Physical activity promotes clinical benefits beyond dopaminergic preservation in Parkinson's disease: a longitudinal analysis of the PPMI cohort.

Authors

Minkyeong Kim, Kyoungjune Pak, Jae-Hyeok Lee, Myung Jun Lee

Published in

Neurological research and practice. Volume 8. Issue 1. Aug 11, 2026. Epub Aug 11, 2026.

Abstract

Physical activity is associated with better clinical outcomes in Parkinson's disease (PD). This study aimed to investigate the effects of physical activity on longitudinal changes in dopamine transporter (DAT) availability and motor and cognitive outcomes. Additionally, it explored whether striatal dopaminergic integrity mediates these effects.
Using data from the Parkinson's Progression Markers Initiative, we included patients with PD who had at least 4 years of follow-up data on the Physical Activity Scale for the Elderly and at least two assessments of DAT imaging, motor and cognitive functions, resulting in three analytical datasets (n = 141, 233, and 259, respectively). Linear mixed-effects models were used to analyse the influence of physical activity on the progression of DAT availability and clinical outcomes. Multilevel mediation analyses investigated the mediation effect of physical activity on the rate of clinical progression.
Higher levels of physical activity were significantly associated with a slower decline in caudate DAT availability, attenuated progression of axial symptoms, rigidity, and overall motor severity, and better preservation of Montreal Cognitive Assessment and Symbol Digit Modalities Test scores. Mediation analyses demonstrated that higher physical activity was significantly associated with slower caudate DAT decline; however, none of the clinical outcomes were significantly mediated by caudate DAT preservation, as all indirect effects were non-significant.
These findings suggest that physical activity is associated with both dopaminergic degeneration and clinical progression in PD. However, the observed clinical benefits are likely primarily driven by mechanisms beyond striatal dopaminergic preservation.

PMID:
42581365
Bibliographic data and abstract were imported from PubMed on 12 Aug 2026.

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