High-Intensity Exercise vs. Parkinson's: SPARX Trial Deep Dive | Can 85% HRmax Slow PD Progression?

This episode dives into the revolutionary SPARX Trial (Phase 2) and the ongoing SPARX3 research, which challenges conventional Parkinson's treatment by treating high-intensity exercise as medicine. We break down the electrifying 6-month mark data that suggests vigorous aerobic activity—specifically hitting 80-85% of maximum heart rate—can potentially slow or halt the progression of motor symptoms in early-stage Parkinson's disease.

If you are looking for evidence-based strategies to lead a fulfilling life with PD, this deep dive into exercise prescription is a must-listen.

Key Topics in This Episode:

• The 6-Month Mark: Why the Phase 2 SPARX results are forcing researchers to redefine exercise as a disease-modifying therapy.
• The Dose Matters: Understanding the difference between moderate and high-intensity heart rate zones and why 85% HRmax is the target.
• Practical Application: How people living with Parkinson's can safely and effectively apply the SPARX findings in their daily life.
• Neuroprotection: The biological theories explaining how intense exercise may offer neuroprotective benefits.

🚨 Crucial Safety Warning 🚨

Before initiating ANY new or high-intensity exercise program, you MUST consult with your physician, neurologist, and, ideally, undergo a cardiologist-supervised exercise stress test. This step is essential to accurately determine your safe maximum heart rate and ensure high-intensity training is appropriate for your specific health profile.

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Chapters

• 0:00 Framing The Big Question
• 1:24 Why Exercise Matters In PD
• 4:31 The Six-Month Benchmark
• 5:12 Inside The SPARX Phase 2 Trial
• 10:25 Training Protocol And Adherence
• 12:10 Results And Motor Score Changes
• 14:20 Phase 3 Design And Measures
• 17:10 What It Means For Daily Life
• 19:35 Finding And Hitting Your Heart-Rate Zone
• 21:40 Safety, Stress Tests, And Clearance
• 24:05 Commitment, Consistency, And Alternatives

Transcript

SPEAKER_00: 0:10

Parkinsons, live an exceptional life. I'm your host, Chris Kestenbutter, and I've been living an exceptional life with Parkinson's for the past 15 years. The mission of this podcast is to help as many people as possible living with Parkinson's to lead a great quality of life. Today's topic is the six-month mark. Can high-intensity exercise reverse Parkinson's disease progression? Now here's a question for you. Can exercise truly be a disease modifying treatment? That's the million-dollar question. Well, in today's episode, I want to see if we can potentially provide you the answer to that question. So we're going to take a deep dive into the famous Spark study, where researchers decided to treat high-intensity exercise like high-powered medication. For six months, one group pushed themselves to the limit. I'll reveal the key metric, the heart rate zone, that separated progress from plateau, and explain why these results are forcing doctors and patients everywhere to rethink Parkinson's treatments. So get ready. The way you look at your workout is about to change forever. So let's take a look at what we'll be covering so that you realize why exercise should be a daily part of your Parkinson's management program. We'll begin with setting the stage and cover why exercise is PD's magic pill. Then we'll move into the benchmark and discuss why six months is an important point, not only for research purposes, but to build habits and consistency. Then it's time to discuss the Sparks trial and its key findings. And then we'll give you practical applications and exercises that you can use to take advantage of the learning from the Sparks trial, and then we'll wrap it up with Beyond the Motor Symptoms and how consistent, sustained exercise can help you in your daily life so that you can live your best life with Parkinson's. Now, before we dive into today's topic, I want to provide a disclaimer that prior to starting any new exercise program, you get approval from your healthcare professionals to ensure that they are appropriate for your specific needs and health status. And the information being presented is for informational purposes only and is not intended to treat Parkinson's or recommend any specific exercise programs. Alright, so let's begin by setting the stage and talk about why I'm always preaching about the benefits of exercise. As we know, Parkinson's results from the progressive loss of dopamine producing neurons in the substantia nigra in the brain. And it's this loss of dopamine is what causes the motor symptoms that we experience, like tremors, bradykinesia, or slowness of movement, and then gait and balance issues. Now, currently medications only treat the symptoms by helping replace the dopamine that we are losing. And while these medications are crucial to helping us live a better quality of life by controlling our motor symptoms, they can just be one piece of the puzzle as well. Now, here's where exercise comes into play as an important piece of your Parkinson's journey. Because the idea is that it might be disease modifying, and that's what we're focusing on today. So can exercise or consistent physical activity help improve our motor symptoms and actually slow disease progression? And also help us with our non motor symptoms, which, as we all know, can be just as disabilitating as well. So things like mood and sleep. Let's think of it this way. If medications can help us with our motor symptoms, and exercise can potentially slow disease progression, then why not take full advantage of these complementary therapies? It's like a one-two punch, if you will. So hopefully, by the end of the episode, you have a great understanding of why exercise can play a crucial role in your Parkinson's journey. Now, from my personal experience living with Parkinson's for the past 15 years, I truly believe that I'm living an exceptional life because exercise has been a cornerstone of my journey. I can notice a definite difference in how I feel if I take any significant time off from exercise. Okay, now that we know how medication and exercise can work in tandem to help us out, let's turn our attention to exercise and why it has become a research focus as a potential disease modifying therapy. Now, I mentioned in the title the six-month mark. So what makes six months a magical number? Well, that's a great question, and I'm glad you asked. So thank you very much for that. Now, many of the exercise studies that were conducted were short-term studies, typically four to twelve weeks in duration. Now, because of the shorter duration, many of these studies only showed transient benefits. But the six-month duration is a critical for observing sustained, clinically significant, and potentially neurobiological changes. So that's why I want to take a deep dive into the SPARKS trial and how the results could have an impact on your daily lives. All right, so what is the SPARKS trial and why is it so significant? Well, the original study titled Study in Parkinson's Disease of Exercise, or SPARCS, SPARX, this study was a multi-center, randomized, controlled futility phase two trial designed to test the feasibility and potential efficacy of moderate and high-intensity exercise and slowing the progression of Parkinson's disease. Now it laid the groundwork for a larger phase three studies. It was published in the Journal of the American Medical Association, or JAMA, neurology in 2018. And the objective of this study was to examine the feasibility and safety of high-intensity treadmill exercise in participants with de novo Parkinson's. So what that means is that they were recently diagnosed and were not taking medication yet. They were evaluating whether the effects on motor symptoms warranted a phase three trial. Now I mentioned earlier that this was a phase two multi-center randomized clinical trial, and it had three groups and a mask assessors. No, not like the Lone Ranger, Zorro, or those scream masks. It means that the assessors didn't know which group each individual was part of. Now the individuals were selected from outpatient and community-based clinics, with the primary endpoint of the study being six months. Individuals with idiopathic Parkinson's between 40 and 80 years of age and that were within five years of diagnosis and who were not exercising at moderate intensity or greater than three times per week and were not expected to need dopaminergic medication within six months. They participated in the study. Now there was a total of 381 volunteers that were screened, and 128 of those people were randomly assigned to one of three groups. One group was high intensity exercise, the second group was moderate intensity exercise, and the third group was a control. The participants participated in either high intensity treadmill exercise four days per week with an 80 to 85% maximum heart rate. There were 43 patients in this group. Now, the next group did moderate intensity treadmill exercise, four days per week, with 60 to 65% maximum heart rate. And there were 45 people in this group, and then the final group was a weight list control group, which consisted of 40 people. Each group did these exercises over six months. And the study's main outcome measures were adherence to prescribed heart rate and exercise frequency of three days per week and safety. And the clinical outcome was a six-month change in the participants' unified Parkinson's disease rating scale motor score. All right, so hopefully you're still with me after all that. I'd just like to set up where they got the participants and what the participants were doing. All right, now before we dive into the results, and if you were really listening closely, which I hope you were, participants were prescribed treadmill exercise four days per week for 26 weeks, or six months, if you will. But they hypothesized that people would exercise for three days a week. So their workout included a five to ten minutes of warm-up, then thirty minutes of treadmill exercise at their target heart rate, and then they cooled down for ten minutes. That sounds doable, right? Now, as I always say, start small and build up. And that's exactly what they did in this study. They increased their intensity and frequency during weeks one through eight until they reached their target heart rate zone. So what were the results? Well, both exercise groups met targeted treadmill exercise intensity. The mean maximum heart rates were 80.2% for the high intensity group and 65.9% for the moderate intensity group, with no changes over time. Now the mean weekly treadmill exercise frequency was 2.8 days per week for the high intensity group and 3.2 days per week for the low intensity group. Now the change in UPDRS, the motor scores, in the high intensity group was 0.3 compared with 3.2% in the usual care or the control group. So the Sparks trial or this study successfully demonstrated that high endurance exercise, 80 to 85% of heart rate max, was safe and feasible for people with early stage PD. Now, in terms of motor symptoms, the key findings centered on the MDS UPDRS part three scores. The high intensity group, the motor scores remained stable, meaning there was no significant deterioration over the six-month period. The control group's motor scores, those were the ones that were on the wait list, significantly worsened. They increased by approximately 15%. And then the moderate intensity group, their motor scores showed an intermediate worsening, and they increased by approximately 8%. So the conclusion was the high-intensity exercise intervention was the only condition that prevented the expected natural progression of motor symptoms typically seen in untreated individuals with Parkinson's over a six-month window. Now, the finding, the necessary evidence to launch the much larger multi-site phase three SPARCS trial. So that leads us into the SPARCS III trial. Now, this trial is known as the study in Parkinson's disease of exercise phase three. So remember the first one was a phase two clinical study. So this is a bigger phase three study. And it's a definitive multi-site clinical trial that's designed to confirm whether the high-intensity aerobic exercise can slow the progression of Parkinson's disease. So this trial essentially is looking at can they reproduce the results from the high-intensity group in this bigger study? So it builds directly on the earlier sparks to phase trial, which we just reviewed. Now, the primary objective of this big phase three study is to test whether the progression of the signs of PD is slowed in individuals with early Parkinson's who perform high-intensity endurance treadmill exercise compared to moderate intensity exercise. So the study protocol calls for an enrollment of 370 participants, and it's enrolling individuals between 40 to 80 years of age who are newly diagnosed, which in this study is typically less than three years, and they're untreated, meaning they're not taking any uh dopaminergic medication, like Levatopa or the dopamine agonists. Now you may be thinking, why can't these people be taking medication for their symptoms while they're participating in this study? Well, the reason is by focusing on untreated patients, research ensure that their observational changes are not attributed, they're attributed solely to exercise intervention and they're eliminating the potential effects that medication can have. So by not taking medication, if they see significant benefits, they can say that it's related to exercise versus if they were taking medication that would muddy the waters and they might have might not be able to make the conclusion that it was exercise alone that caused the uh slow slowness and progression. Now, this trial is 18 months of structured exercise or a year and a half uh training with a total follow-up at 24 months or two years. It also includes a six-month post-interventional observational period to assess sustained effects. So they want to make sure that the effects are being sustained over time. Now the participants are randomized into two active groups, both exercising four times per week for 30 minutes on a treadmill, same as the Sparks 2 trial, phase 2 trial. Group one is the high intensity group with a target heart rate of 80 to 85% of the maximum heart rate. And group two is the moderate intensity or control uh dose with a target heart rate of 60 to 65% of max. So if you remember there, it's the same as in the original Sparks trial. All right, now what's interesting in this study compared to the Sparks trial is the difference within the addition of secondary measures. Now, the primary or main endpoint in this study is measures in the change in motor symptom severity. The primary hypothesis or scientific guess is that the high intensity group will show less worsening or lower score increases than the moderate intensity group. Now, here's what I find interesting. They're also measuring changes in dopaminergic activity in the brain, measured by a DAT scan. And they're also measuring cognitive function, which I always need help with, of course, including measuring memory, attention, and executive function changes. They're also looking at quality of life, fitness, and daily steps, and the amount of circulating levels of BDNF or brain-derived neurotropic factors. Now, this study is ongoing and the results have not been published yet, but the expected results or conclusions based on the trial design can go one or two ways. First, it can confirmation of disease modification. If the high intensity group shows significantly less progression, which is stable or improved UPDRS motor scores compared to the moderate intensity group, the authors would probably conclude that the high intensity aerobic exercise is a disease modifying therapy that should be considered or prescribed as a first line treatment in early Parkinson's. Or number two, if there's no difference, if both groups show similar or minimal changes, or if both decline equally, the authors may conclude that the difference in intensity is not critical for delaying progression, although general symptomatic benefits from moderate exercise could be acknowledged. So, in essence, this trial is poised to provide the highest level of evidence yet regarding the optimal intensity and long-term dose of exercise required to truly slow the Parkinson's progression. All right, we spent a lot of time on this episode taking a deep dive into the clinical data and the sparks and sparks three trials. But if you're living with Parkinson's, your big question probably is, okay, that's great, but how can I apply it in my daily life? And that's a good question. Well, the Sparks and Sparks 3 trial don't just give us hope, they give us a clear, scientifically backed exercise prescription. In addition, a 2023 meta-analysis of 15 randomized clinical trials, which included 654 participants, found that high intensity training, both continuous and interval, showed improved disease severity scores, respiratory fitness, and quality of life. And this data showed symptomatic and functional benefits, but did not confirm slowed progression. That's why the Sparks 3 trial is going to be so critical. Okay, yeah, that's great, Chris, but you still didn't tell me how I can use this in my daily life. Well, think of it this way. Think of high-intensity aerobic exercise, not as a lifestyle suggestion, but as a form of treatment. The data from the six-month mark of the original Sparks trial clearly pointed to a specific regimen that you can use. First, intensity. You need to hit a target heart rate of 80 to 85% of your maximum heart rate. So this isn't really just a nice casual walk. This is hard work that's going to make you sweat and it's going to make you breathe heavier. Now, based on the sparks trial, it's the difference between a moderate workout, which helps with symptoms, and a high-intensity workout, which may potentially slow progression. Second, frequency and duration. The prescription is 30 minutes, four times per week, performed on a treadmill or similar endurance device, like a stationary bike or an elliptical machine. Now, here's the key. Consistency is crucial. The study participants weren't exercising sporadically. They were adhering to a very tight schedule. So remember, consistency is going to help you build the habit of exercising. I have confidence in you. I know you can do it. I know you can go out there on a consistent basis and exercise every day to help improve your quality of life. So find a workout buddy to help you stay on track and get out there and exercise, or join a group fitness class. That's a great way to do it as well. All right, so how do we figure out what 80 to 85% of our maximum heart rate feels like? Well, the maximum heart rate is generally estimated as 220 minus your age. So, for example, I'm 62, my estimated maximum heart rate is 220 minus 62, which is 158 beats per minute. So my target heart rate would be 158 times 0.80 for 80%, which is 126 beats per minute, and 85% would be 158 times 0.85, and that would be 133. So my target heart rate between 80 and 85% would be between 126 and 133. So the key to the entire Sparks concept is about specificity. You need to train in that upper zone long enough to trigger the potential, and that's the keyword here, neuroprotective effects that we discussed. That's why, if you do this type of exercise, it's important to have a heart rate monitor or watch that can measure your heart rate to ensure you're staying in the zone. Now, here's the most important part I want to stress, and this is non negotiable. Safety warning. Before you strap on a heart rate monitor or a watch and jump on a treadmill going for 85% of your maximum heart rate, there's a mandatory first step that cannot and should not be skipped. First you must consult your physician and crucially get a cardiologist's supervised stress test. Now, why is this non negotiable? Because high intensity exercise, especially in a population that may have underlying or undiagnosed conditions, carries risks. The Sparks trial participants were carefully screened, and if you recall, they spent one to eight weeks building their cardiovascular endurance and just didn't jump on and start at 85% of their target heart rate. And a supervised stress test monitored by a cardiologist achieves two vital things. First, safety clearance. It confirms that your cardiovascular system can handle the rigor of high intensity training without adverse effects. And second, accurate targeting. It determines your true maximum heart rate, not just a theoretical number based on your age. This allows you to accurately calculate your personalized 80 to 85% high intensity zone, ensuring that you are pushing hard enough to potentially slow the disease while staying safe. Now remember, always talk to your neurologist and your primary care doctor before initiating any new high-intensity exercise program. They need to be part of the discussion, making sure the process and the entire program is tailored to your specific needs and stage of Parkinson's. So the Sparks trials teach us that exercise is a powerful, potentially disease modifying tool, but it's not a silver bullet. It's like a prescription. The important takeaway is this for people living with Parkinson's, the intention in your movement, work with your care team to safely determine your specific high-intensity target and find an activity you enjoy, whether that's walking, cycling, swimming, boxing, dance, whatever it happens to be, that help you achieve that heart rate and commit to doing it for 30 minutes four times per week. All right. Now, does that mean that if you can't do high-intensity exercise, that you shouldn't do exercise at all? No. You're still going to get the benefits of exercise, but you again, you want to make sure that you get it cleared with your doctor first. So anytime you start any new exercise program, please ensure that you're getting it approved by your doctor. All right. What an incredible journey we've taken today diving into the science that shifts our perspective from managing Parkinson's symptoms to actively confronting disease progression. Now, the core message from the Sparks trials, especially the critical six-month mark, is this high intensity aerobic exercise is not just good for Parkinson's. It may be, and that's the key word, may be, the first true non-pharmaceutically disease modifying agent that we have. Hopefully the Sparks 3 trial data will help provide confirmation and support the Sparks trial on modifying disease progression. However, exercise is a powerful prescribed dose of intentional movement, but it requires commitment and a precise heart rate target and must and most importantly the medical clearance we discussed. The research supports that pushing to that 80 to 85% heart rate zone safely and consistently offers a profound promise. It's a way for us to take back control to fight the progression of the disease on our own terms. Now, if you want to keep the momentum going, I have a few calls to action to help you lead you to your best life with Parkinson's. First, if you found the deep dive valuable, don't miss out on future insights, head on over to LiveParkinsons.com, and there you can subscribe to my free monthly newsletter, which delivers a spotlight topic that you can use in your everyday life and the latest research and new medications that are out, as well as helpful resources straight to your inbox. You can also find other free resources and articles covering topics on exercise, nutrition, optimism, and social interaction. Second, support my mission. My mission for this podcast and my website is simple to help everyone living with Parkinsons to lead a great quality of life. So if you feel inspired to supporting my mission, you can do so easily by clicking on the support the show link right there in the podcast description, or visit my support page at kofi.com slash liveparkinsons. Your donations ensure that I can keep bringing you high-quality research-backed content like this. And then finally, if you want to learn more about my personal journey and the philosophy that powers everything that we discuss, grab my book, Spectacular Life, Four Essential Strategies for Living with Parkinsons, available on Amazon. I want to thank you so much for listening. Remember, stay healthy, stay strong, and go out there and live your best life with Parkinsons. And I hope to see you soon. Thanks again and happy holidays.