Physical activity and prodromal features of Parkinson disease

Abstract

Objective: To investigate the relationship between physical activity and prodromal features of Parkinson disease that often precede the clinical diagnosis.

Methods: Included are participants in 2 well-established cohorts: the Nurses' Health Study and the Health Professionals Follow-up Study. Physical activity was assessed using validated questionnaires at baseline (1986) and every 2 years until 2008. Prodromal features (e.g., constipation, hyposmia, and probable REM sleep behavior disorder [pRBD]) were assessed in 2012-2014.

Results: The multivariable-adjusted odds ratio (OR) for having ≥3 prodromal features vs none comparing the highest to the lowest quintile were 0.65 (95% confidence interval [CI] 0.53-0.79; p _trend = 0.0006) for baseline physical activity and 0.52 (95% CI 0.35-0.76; p _trend = 0.009) for cumulative average physical activity. Considering each feature independently, baseline physical activity was associated with lower odds of constipation (OR 0.78, 95% CI 0.73-0.83; p _trend < 0.0001), excessive daytime sleepiness (OR 0.72, 95% CI 0.60-0.86; p _trend = 0.002), depressive symptoms (OR 0.82, 95% CI 0.69-0.97; p _trend = 0.13), and bodily pain (OR 0.81, 95% CI 0.68-0.96; p _trend = 0.03). Similar or stronger associations were observed for cumulative average physical activity, which, in addition, was associated with pRBD (OR 0.85, 95% CI 0.77-0.95; p _trend = 0.02). In contrast, neither hyposmia nor impaired color vision was associated with physical activity. Early life physical activity was associated with constipation and, in men only, with the co-occurrence of ≥3 features.

Conclusions: The reduced prevalence of prodromal features associated with Parkinson disease in older individuals who were more physically active in midlife and beyond is consistent with the hypothesis that high levels of physical activity may reduce risk of Parkinson disease.

Figure 1. Pooled associations between baseline physical activity and presence of ≥3 prodromal signs

(A) Age-adjusted association between baseline physical activity and presence of ≥3 vs 0 prodromal signs. (B) Multivariate-adjusted association between baseline physical activity and presence of ≥3 vs 0 prodromal signs. (C) Age-adjusted association between baseline physical activity and presence of ≥3 vs 0 prodromal signs, excluding constipation. (D) Multivariate-adjusted association between baseline physical activity and presence of ≥3 vs 0 prodromal signs, excluding constipation. OR = odds ratio.

Figure 2. Pooled associations between cumulative average physical activity and presence of ≥3 prodromal signs

(A) Age-adjusted association between cumulative average physical activity and presence of ≥3 vs 0 prodromal signs. (B) Multivariate-adjusted association between cumulative average physical activity and presence of ≥3 vs 0 prodromal signs. (C) Age-adjusted association between cumulative average physical activity and presence of ≥3 vs 0 prodromal signs, excluding constipation. (D) Multivariate-adjusted association between cumulative average physical activity and presence of ≥3 vs 0 prodromal signs, excluding constipation. OR = odds ratio.