THE RELATIONSHIP BETWEEN PHYSICAL ACTIVITY, PHYSICAL FUNCTION AND PSYCHOSOCIAL VARIABLES IN INDIVIDUALS POST-BARIATRIC SURGERY

The incidence of morbid obesity (BMI ≥ 40 kg•mˉ²) is increasing at an exponential rate. Currently, the most viable option for weight loss is bariatric surgery. Success following surgical procedure is guided by the individual's ability to make behavioral changes. A better understanding of the physical activity behavior of individuals who undergo bariatric surgery will enable the development of effective post-surgical exercise guidelines and interventions to enhance surgical weight loss outcomes. PURPOSE: To define the physical activity profile of subjects 2-5 years post bariatric surgery by examining the relationship between physical activity and weight loss. Additionally, this study examines the association between physical function, psychosocial correlates of physical activity, and weight loss. METHODS: Thirty-seven adults (percentage excess weight loss (%EWL) = 62.15 ±19.93, age = 50.76 ±9.99 years) participated. Subjects wore an activity monitor to measure their physical activity. Body height, weight, physical function, psychosocial variables of physical activity (self-efficacy, expected outcomes (benefits) and perceived barriers) and health related quality of life were measured. Assessment also included demographics, medical history, and dietary questionnaires. RESULTS: This study determined that subjects' who have undergone bariatric surgery participated in 205.33 ±136.98 minutes per week of ≥ 3METs for ≥ 1 minute bouts. The average dropped to 47.56 ± 69.84 minutes per week when including only bouts of 10 continuous minutes or more. Physical activity was correlated with %EWL (r=0.47, p=<0.01) and self-efficacy (r=0.39, p<=0.02), but not with physical function, expected outcomes (benefits), perceived barriers, or HRQOL. Physical function was correlated with %EWL (p<0.05). CONCLUSIONS: The subjects' activity level failed to meet standards that have been shown necessary for weight maintenance. Those subjects that were more confident in their ability to exercise were more active and had more success losing weight. These findings suggest that behavioral interventions should include a strategy to address self-efficacy. The disparity between physical activity and physical function would suggest that subjects are capable of performing most exercise and mobility activities. Future research should focus on exercise interventions that address self-efficacy and other behavioral barriers (e.g. musculoskeletal pain, psychosocial factors, and social stigma) with the goal of maximizing post surgical weight loss success

Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With De Novo Parkinson Disease: A Phase 2 Randomized Clinical Trial

Importance Parkinson disease is a progressive neurologic disorder. Limited evidence suggests endurance exercise modifies disease severity, particularly high-intensity exercise. Objectives To examine the feasibility and safety of high-intensity treadmill exercise in patients with de novo Parkinson disease who are not taking medication and whether the effect on motor symptoms warrants a phase 3 trial. Design, Setting, and Participants The Study in Parkinson Disease of Exercise (SPARX) was a phase 2, multicenter randomized clinical trial with 3 groups and masked assessors. Individuals from outpatient and community-based clinics were enrolled from May 1, 2012, through November 30, 2015, with the primary end point at 6 months. Individuals with idiopathic Parkinson disease (Hoehn and Yahr stages 1 or 2) aged 40 to 80 years within 5 years of diagnosis who were not exercising at moderate intensity greater than 3 times per week and not expected to need dopaminergic medication within 6 months participated in this study. A total of 384 volunteers were screened by telephone; 128 were randomly assigned to 1 of 3 groups (high-intensity exercise, moderate-intensity exercise, or control). Interventions High-intensity treadmill exercise (4 days per week, 80%-85% maximum heart rate [n = 43]), moderate-intensity treadmill exercise (4 days per week, 60%-65% maximum heart rate [n = 45]), or wait-list control (n = 40) for 6 months. Main Outcomes and Measures Feasibility measures were adherence to prescribed heart rate and exercise frequency of 3 days per week and safety. The clinical outcome was 6-month change in Unified Parkinson’s Disease Rating Scale motor score. Results A total of 128 patients were included in the study (mean [SD] age, 64 [9] years; age range, 40-80 years; 73 [57.0%] male; and 108 [84.4%] non-Hispanic white). Exercise rates were 2.8 (95% CI, 2.4-3.2) days per week at 80.2% (95% CI, 78.8%-81.7%) maximum heart rate in the high-intensity group and 3.2 (95% CI, 2.8-3.6; P = .13) days per week at 65.9% (95% CI, 64.2%-67.7%) maximum heart rate in the moderate-intensity group (P < .001). The mean change in Unified Parkinson’s Disease Rating Scale motor score in the high-intensity group was 0.3 (95% CI, −1.7 to 2.3) compared with 3.2 (95% CI, 1.4 to 5.1) in the usual care group (P = .03). The high-intensity group, but not the moderate-intensity group, reached the predefined nonfutility threshold compared with the control group. Anticipated adverse musculoskeletal events were not severe. Conclusions and Relevance High-intensity treadmill exercise may be feasible and prescribed safely for patients with Parkinson disease. An efficacy trial is warranted to determine whether high-intensity treadmill exercise produces meaningful clinical benefits in de novo Parkinson disease

Study in Parkinson’s disease of exercise phase 3 (SPARX3): study protocol for a randomized controlled trial

BackgroundTo date, no medication has slowed the progression of Parkinson's disease (PD). Preclinical, epidemiological, and experimental data on humans all support many benefits of endurance exercise among persons with PD. The key question is whether there is a definitive additional benefit of exercising at high intensity, in terms of slowing disease progression, beyond the well-documented benefit of endurance training on a treadmill for fitness, gait, and functional mobility. This study will determine the efficacy of high-intensity endurance exercise as first-line therapy for persons diagnosed with PD within 3 years, and untreated with symptomatic therapy at baseline.MethodsThis is a multicenter, randomized, evaluator-blinded study of endurance exercise training. The exercise intervention will be delivered by treadmill at 2 doses over 18 months: moderate intensity (4 days/week for 30 min per session at 60-65% maximum heart rate) and high intensity (4 days/week for 30 min per session at 80-85% maximum heart rate). We will randomize 370 participants and follow them at multiple time points for 24 months. The primary outcome is the Movement Disorders Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) motor score (Part III) with the primary analysis assessing the change in MDS-UPDRS motor score (Part III) over 12 months, or until initiation of symptomatic antiparkinsonian treatment if before 12 months. Secondary outcomes are striatal dopamine transporter binding, 6-min walk distance, number of daily steps, cognitive function, physical fitness, quality of life, time to initiate dopaminergic medication, circulating levels of C-reactive protein (CRP), and brain-derived neurotrophic factor (BDNF). Tertiary outcomes are walking stride length and turning velocity.DiscussionSPARX3 is a Phase 3 clinical trial designed to determine the efficacy of high-intensity, endurance treadmill exercise to slow the progression of PD as measured by the MDS-UPDRS motor score. Establishing whether high-intensity endurance treadmill exercise can slow the progression of PD would mark a significant breakthrough in treating PD. It would have a meaningful impact on the quality of life of people with PD, their caregivers and public health.Trial registrationClinicalTrials.gov NCT04284436 . Registered on February 25, 2020