Staying active protects against anxiety, apathy in Parkinson’s disease

Higher levels of physical activity may help combat anxiety and apathy among patients with early Parkinson’s disease (PD), according to a recent Singapore study.

“To the best of our knowledge, this longitudinal cohort is the first to compare baseline self-reported physical activity with changes in a wide spectrum of motor, nonmotor and quality of life (QoL) scores amongst early PD patients,” the researchers said, pointing out that the use of self-reports could have introduced bias into the analysis.

A total of 121 PD patients (mean age, 64.5±8.2 years) were enrolled from the PD Longitudinal Singapore Study. Annual measurements of physical activity were carried out using the Physical Activity Scale for the Elderly (PASE). Participants were followed prospectively to determine the impact of physical activity on PD-related motor, nonmotor, and QoL symptoms.

Patients were divided into two groups according to the median PASE score of 150. Those with higher physical activity at baseline (PASE >150) had significantly better QoL (p=0.031) than comparators who fell below the median PASE. Motor scores in the Movement Disorders Society-Unified PD Rating Scale (MDS-UPDRS) were also lower in more active participants, suggesting better baseline motor function. [Front Neurol 2021;doi:10.3389/fneur.2020.625897]

Over time, there was an overall decline in physical activity, with PASE scores dropping by a mean of 17.83 (p=0.0163) points after a year.

Similarly, performance in various outcome measures deteriorated, including the motor assessment and motor experiences of daily living parts of the MDS-UPDRS, as well as in QoL. Additionally, those with low physical activity at baseline saw significant spikes in anxiety scores by the 1-year follow-up.

Multivariate regression analysis revealed that PD patients who fell above the median PASE at baseline were significantly protected from anxiety at follow-up (β, –0.27, 95 percent confidence interval [CI], –0.52 to –0.01; p=0.0373). Anxiety was measured using the Hospital Anxiety and Depression Scale.

Similarly, apathy, assessed using the Apathy Scale, was significantly attenuated in participants who were more physically active at baseline (β, –0.33, 95 percent CI, –0.60 to –0.06; p=0.0174). Statistical analyses were adjusted for age, sex, ethnicity, education, MDS-UPDRS motor assessment, and motor subtype, among other confounders.

However, physical activity showed no significant impact on motor symptoms or QoL. The principal findings also remained unchanged even after excluding the participants who had changed PASE groups by the 1-year follow-up.

“While we found that decreased anxiety and apathy were associated with greater baseline physical activity in our study, we are aware of the possibility that participants with greater anxiety and apathy would engage in less physical activity,” the researchers said, pointing out that this “in turn could lead to a downward spiral of worsening anxiety and apathy over time.”

“Further studies are needed to establish the pathophysiological effects of physical activity on anxiety and apathy,” they said. “Future studies could incorporate longer follow-up durations and the use of technology devices, such as movement sensors, as well as brain imaging to provide objective measures of physical activity and affective conditions so that we can further decipher the causal relationship between physical activity and mood symptoms.”