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Researchers from the University of Maryland (UM) School of Medicine, in Baltimore, and the Baltimore VA Medical Center have launched a study of exercise and computerized memory training to see if the activities can help people with Parkinson's disease prevent changes in executive function. Many patients develop problems in this area, which can prevent them from working and eventually may require a caregiver to take over more of the complex cognitive tasks of daily living.

"Studies of normal aging show that memory and executive function can be improved with exercise, such as walking several days a week," stated principal investigator Karen Anderson, MD, assistant professor of neurology and psychiatry at the UM School of Medicine, a neuro-psychiatrist at the Maryland Parkinson's Disease and Movement Disorders Center at the University of Maryland Medical Center, and a mental health clinician at the Baltimore VA Medical Center.

"We want to see if exercise can slow or reverse some of these memory changes in Parkinson's patients," she said. "We will also investigate whether a computer game designed to improve executive function may make a difference as well. The other question is what happens when you put the two interventions together? If there is memory improvement, will it be even better than with one of the interventions, or is it more efficient to do just one or the other?"

The researchers, who received funding through a VA Merit Award, plan to enroll about 90 patients who will be divided randomly into three groups: exercisers walking on a treadmill, memory game players, and those doing both exercise and memory games. Participants in each group will receive a memory assessment at the beginning of the study. They will undergo training three times a week for three months and then be retested. The researchers will test the participants again three months later to see if there are longer-term benefits to the training.

With both the treadmill walking and the memory game, the exercise or video game will become more challenging as the participant improves. The memory training works like a video game, with players advancing to a higher level of difficulty. Trainers may increase the speed or slope of the treadmill for the exercisers to make it more aerobically challenging.

"This new study builds on our experience from a previous study of exercise for gait and mobility in Parkinson's disease," said co-investigator Lisa Shulman, MD, professor of neurology at the UM School of Medicine and co-director of the Maryland Parkinson's Disease and Movement Disorders Center. "Since both motor function and cognitive function are important for mobility and performance of daily activities, this new study will investigate the individual and combined effects of treadmill training and cognitive training."

Patients with Parkinson's "are eager to know if there is anything they can do to give them greater control over their condition," she explained. "Mobility and memory are the two key components to preserve independence. If these treatment strategies are found to be effective, we will learn important new approaches to delaying disability."

The treadmill training will take place at the Baltimore VA Medical Center in the Maryland Exercise and Robotics Center of Excellence, a gym facility with specialized equipment for people with physical limitations or balance issues. Participants will wear a safety harness while walking on the treadmill, and experienced exercise physiologists will supervise the sessions.

The computerized memory training game will take place both at the VA and UM School of Medicine.

"This study shows the commitment of our faculty to exploring new approaches, such as exercise and memory training, to help patients with illnesses such as Parkinson's disease around the world," said E. Albert Reece, MD, PhD, MBA, vice president for medical affairs at the University of Maryland and dean of the UM School of Medicine.

The researchers expanded the exercise studies to patients with Parkinson's after finding success with treadmill training for patients with stroke. Their research at the UM School of Medicine and the VA Maryland Health Care System found that regular exercise on a treadmill can improve walking ability in patients even years after having a stroke.

"We have seen that the consistent, repetitive motion of walking may help the brain to develop new connections to compensate for the damaged ones," said co-investigator Richard Macko, MD, director of the Maryland Exercise and Robotics Center of Excellence at the VA Maryland Health Care System and professor of neurology at the UM School of Medicine. "This new Parkinson's study takes the concept of exercise training for neurology patients in a new direction. We will be interested to see if this consistent training will produce benefits to memory."