CU Anschutz scientists and providers offer a robust community of research and evidence-based care to help lessen the disease's hold
At 79, Sarah Schoentgen exercises more than many people half her age. On top of walking in her Denver neighborhood and peddling on her home stationary bike, Schoentgen works out at least twice weekly with a personal trainer and joins a class at the YMCA at least once a week.
For her, all the stepping, stretching and weightlifting goes beyond keeping her energy and strength up. Schoentgen made exercise a required regimen after a Parkinson's disease (PD) diagnosis two years ago this April. Since then, her mood has improved and her foot no longer drags, causing her to trip and fall.
"I wasn't as committed," Schoentgen said of her exercise routine before she finally received a diagnosis of the progressive neurodegenerative disease at the University of Colorado Movement Disorders Center. "I didn't take exercise classes. I didn't go to the Y. I didn't set heart-rate goals."
'Exercise, exercise, exercise'
Schoentgen suspected something was wrong over two decades ago, when she lost her sense of smell, a sign of PD and other neurological diseases. But there weren't enough other symptoms for a neurologist to make a diagnosis. Then, about four years ago, she noticed she was dragging her left foot.
"And I just went down the wrong rabbit hole trying to get diagnosed," said Schoentgen, a Harvard graduate who left a long career in public health to teach English as a second language to newcomers seeking asylum.
At least six MRIs and nearly two years later, Schoentgen was sent to the Movement Disorders Center at the CU Anschutz Medical Campus. "That guy just nailed it within minutes of looking at me. And what I was told, even right then, is the most important thing you can do is exercise, exercise, exercise," she said.
Incidence of Parkinson's disease has increased 11% since 2021, largely because of aging, affecting over 25 million people worldwide. About 90,000 new U.S. cases are diagnosed each year.
Putting an emphasis on exercise has become more common among Parkinson's experts since scientists made a connection between exercise and improved motor symptoms.
Much of the pioneering work on that link has been done by CU Anschutz researchers, including Cory Christiansen, PhD, professor of Physical Medicine and Rehabilitation at the CU School of Medicine, dating back 15 years.
"Since 2010, studies on animal models of Parkinson's have shown through imaging and blood testing that exercise will improve the ability of dopamine to communicate between nerves," Christiansen said. Dopamine deficiency underlies PD, most notably in the area of the brain responsible for controlling movement. Drugs for the disease work to increase the neurotransmitter, as does exercise.
Research published in 2018 from the Study in Parkinson's Disease of Exercise (SPARX) concluded that high-intensity treadmill exercise (four days per week at 80%-85% maximum heart rate) was safe and feasible for PD patients to help control symptoms.
The phase 2 randomized clinical trial was published in JAMA Neurology and led by noted CU Anschutz researchers Margaret Schenkman, PT, PhD, former director of the CU SOM Physical Therapy Program, and Wendy Kohrt, PhD, distinguished professor of medicine in the Division of Geriatric Medicine.
And it revealed something even more exciting.
Halt progression? 'That's a game-changer'
"We showed that there was a 'signal of efficacy' that the people who exercised at high intensity had a decreased rate of progression of motor symptoms," Christiansen said. "There are no current treatments that can cure Parkinson disease. They will only treat the symptoms. So right now, the first-line treatment for Parkinson's is exercise."
A "signal of efficacy" in research means sufficient evidence of a finding to support further study.
SPARX researchers chose walking for the study for its functionality and accessibility, Christiansen said. PD's telltale motor symptoms include tremors, rigidity, slow movement (bradykinesia) and gait and balance issues. "All of those relate to how people function in terms of moving in their community, moving in their house, participating in life activities," Christiansen said.
"So, if we can reduce the difficulty people have with those (daily) tasks - which there's a lot of evidence to show that exercise helps - AND reduce the progression of the disease itself at the level of the brain, then that's a game-changer in terms of quality of life for people with Parkinson's disease."
Christiansen said researchers at other universities have also shown the signal of efficacy for delayed progression in studies on cycling and even strength training.
Although Parkinson's motor symptoms, such as tremors and gait issues, are most recognizable, the neurological disorder has a long list and wide range of symptoms, from cognitive issues to sleep problems and from vision troubles to weight loss.
Resistance training is a key focus of another study on campus (which Schoentgen is part of) looking at exercise's effects on sleep in Parkinson's patients.
"As a result of these classes, I can lift a lot more," Schoentgen said of the ExCITES (Exercise-Induced Cognitive Improvement Through Enhanced Sleep) study, led by Amy Amara, MD, professor of neurology. "I'm not hesitating to carry a heavy bag of groceries in anymore, or a flowerpot that I would have never considered trying to lift before."
Peter Mahowald, a nurse on campus, also volunteers for ExCITES. Mahowald, whose PD began with a "little twitch of my right index finger" that turned into difficulty holding his razor, has become involved in "everything I can" since his diagnosis about two years ago. That includes joining the Michael J. Fox PPMI (Parkinson's Progression Markers Initiative) study arm on campus, where he met Amara and joined her exercise-centered study.
"Everything I've looked at said vigorous physical activity is absolutely essential to not cure Parkinson's, but to certainly help to alleviate symptoms and possibly slow progression of the disease," Mahowald said. "I've never shied away from physical activity since I was diagnosed. I hike. I backpack. I work out."
New study will set 'dose,' evaluate progression
Now, recruitment is underway for a 25-site SPARX3 randomized clinical trial that will further investigate the exercise and PD progression link in patients who have not yet begun medication, as well as measure the effects of moderate exercise.
"We really don't know if moderate intensity is that much different from high intensity as far as outcomes," said Christiansen, who is leading the CU Anschutz arm of the phase 3 study. If the study finds moderate intensity is as effective, that can help with setting guidelines for researchers and with managing an exercise schedule among other responsibilities for patients.
Another primary goal of the study, which Christiansen said will be the largest Parkinson's endurance exercise trial to date, is to pinpoint the amount of exercise needed to slow disease progression in the early stages.
"We'll study outcomes, such as brain scans, blood biomarkers and clinical measures of disease progression, to determine that effectiveness and develop a specific exercise regimen," Christiansen said. "Basically, we'll set dose of mode, intensity and frequency of the exercise."
There are current practice guidelines for that, but this will provide landmark evidence to support clinicians in knowing how to guide patients, he said.
Having the study-provided personal trainers guide her exercise, provide companionship and create accountability has been priceless, Schoentgen said. While challenging, the extra workouts each week have motivated them only more to make exercise a life priority, she and Mahowald said.
"I'm actually stronger than I was before this diagnosis," Schoentgen said. Her increased exercise routine has also improved her mood, quickened her pace and added to her social life, she said, after she was caught watching the clock during an interview. "I can't miss my Y class; I have to see my friends."
Mahowald said he also has had a notable increase in strength and become comfortable with weightlifting because of the study. "My blood pressure's better. And I just feel a little bit more limber. I'm actually starting back with my own personal trainer (at the CU Anschutz Health and Wellness Center) on Thursday," he said. "So, yeah, I'm definitely sticking with it."
Find more ongoing studies on campus aimed at improving the lives of people with Parkinson's disease.
Photo at top: Sarah Schoentgen works out as part of a study at the Clinical Translational Research Center (CTRC) exercise lab.
The CU Anschutz advantage?
Being treated for their Parkinson's disease at the University of Colorado Anschutz Medical Campus resulted in a number of factors that helped better their outcomes, including joining research studies, said Sarah Schoentgen and Peter Mahowald.
Some of the benefits:
- Working with PD experts at the CU Movement Disorders Center includes physical and occupational therapists who work specifically with Parkinson's patients.
- Schoentgen's PT recommended exercise videos on YouTube, created by the Parkinson's Foundation, that she can do at home.
- Schoentgen also learned about an exercise class at the YMCA for Parkinson's patients, which she rarely misses because of the disease-focused exercises and the new friends.
- Joining studies offered guided workouts on state-of-the-art equipment with personal trainers.
- The sleep experts in Mahowald's study perfected problems with his sleep apnea CPAP (continuous positive airway pressure) machine apparatus that his own providers hadn't succeeded in doing for years, significantly improving his slumber.
- Being in research studies offered them engagement and a greater sense of purpose.
