Aerobic exercise to improve cardiorespiratory function in Parkinson's

Abstract

Introduction
Cardiopulmonary impairments are the leading cause of morbidity and mortality in advanced stages of Parkinson’s. Although there is some evidence of pulmonary impairments in the earlier stages, symptoms remain asymptomatic until advanced stages. Aerobic exercise and lung function in people living with Parkinson’s (PLwP) has not yet been investigated. This thesis aims to:
• Review prevalence of pulmonary function, cardiovascular response to exercise, and effects of aerobic exercise on cardiopulmonary function, in PLwP.
• Pilot and investigate feasibility of a trial of aerobic exercise to improve cardiopulmonary function in PLwP.
• Survey the effects of COVID-19 pandemic on physical activity in PLwP.

Methods
• Reviews of published literature with systematic search, quality assessment and narrative synthesis of findings
• Mixed-methods, single-blind feasibility study exploring: recruitment, attrition, intervention, outcome measures, inclusion and exclusion criteria. Pulmonary function, cardiac fitness, and physical activity were assessed at baseline, 8-weeks and 12-weeks. Participants’ experiences and acceptability of intervention and outcome measures were explored in focus groups.
• Online questionnaire to explore effects of COVID-19 pandemic on physical activities in PLwP.

Results
• PLwP suffer from obstructive and/or restrictive pulmonary disease; cardiac fitness in PLwP is variable; aerobic exercise improves cardiac fitness but no studies have assessed effects of aerobic exercise on pulmonary function in Parkinson’s.
• Twenty-four PLwP were recruited and 15 completed the EXoCARP trial, with low attrition (n=7), five due to the COVID-19 pandemic. Feasibility and acceptability of outcomes and intervention was confirmed.
• Outdoor and gym-based physical activity decreased in PLwP during the COVID-19 pandemic; many PLwP accessed online resources to exercise at home.

Conclusions
People with early stages of Parkinson’s should be screened for asymptomatic pulmonary impairments that could be managed, to prevent late-stage complications. Feasibility of a larger trial of aerobic exercise and cardiopulmonary function in Parkinson’s was confirmed. Considering remote/online or home-based exercises is warranted for future exercise trials.