Aerobic Fitness Is Associated with Better Cognitive and Motor Function in Mild-moderate Parkinson’s Disease
Ergun Uc1, Alejandro Comellas2, Joel Kline2, Jeffrey Dawson3, Nandakumar Narayanan4, Matthew Rizzo7, Michelle Voss5, Steven Anderson4, Christina Weber4, Warren Darling6
1Neurology, University of Iowa/Iowa City VA Medical Center, 2Internal Medicine, 3Biostatistics, 4Neurology, 5Psychological and Brain Sciences, 6Health and Human Physiology, University of Iowa, 7Neurology, University of Nebraska Medical Center
Objective:
To determine association of aerobic fitness with cognition and motor function in mild-moderate Parkinson’s disease (PD).
Background:
There is preliminary evidence that aerobic exercise can improve motor and cognitive function in PD.
Design/Methods:
At baseline of an ongoing clinical trial on aerobic exercise (NCT03808675), independently living PD patients without significant systemic and neurologic comorbidities underwent cognitive and motor (in the “practically defined” OFF and ON states) testing. Aerobic fitness was determined by measuring VO2max during cycle ergometry.
Results:
Fifty-seven PD patients completed baseline testing (Age=66.4±7.5 years; 42 men, 15 women; median Hoehn-Yahr stage II [range I-II], and median MMSE 29 [range 25-30]. Compared to a demographically similar historic control group from our driving studies, the PD group performed mildly but significantly (p<0.05) worse on most cognitive outcome measures, including the MMSE. Within the PD group, VO2max correlated (Pearson) negatively with age (r=-0.39, p<0.01) and was higher in men than women (23.5±5.3 vs. 20.0±5.1 ml/kg/min, p<0.05). Multiple regression adjusting for age, sex, levodopa equivalent daily dosing (mg; for ON-state motor testing only) revealed that higher VO2max correlated significantly with better motor performance on the OFF-state Finger Tapping Speed and Peg Board Time (p<0.05), and the ON-state 2-Minute Walk Test distance (p<0.001) and 4-meter Walk Test time (p<0.05). Multiple regression adjusting for age, sex, and education (years) revealed that higher VO2max correlated significantly with better cognitive performance on the MoCA and Benton Visual Retention Test (p<0.05), and Block Design Test (p=0.05), and on the Flanker Response Inhibition Task (p<0.01). There were no significant correlations with the MDS-UPDRS section scores and memory tests.
Conclusions:
Aerobic fitness is independently associated with cognition (primarily, executive and visuospatial abilities) and motor function (primarily, OFF-state bradykinesia and dexterity, and ON-state ambulation). Our results suggest that aerobic exercise training may have the potential to improve cognitive and motor functions in PD.