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

Episode Transcript
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SPEAKER_00 (00:10):
Parkinsons, live an exceptional life.
I'm your host, ChrisKestenbutter, and I've been
living an exceptional life withParkinson's for the past 15
years.
The mission of this podcast isto help as many people as
possible living with Parkinson'sto lead a great quality of life.
Today's topic is the six-monthmark.
Can high-intensity exercisereverse Parkinson's disease

(00:31):
progression?
Now here's a question for you.
Can exercise truly be a diseasemodifying treatment?
That's the million-dollarquestion.
Well, in today's episode, I wantto see if we can potentially
provide you the answer to thatquestion.
So we're going to take a deepdive into the famous Spark
study, where researchers decidedto treat high-intensity exercise

(00:54):
like high-powered medication.
For six months, one group pushedthemselves to the limit.
I'll reveal the key metric, theheart rate zone, that separated
progress from plateau, andexplain why these results are
forcing doctors and patientseverywhere to rethink
Parkinson's treatments.
So get ready.
The way you look at your workoutis about to change forever.

(01:16):
So let's take a look at whatwe'll be covering so that you
realize why exercise should be adaily part of your Parkinson's
management program.
We'll begin with setting thestage and cover why exercise is
PD's magic pill.
Then we'll move into thebenchmark and discuss why six
months is an important point,not only for research purposes,

(01:39):
but to build habits andconsistency.
Then it's time to discuss theSparks trial and its key
findings.
And then we'll give youpractical applications and
exercises that you can use totake advantage of the learning
from the Sparks trial, and thenwe'll wrap it up with Beyond the
Motor Symptoms and howconsistent, sustained exercise

(01:59):
can help you in your daily lifeso that you can live your best
life with Parkinson's.
Now, before we dive into today'stopic, I want to provide a
disclaimer that prior tostarting any new exercise
program, you get approval fromyour healthcare professionals to
ensure that they are appropriatefor your specific needs and
health status.
And the information beingpresented is for informational

(02:20):
purposes only and is notintended to treat Parkinson's or
recommend any specific exerciseprograms.
Alright, so let's begin bysetting the stage and talk about
why I'm always preaching aboutthe benefits of exercise.
As we know, Parkinson's resultsfrom the progressive loss of
dopamine producing neurons inthe substantia nigra in the

(02:40):
brain.
And it's this loss of dopamineis what causes the motor
symptoms that we experience,like tremors, bradykinesia, or
slowness of movement, and thengait and balance issues.
Now, currently medications onlytreat the symptoms by helping
replace the dopamine that we arelosing.
And while these medications arecrucial to helping us live a

(03:01):
better quality of life bycontrolling our motor symptoms,
they can just be one piece ofthe puzzle as well.
Now, here's where exercise comesinto play as an important piece
of your Parkinson's journey.
Because the idea is that itmight be disease modifying, and
that's what we're focusing ontoday.
So can exercise or consistentphysical activity help improve

(03:24):
our motor symptoms and actuallyslow disease progression?
And also help us with our nonmotor symptoms, which, as we all
know, can be just asdisabilitating as well.
So things like mood and sleep.
Let's think of it this way.
If medications can help us withour motor symptoms, and exercise
can potentially slow diseaseprogression, then why not take

(03:46):
full advantage of thesecomplementary therapies?
It's like a one-two punch, ifyou will.
So hopefully, by the end of theepisode, you have a great
understanding of why exercisecan play a crucial role in your
Parkinson's journey.
Now, from my personal experienceliving with Parkinson's for the
past 15 years, I truly believethat I'm living an exceptional

(04:07):
life because exercise has been acornerstone of my journey.
I can notice a definitedifference in how I feel if I
take any significant time offfrom exercise.
Okay, now that we know howmedication and exercise can work
in tandem to help us out, let'sturn our attention to exercise
and why it has become a researchfocus as a potential disease

(04:29):
modifying therapy.
Now, I mentioned in the titlethe six-month mark.
So what makes six months amagical number?
Well, that's a great question,and I'm glad you asked.
So thank you very much for that.
Now, many of the exercisestudies that were conducted were
short-term studies, typicallyfour to twelve weeks in
duration.

(04:49):
Now, because of the shorterduration, many of these studies
only showed transient benefits.
But the six-month duration is acritical for observing
sustained, clinicallysignificant, and potentially
neurobiological changes.
So that's why I want to take adeep dive into the SPARKS trial
and how the results could havean impact on your daily lives.

(05:12):
All right, so what is the SPARKStrial and why is it so
significant?
Well, the original study titledStudy in Parkinson's Disease of
Exercise, or SPARCS, SPARX, thisstudy was a multi-center,
randomized, controlled futilityphase two trial designed to test

(05:33):
the feasibility and potentialefficacy of moderate and
high-intensity exercise andslowing the progression of
Parkinson's disease.
Now it laid the groundwork for alarger phase three studies.
It was published in the Journalof the American Medical
Association, or JAMA, neurologyin 2018.

(05:53):
And the objective of this studywas to examine the feasibility
and safety of high-intensitytreadmill exercise in
participants with de novoParkinson's.
So what that means is that theywere recently diagnosed and were
not taking medication yet.
They were evaluating whether theeffects on motor symptoms

(06:14):
warranted a phase three trial.
Now I mentioned earlier thatthis was a phase two
multi-center randomized clinicaltrial, and it had three groups
and a mask assessors.
No, not like the Lone Ranger,Zorro, or those scream masks.
It means that the assessorsdidn't know which group each
individual was part of.

(06:35):
Now the individuals wereselected from outpatient and
community-based clinics, withthe primary endpoint of the
study being six months.
Individuals with idiopathicParkinson's between 40 and 80
years of age and that werewithin five years of diagnosis
and who were not exercising atmoderate intensity or greater

(06:57):
than three times per week andwere not expected to need
dopaminergic medication withinsix months.
They participated in the study.
Now there was a total of 381volunteers that were screened,
and 128 of those people wererandomly assigned to one of
three groups.

(07:17):
One group was high intensityexercise, the second group was
moderate intensity exercise, andthe third group was a control.
The participants participated ineither high intensity treadmill
exercise four days per week withan 80 to 85% maximum heart rate.
There were 43 patients in thisgroup.

(07:39):
Now, the next group did moderateintensity treadmill exercise,
four days per week, with 60 to65% maximum heart rate.
And there were 45 people in thisgroup, and then the final group
was a weight list control group,which consisted of 40 people.
Each group did these exercisesover six months.
And the study's main outcomemeasures were adherence to

(08:01):
prescribed heart rate andexercise frequency of three days
per week and safety.
And the clinical outcome was asix-month change in the
participants' unifiedParkinson's disease rating scale
motor score.
All right, so hopefully you'restill with me after all that.
I'd just like to set up wherethey got the participants and

(08:23):
what the participants weredoing.
All right, now before we diveinto the results, and if you
were really listening closely,which I hope you were,
participants were prescribedtreadmill exercise four days per
week for 26 weeks, or sixmonths, if you will.
But they hypothesized thatpeople would exercise for three
days a week.
So their workout included a fiveto ten minutes of warm-up, then

(08:46):
thirty minutes of treadmillexercise at their target heart
rate, and then they cooled downfor ten minutes.
That sounds doable, right?
Now, as I always say, startsmall and build up.
And that's exactly what they didin this study.
They increased their intensityand frequency during weeks one
through eight until they reachedtheir target heart rate zone.

(09:09):
So what were the results?
Well, both exercise groups mettargeted treadmill exercise
intensity.
The mean maximum heart rateswere 80.2% for the high
intensity group and 65.9% forthe moderate intensity group,
with no changes over time.

(09:30):
Now the mean weekly treadmillexercise frequency was 2.8 days
per week for the high intensitygroup and 3.2 days per week for
the low intensity group.
Now the change in UPDRS, themotor scores, in the high
intensity group was 0.3 comparedwith 3.2% in the usual care or

(09:53):
the control group.
So the Sparks trial or thisstudy successfully demonstrated
that high endurance exercise, 80to 85% of heart rate max, was
safe and feasible for peoplewith early stage PD.
Now, in terms of motor symptoms,the key findings centered on the

(10:14):
MDS UPDRS part three scores.
The high intensity group, themotor scores remained stable,
meaning there was no significantdeterioration over the six-month
period.
The control group's motorscores, those were the ones that
were on the wait list,significantly worsened.
They increased by approximately15%.

(10:36):
And then the moderate intensitygroup, their motor scores showed
an intermediate worsening, andthey increased by approximately
8%.
So the conclusion was thehigh-intensity exercise
intervention was the onlycondition that prevented the
expected natural progression ofmotor symptoms typically seen in
untreated individuals withParkinson's over a six-month

(10:58):
window.
Now, the finding, the necessaryevidence to launch the much
larger multi-site phase threeSPARCS trial.
So that leads us into the SPARCSIII trial.
Now, this trial is known as thestudy in Parkinson's disease of
exercise phase three.
So remember the first one was aphase two clinical study.

(11:20):
So this is a bigger phase threestudy.
And it's a definitive multi-siteclinical trial that's designed
to confirm whether thehigh-intensity aerobic exercise
can slow the progression ofParkinson's disease.
So this trial essentially islooking at can they reproduce
the results from thehigh-intensity group in this
bigger study?

(11:41):
So it builds directly on theearlier sparks to phase trial,
which we just reviewed.
Now, the primary objective ofthis big phase three study is to
test whether the progression ofthe signs of PD is slowed in
individuals with earlyParkinson's who perform
high-intensity endurancetreadmill exercise compared to

(12:03):
moderate intensity exercise.
So the study protocol calls foran enrollment of 370
participants, and it's enrollingindividuals between 40 to 80
years of age who are newlydiagnosed, which in this study
is typically less than threeyears, and they're untreated,
meaning they're not taking anyuh dopaminergic medication, like

(12:27):
Levatopa or the dopamineagonists.
Now you may be thinking, whycan't these people be taking
medication for their symptomswhile they're participating in
this study?
Well, the reason is by focusingon untreated patients, research
ensure that their observationalchanges are not attributed,
they're attributed solely toexercise intervention and

(12:49):
they're eliminating thepotential effects that
medication can have.
So by not taking medication, ifthey see significant benefits,
they can say that it's relatedto exercise versus if they were
taking medication that wouldmuddy the waters and they might
have might not be able to makethe conclusion that it was
exercise alone that caused theuh slow slowness and

(13:11):
progression.
Now, this trial is 18 months ofstructured exercise or a year
and a half uh training with atotal follow-up at 24 months or
two years.
It also includes a six-monthpost-interventional
observational period to assesssustained effects.
So they want to make sure thatthe effects are being sustained
over time.

(13:31):
Now the participants arerandomized into two active
groups, both exercising fourtimes per week for 30 minutes on
a treadmill, same as the Sparks2 trial, phase 2 trial.
Group one is the high intensitygroup with a target heart rate
of 80 to 85% of the maximumheart rate.
And group two is the moderateintensity or control uh dose

(13:53):
with a target heart rate of 60to 65% of max.
So if you remember there, it'sthe same as in the original
Sparks trial.
All right, now what'sinteresting in this study
compared to the Sparks trial isthe difference within the
addition of secondary measures.
Now, the primary or mainendpoint in this study is

(14:15):
measures in the change in motorsymptom severity.
The primary hypothesis orscientific guess is that the
high intensity group will showless worsening or lower score
increases than the moderateintensity group.
Now, here's what I findinteresting.
They're also measuring changesin dopaminergic activity in the
brain, measured by a DAT scan.

(14:37):
And they're also measuringcognitive function, which I
always need help with, ofcourse, including measuring
memory, attention, and executivefunction changes.
They're also looking at qualityof life, fitness, and daily
steps, and the amount ofcirculating levels of BDNF or
brain-derived neurotropicfactors.

(15:00):
Now, this study is ongoing andthe results have not been
published yet, but the expectedresults or conclusions based on
the trial design can go one ortwo ways.
First, it can confirmation ofdisease modification.
If the high intensity groupshows significantly less
progression, which is stable orimproved UPDRS motor scores

(15:22):
compared to the moderateintensity group, the authors
would probably conclude that thehigh intensity aerobic exercise
is a disease modifying therapythat should be considered or
prescribed as a first linetreatment in early Parkinson's.
Or number two, if there's nodifference, if both groups show
similar or minimal changes, orif both decline equally, the

(15:44):
authors may conclude that thedifference in intensity is not
critical for delayingprogression, although general
symptomatic benefits frommoderate exercise could be
acknowledged.
So, in essence, this trial ispoised to provide the highest
level of evidence yet regardingthe optimal intensity and
long-term dose of exerciserequired to truly slow the

(16:08):
Parkinson's progression.
All right, we spent a lot oftime on this episode taking a
deep dive into the clinical dataand the sparks and sparks three
trials.
But if you're living withParkinson'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 3trial don't just give us hope,

(16:31):
they give us a clear,scientifically backed exercise
prescription.
In addition, a 2023meta-analysis of 15 randomized
clinical trials, which included654 participants, found that
high intensity training, bothcontinuous and interval, showed
improved disease severityscores, respiratory fitness, and

(16:56):
quality of life.
And this data showed symptomaticand functional benefits, but did
not confirm slowed progression.
That's why the Sparks 3 trial isgoing 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 aerobicexercise, not as a lifestyle

(17:20):
suggestion, but as a form oftreatment.
The data from the six-month markof the original Sparks trial
clearly pointed to a specificregimen that you can use.
First, intensity.
You need to hit a target heartrate of 80 to 85% of your
maximum heart rate.
So this isn't really just a nicecasual walk.
This is hard work that's goingto make you sweat and it's going

(17:43):
to make you breathe heavier.
Now, based on the sparks trial,it's the difference between a
moderate workout, which helpswith symptoms, and a
high-intensity workout, whichmay potentially slow
progression.
Second, frequency and duration.
The prescription is 30 minutes,four times per week, performed
on a treadmill or similarendurance device, like a

(18:06):
stationary bike or an ellipticalmachine.
Now, here's the key.
Consistency is crucial.
The study participants weren'texercising sporadically.
They were adhering to a verytight schedule.
So remember, consistency isgoing to help you build the
habit of exercising.
I have confidence in you.

(18:27):
I know you can do it.
I know you can go out there on aconsistent basis and exercise
every day to help improve yourquality of life.
So find a workout buddy to helpyou stay on track and get out
there and exercise, or join agroup fitness class.
That's a great way to do it aswell.
All right, so how do we figureout what 80 to 85% of our
maximum heart rate feels like?

(18:48):
Well, the maximum heart rate isgenerally estimated as 220 minus
your age.
So, for example, I'm 62, myestimated maximum heart rate is
220 minus 62, which is 158 beatsper minute.
So my target heart rate would be158 times 0.80 for 80%, which is

(19:15):
126 beats per minute, and 85%would be 158 times 0.85, and
that would be 133.
So my target heart rate between80 and 85% would be between 126
and 133.
So the key to the entire Sparksconcept is about specificity.

(19:39):
You need to train in that upperzone long enough to trigger the
potential, and that's thekeyword here, neuroprotective
effects that we discussed.
That's why, if you do this typeof exercise, it's important to
have a heart rate monitor orwatch that can measure your
heart rate to ensure you'restaying in the zone.

(20:00):
Now, here's the most importantpart I want to stress, and this
is non negotiable.
Safety warning.
Before you strap on a heart ratemonitor or a watch and jump on a
treadmill going for 85% of yourmaximum heart rate, there's a
mandatory first step that cannotand should not be skipped.
First you must consult yourphysician and crucially get a

(20:23):
cardiologist's supervised stresstest.
Now, why is this non negotiable?
Because high intensity exercise,especially in a population that
may have underlying orundiagnosed conditions, carries
risks.
The Sparks trial participantswere carefully screened, and if
you recall, they spent one toeight weeks building their

(20:45):
cardiovascular endurance andjust didn't jump on and start at
85% of their target heart rate.
And a supervised stress testmonitored by a cardiologist
achieves two vital things.
First, safety clearance.
It confirms that yourcardiovascular system can handle
the rigor of high intensitytraining without adverse

(21:05):
effects.
And second, accurate targeting.
It determines your true maximumheart rate, not just a
theoretical number based on yourage.
This allows you to accuratelycalculate your personalized 80
to 85% high intensity zone,ensuring that you are pushing
hard enough to potentially slowthe disease while staying safe.

(21:26):
Now remember, always talk toyour neurologist and your
primary care doctor beforeinitiating any new
high-intensity exercise program.
They need to be part of thediscussion, making sure the
process and the entire programis tailored to your specific
needs and stage of Parkinson's.
So the Sparks trials teach usthat exercise is a powerful,

(21:49):
potentially disease modifyingtool, but it's not a silver
bullet.
It's like a prescription.
The important takeaway is thisfor people living with
Parkinson's, the intention inyour movement, work with your
care team to safely determineyour specific high-intensity
target and find an activity youenjoy, whether that's walking,

(22:11):
cycling, swimming, boxing,dance, whatever it happens to
be, that help you achieve thatheart rate and commit to doing
it for 30 minutes four times perweek.
All right.
Now, does that mean that if youcan't do high-intensity
exercise, that you shouldn't doexercise at all?
No.
You're still going to get thebenefits of exercise, but you

(22:34):
again, you want to make surethat you get it cleared with
your doctor first.
So anytime you start any newexercise program, please ensure
that you're getting it approvedby your doctor.
All right.
What an incredible journey we'vetaken today diving into the
science that shifts ourperspective from managing
Parkinson's symptoms to activelyconfronting disease progression.

(22:55):
Now, the core message from theSparks trials, especially the
critical six-month mark, is thishigh intensity aerobic exercise
is not just good forParkinson's.
It may be, and that's the keyword, may be, the first true
non-pharmaceutically diseasemodifying agent that we have.
Hopefully the Sparks 3 trialdata will help provide

(23:18):
confirmation and support theSparks trial on modifying
disease progression.
However, exercise is a powerfulprescribed dose of intentional
movement, but it requirescommitment and a precise heart
rate target and must and mostimportantly the medical
clearance we discussed.

(23:38):
The research supports thatpushing to that 80 to 85% heart
rate zone safely andconsistently offers a profound
promise.
It's a way for us to take backcontrol to fight the progression
of the disease on our own terms.
Now, if you want to keep themomentum going, I have a few
calls to action to help you leadyou to your best life with

(23:59):
Parkinson's.
First, if you found the deepdive valuable, don't miss out on
future insights, head on over toLiveParkinsons.com, and there
you can subscribe to my freemonthly newsletter, which
delivers a spotlight topic thatyou can use in your everyday
life and the latest research andnew medications that are out, as
well as helpful resourcesstraight to your inbox.

(24:20):
You can also find other freeresources and articles covering
topics on exercise, nutrition,optimism, and social
interaction.
Second, support my mission.
My mission for this podcast andmy website is simple to help
everyone living with Parkinsonsto lead a great quality of life.
So if you feel inspired tosupporting my mission, you can

(24:43):
do so easily by clicking on thesupport the show link right
there in the podcastdescription, or visit my support
page at kofi.com slashliveparkinsons.
Your donations ensure that I cankeep bringing you high-quality
research-backed content likethis.
And then finally, if you want tolearn more about my personal
journey and the philosophy thatpowers everything that we

(25:05):
discuss, grab my book,Spectacular Life, Four Essential
Strategies for Living withParkinsons, available on Amazon.
I want to thank you so much forlistening.
Remember, stay healthy, staystrong, and go out there and
live your best life withParkinsons.
And I hope to see you soon.
Thanks again and happy holidays.

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

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