Neurological conditions are the leading cause of disability world-wide, with the prevalence of Parkinson’s Disease (PD) steadily increasing compared to any other neurodegenerative disorder (1).  It is estimated that PD has an annual incidence of 400–1,900 cases per 100,000 people worldwide (3), with the current global estimate of PD prevalence sitting at 6.1 million individuals (5).

Do you, or a close friend or family member, require specialist support to better manage your Parkinson’s symptoms?

What exactly is Parkinson’s Disease?

PD is characterised by the degeneration of the neurons of the part of the brain that plays a role in reward and movement, which promotes a significant decrease in dopamine levels, an important neurotransmitter in maintaining nervous system control (2) (learn more on the important role of dopamine here). Consequently, this results in the decline of a number of important neurological functions, which presents as motor control and movement coordination deterioration.

Symptoms associated with PD typically include tremors, movement impairment, rigidity, postural instability, altered gait pattern, freezing of gait, and motor coordination deficits (4). Other symptoms such as cognitive impairment, dementia, insomnia, depression, anxiety, apathy, bladder dysfunction, pain, and fatigue can also occur during the course of the disease (4).

As a result of the symptoms experienced, people with PD tend to live a more sedentary lifestyle leading to further deterioration of functional independence, daily activities and social interactions and, consequently, lead to poorer quality of life (1, 4). Exercise, along with pharmacological therapy, is a vital component in the management of PD.

Below are 5 main reasons why exercise should be an essential part of your PD management plan.

Reason #1 – Exercise reduces the risk of developing PD as well as slowing PD progression

Individuals that engage in moderate to vigorous exercise during ‘midlife’ (ages 30s – 40s) significantly reduce their risk of developing PD. This is due to the fact that exercise modulates a range of supporting systems for brain maintenance and plasticity, including the formation of new neurons between the nervous system; formation of new blood vessels; reparation of cellular damage and reduced inflammation; and promotion of the production of growth factors.

Furthermore, engaging in ongoing aerobic exercise 3 times per week for 30 to 45 minutes at an intensity of 50 to 80% of heart rate reserve (HRR = difference between age-predicted maximum heart rate, and resting heart rate (click here for a HRR calculator)) stimulates functional and structural neuroplasticity (the brain’s ability to learn new behaviours through modification of existing neural networks) in individuals with PD (7).

Reason #2 – Increasing general strength and fitness will assist in maintaining independence in activities of daily living and reduce risk of other conditions developing

Muscle weakness, particularly lower limb strength, is commonly observed in individuals with PD and greatly contributes to postural instability, poor physical function and walking performance, as well as increased risk of falls (3). Therefore, focusing on increasing muscle strength will assist individuals with PD to feel more balanced and strong during functional everyday activities, thus improving walking performance. This will likely have a positive effect on increasing confidence in movement ability, and maintaining or even improving independence – all of which directly impacts quality of life.

Furthermore, cardiorespiratory fitness (VO2max) was reported to be 20–25% lower in patients with PD compared to healthy aged-matched individuals (3). Poor cardiorespiratory fitness is associated with increased risk of cardiovascular disease and mortality. The occurrence of several risk factors for cardiovascular disease (insulin resistance, hyperlipidemia, insulin resistance, hypertension) is associated with a faster deterioration in motor symptoms of PD.

Increasing your cardiovascular fitness (A.K.A aerobic fitness) will make your body more able to combat the challenges of PD and other disorders of ageing. It will help improve particular motor and non-motor symptoms of PD through keeping neurons alive, healthy, and functioning properly in the brain thus staving off PD’s effects (10).

Reason #3 – Exercise has been shown to improve specific symptoms that commonly affect people with Parkinson’s Disease

PD is associated with many motor and non-motor symptoms including tremors, movement impairment, rigidity, postural instability, altered gait pattern, freezing of gait, and motor coordination deficits as well as cognitive impairment, dementia, insomnia, depression, anxiety, apathy, bladder dysfunction, pain, and fatigue.

The benefits of exercise in PD management is quite phenomenal. Exercise assists in the prevention of cardiovascular complications; arrest of osteoporosis; improved cognitive function; prevention of depression; improved sleep; decreased fatigue; improved functional motor performance; improved medication effectiveness; decreased constipation; and optimisation of the dopaminergic system (6).

Reason #4 – Exercise has a neuro-protective effect

Exercise directly impacts the underlying disease pathology of PD by inducing an increase in dopamine release and the uptake of dopamine in the mid-brain. This results in slowing disease progression and demonstrates the neuro-protective role of exercise (8). Neuro-protection refers to the ability of a treatment to preserve the neurons in the brain from deteriorating – and that is what is necessary to slow down or halt the progression of diseases like PD in which nerves degenerate and die (10).

Reason #5 – Exercise increases the effectiveness of Parkinson’s medication

Levadopa is the most commonly administered medication to treat PD symptoms. Its effect comes from being transported to the brain and converted to dopamine, therefore improving the dopamine deficit that occurs in individuals with PD (6). Exercise improves Levadopa absorption through accelerated gastric passage and/or increased mesenteric (the organ that attaches to the intestines) blood flow. Furthermore, the exercise-induced increase in blood pressure and heart rate enables Levodopa to cross the blood–brain barrier more efficiently (6).

PD is a complex condition that requires specialist support and guidance to halt the rate of functional and cognitive decline. As Exercise Physiologists, we can implement the safest and most evidence-based physical activity for you and your stage of PD.

Due to its vast amount of benefits, we firmly believe exercise must be part of your Parkinson’s management plan.

Lomé Heyns

Reference List:

1. Armstrong MJ, Okun MS. Diagnosis and Treatment of Parkinson Disease. JAMA. 2020 Feb 11;323(6):548–60.
2. Monteiro-Junior RS, Cevada T, Oliveira BRR, Lattari E, Portugal EMM, Carvalho A, et al. We need to move more: Neurobiological hypotheses of physical exercise as a treatment for Parkinson’s disease. Medical Hypotheses. 2015 Nov;85(5):537–41.
3. Mak MK, Wong-Yu IS, Shen X, Chung CL. Long-term effects of exercise and physical therapy in people with Parkinson disease. Nature Reviews Neurology [Internet]. 2017 Oct 13;13(11):689–703. Available from: https://www.nature.com/articles/nrneurol.2017.128
4. Fayyaz M, Jaffery SS, Anwar F, Zil-E-Ali A, Anjum I. The Effect of Physical Activity in Parkinson’s Disease: A Mini-Review. Cureus. 2018 Jul 18;10(7).
5. American College of Sports Medicine. ACSM’s guidelines for exercise testing and prescription. 11th ed. Liguori G, Feito Y, Fountaine C, Roy BA, editors. Philadelphia: Wolters Kluwer; 2021.
6. Speelman AD, van de Warrenburg BP, van Nimwegen M, Petzinger GM, Munneke M, Bloem BR. How might physical activity benefit patients with Parkinson disease? Nature Reviews Neurology [Internet]. 2011 Jul 12;7(9):528–34. Available from: https://www.nature.com/articles/nrneurol.2011.107
7. Johansson ME, Cameron IGM, van der Kolk NM, De Vries NM, Klimars E, Toni I, et al. Aerobic exercise alters brain function and structure in Parkinson’s disease a randomized controlled trial. Annals of Neurology. 2021 Dec 24;91(2).
8. Ellis T, Rochester L. Mobilizing Parkinson’s Disease: The Future of Exercise. Brundin P, Langston JW, Bloem BR, editors. Journal of Parkinson’s Disease. 2018 Dec 18;8(s1):S95–100.
9. Schootemeijer S, van der Kolk NM, Bloem BR, de Vries NM. Current Perspectives on Aerobic Exercise in People with Parkinson’s Disease. Neurotherapeutics. 2020 Aug 17;17(4).
10. Gilbert DR. Why exercise is critical for people with Parkinson’s | APDA [Internet]. American Parkinson Disease Association. 2021. Available from: https://www.apdaparkinson.org/article/why-exercise-with-pd/