician experience, patient preference, and local health resources and availability.

What type of exercise improves the symptoms and disease course?

Exercise needs to be sustained to be beneficial

Exercise can be beneficial for patients with PD, said Professor Fox. Four weeks of gait training or 8 weeks of balance training have positive effects that persist for 3–12 months; and sustained strength training, aerobic training, tai chi, or dance therapy for at least 12 weeks can produce long-term benefits.¹

However, few clinical trials have been carried out on the effect of exercise on patients with early PD and not on medication, added Professor Fox, but the following studies provide some guidance:

Home-based aerobic exercise attenuates off-state motor signs

• A phase 2 randomized clinical trial (RCT) involving 128 patients with PD and not on medication established that 80% to 85% and 60% to 65% exercise intensities are safe and feasible, and that high-intensity treadmill exercise is nonfutile²
• An RCT involving 130 patients with mild PD and on stable dopaminergic medication, showed that home-based aerobic exercise attenuates off-state motor signs³
• A retrospective study of 237 patients with early PD not on dopaminergic medication, revealed that regular physical activity and exercise were associated with an improved course of the disease

Regular physical activity and exercise are beneficial

Symptomatic motor therapies

Any of the dopaminergic medications will reduce the motor symptoms of PD,⁵ said Professor Fox. These include levodopa, dopamine agonists, and monoamine oxidase B inhibitors, which are all recommended as first-line treatments by the National Institute for Health and Care Excellence for early PD.⁶

Any dopaminergic drug will reduce the motor symptoms of Parkinson’s disease

Choice of medication will depend upon a range of factors including:

• The patient’s symptoms, comorbidities, current medication, lifestyle, preferences, needs, and goals⁶
• The potential benefits and adverse effects of each treatment⁶
• Local resources and availability

Many factors contribute to the choice of dopaminergic medication

Finally, Professor Fox highlighted the 147 ongoing clinical trials of drug therapies for PD,⁷ and suggested encouraging patients to take part in a clinical trial if appropriate. We must not let our patients lose hope, she said. It’s important to take the positives and look forward.