The effects of agility training on the progression of Parkinson's symptoms

In light of the World Parkinson Day, we propose you an editorial tackling the issue of physical exercise as a method to slow down the effects of Parkinson's disease, the chronic disease affecting 10 million people worldwide at various stages.

Parkinson's disease (PD) is associated with a deterioration of physical abilities, highlighted by a progressive decline in postural control, walking ability and an increased risk for falling, muscular stiffness and tremors. Leaving aside the cognitive symptoms stemming from Parkinson's, these symptoms clearly results in a progressively worsening quality life.

Notwithstanding the importance and the magnitude that pharmacological treatments have in the treatment of motor symptoms, a new field of research suggests that physical exercise can also improve Parkinson's disease patients’ physical abilities. This field of research is still experimental, but it is generating interesting results that might affect for the better the wellbeing of Parkinson's disease patients.

Among the different kinds of training that can be performed by Parkinson's disease patients, high-intensity agility training has been tested to be the most effective form of training to ameliorate significantly patients’ physical ability, especially when compared against low frequency training, as this study demonstrated.

What high-intensity agility training is

Agility training is defined as that training that stimulates the ability to move and change the position of the body quickly and effectively, improving coordination, balance, speed and enhancing reflexes. When performed in high intensity, the agility tests are mostly anaerobic exercises, which should ideally raise VO2 to an average of 70% throughout the training sessions for healthy individuals.

Multiple agility exercises, such as lateral plyometric jumps, cone drills and shuttle runs, constitute the basis of multiple training formats, ranging from the more sports based ones like Skillathletic to the pure rehabilitative ones.

The best agility exercises for your motor coordination

A good proxy to measure your motor coordination and improve it is by doing these 3 simple agility exercises, which require small to no equipment and can be performed anywhere and at any time:

• Plyometric box step ups: start by standing in front of the box. Step up onto the box with one leg, then bring the other leg up as you straighten both legs. Step back down and repeat on the opposite side.

• Speed Ladder lateral running: Keeping a low centre of gravity, step side-to-side through the ladder one foot at a time. Touch in each rung of the ladder with both feet. Land on the balls of the feet. Repeat right to left and left to right.
• Shuttle Runs: shuttle run is probably the most standard agility training exercise to stimulate coordination, sprints and balance. Set a training area with 3 cones, about 10 metres apart from each other. With explosive speed, sprint from the first cone to the second cone, touch it and then sprint back. Subsequently, run from the first to the third cone, touch the tip of the cone and sprint to the initial position.

Testing agility training on Parkinson's patients

However, high-intensity agility training presents some long-term issues for Parkinson's patients. The first one is that patients are likely to perform this kind of training for a certain period, meaning that once the training regime is interrupted, the deterioration of physical abilities gradually returns to pre-training levels. Unfortunately, neither the length of the effects stemming from this Parkinson's specific training nor its effects on the drug dosage are certain.

To solve this problem, interesting findings have been highlighted in a 2019 paper by Tollár, published by the American College of Sports Medicine in its Medicine & Science in Sports & Exercise journal. In it, Tollár determines not only the immediate effects of a 3 weeks high-intensity and high-frequency agility training on a sample of patients diagnosed with Parkinson's, but assesses the long term effects of such training with and without a 2 years long high-intensity and medium-frequency agility maintenance program.

Description and methodology of the experiment

The experiment involved 55 patients at the same stage of Parkinson's disease, who were randomly assigned to three groups. The main group would have performed both the initial and the maintenance training; a second group was only asked to do the high frequency agility training and to interrupt training after the 3 weeks period; a third one would have instead performed no form of exercise.

All patients were examined before and after the 3 weeks training period, and then on a trimestral schedule. Each examination included a neurological and mobility exam to assess the patients’ change in their biometrics, measured with the standard metrics used in Parkinson's medical evaluations. All patients remained on medication and were not asked to decrease the dosage during the experiment.

The three weeks high-intensity and high frequency training program consisted of 15 1-hour long training sessions, targeted at specific mobility deficits the patients encountered in a preliminary testing phase. The 2 years maintenance period instead was composed of three different 2-hours long training sessions, where patients were asked to do the same exercise of the previous phase.

The effects of Agility Training on the progression of Parkinson's disease symptoms

The 3-weeks long high frequency program improved the mobility of training patients considerably. The maintenance program did not increase the positive effects of the high frequency training period, though it maintained the benefits throughout the experiment period. Conversely, the group that did not follow the maintenance training period lost all of the benefits from the 3-weeks period in 3 to 12 months.

Without any exercise during the 2 years interval, patients that did not undertake the 3 weeks training program saw their physical outcomes declining steadily from the baseline.

The experiment proves that there is a direct correlation between agility training and the slowdown of Parkinson's symptoms, which are then contained when maintenance training comes into play. At the same time, it is interesting to notice that the benefits of a 3 weeks high-intensity athletic effort wears down in months when not continued, signalling that the positive effects of agility training in Parkinson's disease patients outweigh the duration of the training period itself.

These results, though being some of the first in this field of research, highlight the importance of physical activity not only as a measure to counter the risk of general diseases, but also as an effective medicine to soothe some of the symptoms.