Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease.
Long-term Effect of Regular Physical Activity and Exercise Habits in Patients With Early Parkinson Disease.
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有规律的体力活动和锻炼习惯对早期帕金森病患者的长期影响
DOI：
10.1212/wnl.0000000000013218
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发表时间：
2022-02-22
期刊：
影响因子：
9.9
通讯作者：
Takahashi R
中科院分区：
文献类型：
--
作者：
Tsukita K;Sakamaki-Tsukita H;Takahashi R
由于缺乏长期观察或对混杂因素进行全面调整，有关运动和定期体力活动对帕金森病（PD）长期影响的可靠结论尚未得出。在这里，使用帕金森病进展标志物倡议研究的数据，包括对许多临床参数的纵向和综合评估，我们研究了定期体力活动和运动习惯对PD过程的长期影响。在这项回顾性、观察性队列研究中，我们主要使用多变量线性混合效应模型来分析他们的定期体力活动和中度至剧烈运动水平的相互作用效应，在调整年龄、性别、左旋多巴等效剂量和疾病持续时间后，使用老年人体力活动量表问卷测量临床参数的进展。我们还计算了自举95%置信区间（CI），并使用多重插补方法进行了敏感性分析，使用倾向评分匹配进行了亚组分析，以匹配所有基线背景因素。纳入了237例早期PD患者（中位[四分位距]年龄63. 0 [56. 0 - 70. 0]岁，男性69. 2%，随访持续时间5. 0 [4. 0 - 6. 0]年）。基线时定期体力活动和中度至剧烈运动水平对PD随后的临床进展无显著影响。然而，随着时间的推移，平均有规律的整体身体活动水平与姿势和步态稳定性的缓慢恶化显著相关（相互作用项的标准化固定效应系数[β相互作用] = −0.10 [95% CI −0.14至−0.06]），日常生活活动（β相互作用= 0.08 [95% CI 0.04-0.12]）和处理速度（β相互作用= 0.05 [95% CI 0.03-0.08]）。中度至剧烈运动水平优先与姿势和步态稳定性下降较慢相关（β相互作用=-0.09 [95%CI-0.13至0.05]），而工作相关活动水平主要与处理速度下降较慢相关（β相互作用= 0.07 [95%CI 0.04-0.09]）。多重插补和倾向评分匹配证实了我们结果的稳健性。从长远来看，保持高水平的定期体力活动和锻炼习惯与PD的临床病程较好密切相关，每种类型的体力活动具有不同的影响。ClinicalTrials.gov标识符：NCT 01176565。这项研究提供了II类证据，表明早期PD患者总体规律体力活动水平的持续增加与几个临床参数的下降较慢相关。
Owing to the lack of long-term observations or comprehensive adjustment for confounding factors, reliable conclusions regarding long-term effects of exercise and regular physical activity in Parkinson disease (PD) have yet to be drawn. Here, using data from the Parkinson's Progression Markers Initiative study that includes longitudinal and comprehensive evaluations of many clinical parameters, we examined the long-term effects of regular physical activity and exercise habits on the course of PD. In this retrospective, observational cohort study, we primarily used the multivariate linear mixed-effects models to analyze the interaction effects of their regular physical activity and moderate to vigorous exercise levels, measured with the Physical Activity Scale for the Elderly questionnaire, on the progression of clinical parameters, after adjusting for age, sex, levodopa equivalent dose, and disease duration. We also calculated bootstrapping 95% confidence intervals (CIs) and conducted sensitivity analyses using the multiple imputation method and subgroup analyses using propensity score matching to match for all baseline background factors. Two hundred thirty-seven patients with early PD (median [interquartile range] age, 63.0 [56.0–70.0] years, male 69.2%, follow-up duration 5.0 [4.0–6.0] years) were included. Regular physical activity and moderate to vigorous exercise levels at baseline did not significantly affect the subsequent clinical progression of PD. However, average regular overall physical activity levels over time were significantly associated with slower deterioration of postural and gait stability (standardized fixed-effects coefficients of the interaction term [βinteraction] = −0.10 [95% CI −0.14 to −0.06]), activities of daily living (βinteraction = 0.08 [95% CI 0.04–0.12]), and processing speed (βinteraction = 0.05 [95% CI 0.03–0.08]) in patients with PD. Moderate to vigorous exercise levels were preferentially associated with slower decline of postural and gait stability (βinteraction = −0.09 [95% CI −0.13 to −0.05]), and work-related activity levels were primarily associated with slower deterioration of processing speed (βinteraction = 0.07 [95% CI 0.04–0.09]). Multiple imputation and propensity score matching confirmed the robustness of our results. In the long term, the maintenance of high regular physical activity levels and exercise habits was robustly associated with better clinical course of PD, with each type of physical activity having different effects. ClinicalTrials.gov Identifier: NCT01176565. This study provides Class II evidence that sustained increase in overall regular physical activity levels in patients with early PD was associated with slower decline of several clinical parameters.