Aerobic Exercise Alters Brain Function and Structure in Parkinson's Disease: A Randomized Controlled Trial.

Martin E Johansson, Ian G M Cameron, Nicolien M Van der Kolk, Nienke M de Vries, Eva Klimars, Ivan Toni, Bastiaan R Bloem, Rick C Helmich

Journal: Annals of neurology 2022;91(2):203-216

PMID: 34951063

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Plain Language Summary

An increasing number of studies suggest that motor symptoms associated with Parkinson’s disease (PD) can be improved through physical exercise. The aim of this study was to investigate the effect of aerobic exercise on cerebral changes (PD symptoms, brain function, and eye movements). This study is a single-centre, prospective double-blind, randomised, placebo-controlled trial. Participants (n=56) were randomly assigned to one of two intervention groups (1:1 ratio) - two home-based exercise programs: aerobic exercise (n=25) or stretching (n=31). Results show that aerobic exercise stabilises motor progression and enhances cognitive performance in individuals with PD by stimulating functional and structural plasticity in corticostriatal sensorimotor and cognitive control networks. Authors conclude aerobic exercise stimulates functional and structural neuroplasticity in both motor and cognitive brain networks in PD.

Abstract

OBJECTIVE

Randomized clinical trials have shown that aerobic exercise attenuates motor symptom progression in Parkinson's disease, but the underlying neural mechanisms are unclear. Here, we investigated how aerobic exercise influences disease-related functional and structural changes in the corticostriatal sensorimotor network, which is involved in the emergence of motor deficits in Parkinson's disease. Additionally, we explored effects of aerobic exercise on tissue integrity of the substantia nigra, and on behavioral and cerebral indices of cognitive control.

METHODS

The Park-in-Shape trial is a single-center, double-blind randomized controlled trial in 130 Parkinson's disease patients who were randomly assigned (1:1 ratio) to aerobic exercise (stationary home trainer) or stretching (active control) interventions (duration = 6 months). An unselected subset from this trial (exercise, n = 25; stretching, n = 31) underwent resting-state functional and structural magnetic resonance imaging (MRI), and an oculomotor cognitive control task (pro- and antisaccades), at baseline and at 6-month follow-up.

RESULTS

Aerobic exercise, but not stretching, led to increased functional connectivity of the anterior putamen with the sensorimotor cortex relative to the posterior putamen. Behaviorally, aerobic exercise also improved cognitive control. Furthermore, aerobic exercise increased functional connectivity in the right frontoparietal network, proportionally to fitness improvements, and it reduced global brain atrophy.

INTERPRETATION

MRI, clinical, and behavioral results converge toward the conclusion that aerobic exercise stabilizes disease progression in the corticostriatal sensorimotor network and enhances cognitive performance. ANN NEUROL 2022;91:203-216.

Address: Donders Institute for Brain, Cognition and Behavior, Center for Cognitive Neuroimaging, Radboud University, Nijmegen, The Netherlands.; Donders Institute for Brain, Cognition and Behavior, Center for Medical Neuroscience, Department of Neurology, Center of Expertise for Parkinson and Movement Disorders, Radboud University Medical Center, Nijmegen, The Netherlands.; Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands.; Faculty of Electrical Engineering, Mathematics, and Computer Science, University of Twente, Enschede, The Netherlands.; Precision Health, Nutrition and Behavior, OnePlanet Research Center, Nijmegen, The Netherlands.

DOI: 10.1002/ana.26291

Patient Centred Factor

Mediators: Parkinson's disease

Clinical Imbalances

Neurological

Laboratory Testing

Imaging

Modifiable Lifestyle Factors

Exercise and movement

Jadad Score

Allocation Concealment

Yes

Nutrition Evidence Keywords

Exercise Physical exercise

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MeSH Terms: Aged, Behavior, Brain, Cognition, Double-Blind Method, Exercise, Exercise Therapy, Female, Humans, Magnetic Resonance Imaging, Male, Middle Aged, Nerve Net, Parkinson Disease, Prospective Studies, Psychomotor Performance, Putamen, Sensorimotor Cortex, Substantia Nigra