title: Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting.
abstract: OBJECTIVE
  To (1) investigate effects of aerobic walking on motor function, cognition, and quality of life in Parkinson disease (PD), and (2) compare safety, tolerability, and fitness benefits of different forms of exercise intervention: continuous/moderate intensity vs interval/alternating between low and vigorous intensity, and individual/neighborhood vs group/facility setting.
  
  
  METHODS
  Initial design was a 6-month, 2 × 2 randomized trial of different exercise regimens in independently ambulatory patients with PD. All arms were required to exercise 3 times per week, 45 minutes per session.
  
  
  RESULTS
  Randomization to group/facility setting was not feasible because of logistical factors. Over the first 2 years, we randomized 43 participants to continuous or interval training. Because preliminary analyses suggested higher musculoskeletal adverse events in the interval group and lack of difference between training methods in improving fitness, the next 17 participants were allocated only to continuous training. Eighty-one percent of 60 participants completed the study with a mean attendance of 83.3% (95% confidence interval: 77.5%-89.0%), exercising at 46.8% (44.0%-49.7%) of their heart rate reserve. There were no serious adverse events. Across all completers, we observed improvements in maximum oxygen consumption, gait speed, Unified Parkinson's Disease Rating Scale sections I and III scores (particularly axial functions and rigidity), fatigue, depression, quality of life (e.g., psychological outlook), and flanker task scores (p < 0.05 to p < 0.001). Increase in maximum oxygen consumption correlated with improvements on the flanker task and quality of life (p < 0.05).
  
  
  CONCLUSIONS
  Our preliminary study suggests that aerobic walking in a community setting is safe, well tolerated, and improves aerobic fitness, motor function, fatigue, mood, executive control, and quality of life in mild to moderate PD.
  
  
  METHODS
  This study provides Class IV evidence that in patients with PD, an aerobic exercise program improves aerobic fitness, motor function, fatigue, mood, and cognition.
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign. ergun-uc@uiowa.edu.
authors.forename: Ergun Y
authors.initials: EY
authors.lastname: Uc
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Doerschug
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Vincent
authors.initials: V
authors.lastname: Magnotta
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Dawson
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Teri R
authors.initials: TR
authors.lastname: Thomsen
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Joel N
authors.initials: JN
authors.lastname: Kline
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Matthew
authors.initials: M
authors.lastname: Rizzo
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Sara R
authors.initials: SR
authors.lastname: Newman
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Sonya
authors.initials: S
authors.lastname: Mehta
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Grabowski
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Joel
authors.initials: J
authors.lastname: Bruss
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Derek R
authors.initials: DR
authors.lastname: Blanchette
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Steven W
authors.initials: SW
authors.lastname: Anderson
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Michelle W
authors.initials: MW
authors.lastname: Voss
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Arthur F
authors.initials: AF
authors.lastname: Kramer
authors.affiliation: From the Departments of Neurology (E.Y.U., T.R.T., M.R., S.R.N., J.B., S.W.A.), Internal Medicine (K.C.D., J.N.K.), Radiology (V.M.), Biostatistics (J.D.D., D.R.B.), Psychology (M.W.V.), and Health and Human Physiology (W.G.D.), University of Iowa, Iowa City; Neurology Service (E.Y.U., T.R.T., S.R.N.), Veterans Affairs Medical Center, Iowa City, IA; Department of Neurology (S.M., T.J.G.), University of Washington, Seattle; and Department of Psychology (A.F.K.), Beckman Institute, University of Illinois, Urbana-Champaign.
authors.forename: Warren G
authors.initials: WG
authors.lastname: Darling
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010300:Parkinson Disease / Q000175:diagnosis / Q000503:physiopathology* / Q000628:therapy*; D011788:Quality of Life; D012111:Residence Characteristics; D016896:Treatment Outcome