Reader Response: Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease
TalytaCortez Grippe, Research Fellow, Krembil Research Institute, Toronto Western Hospital
ConnieMarras, Assistant Professor of Neurology, Neurologist, Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology, University of Toronto
MiriamRafferty, Research Scientist, Assistant Professor of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab; Department of Physical Rehabilitation and Medicine, Northwestern University
Anthony ELang, Professor of Neurology , Neurologist, Movement Disorders Clinic, Toronto Western Hospital; Division of Neurology, University of Toronto
Submitted February 07, 2022
Dr. Tsukita and colleagues’ PPMI database analysis reports the effects of physical activity on the progression of PD clinical parameters, measured using the Physical Activity Scale for the Elderly (PASE). It confirms prior studies showing that regular exercise is associated with improved outcomes.2 Although the study uses rigorous statistical methods, the reported association between maintained physical activity and concurrent slower deterioration of postural and gait stability should be interpreted carefully.
The authors emphasize the mechanisms by which exercise may improve outcomes; the title implies causation. However, impaired postural and gait stability are well known to affect physical activity in PD.3 Many of the activities listed in the PASE require good balance. Thus, postural and gait impairments could be responsible for reducing exercise. We believe this reverse causation is a critical factor to consider before assuming that the reduced rate of posture and gait deterioration is a direct effect of the amount and regularity of the exercise performed.
Additionally, the PASE questionnaire, based on a 1-week recall, is limited by lower reliability than questionnaires with longer timeframes and only moderate correlation with objective activity monitoring in people with PD.4,5 Psychometrically strong, clinical measures of physical activity are needed.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References
Tsukita K, Sakamaki-Tsukita H, Takahashi R. Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease [published online ahead of print, 2022 Jan 12]. Neurology. 2022;10.1212/WNL.0000000000013218.
Rafferty MR, Schmidt PN, Luo ST, et al. Regular Exercise, Quality of Life, and Mobility in Parkinson's Disease: A Longitudinal Analysis of National Parkinson Foundation Quality Improvement Initiative Data. J Parkinsons Dis. 2017;7(1):193-202. doi:10.3233/JPD-160912
van Nimwegen M, Speelman AD, Hofman-van Rossum EJ, et al. Physical inactivity in Parkinson's disease. J Neurol. 2011;258(12):2214-2221. doi:10.1007/s00415-011-6097-7
Ånfors S, Kammerlind AS, Nilsson MH. Test-retest reliability of physical activity questionnaires in Parkinson's disease. BMC Neurol. 2021;21(1):399. Published 2021 Oct 15. doi:10.1186/s12883-021-02426-y
Mantri S, Wood S, Duda JE, Morley JF. Comparing self-reported and objective monitoring of physical activity in Parkinson disease. Parkinsonism Relat Disord. 2019;67:56-59. doi:10.1016/j.parkreldis.2019.09.004
Dr. Tsukita and colleagues’ PPMI database analysis reports the effects of physical activity on the progression of PD clinical parameters, measured using the Physical Activity Scale for the Elderly (PASE). It confirms prior studies showing that regular exercise is associated with improved outcomes.2 Although the study uses rigorous statistical methods, the reported association between maintained physical activity and concurrent slower deterioration of postural and gait stability should be interpreted carefully.
The authors emphasize the mechanisms by which exercise may improve outcomes; the title implies causation. However, impaired postural and gait stability are well known to affect physical activity in PD.3 Many of the activities listed in the PASE require good balance. Thus, postural and gait impairments could be responsible for reducing exercise. We believe this reverse causation is a critical factor to consider before assuming that the reduced rate of posture and gait deterioration is a direct effect of the amount and regularity of the exercise performed.
Additionally, the PASE questionnaire, based on a 1-week recall, is limited by lower reliability than questionnaires with longer timeframes and only moderate correlation with objective activity monitoring in people with PD.4,5 Psychometrically strong, clinical measures of physical activity are needed.
Disclosure
The authors report no relevant disclosures. Contact journal@neurology.org for full disclosures.
References