Exercise

Exercise is an important part of healthy living for everyone. For those with Parkinson’s disease (PD), exercise is more than healthy — it is a vital component to maintaining balance, mobility and activities of daily living. Research shows that exercise and physical activity can not only maintain and improve mobility, flexibility and balance but also ease non-motor PD symptoms such as depression or constipation.

The Parkinson’s Outcomes Project shows that people with PD who start exercising earlier in their disease course for a minimum of 2.5 hours per week experience a slowed decline in quality of life compared to those who start later. Establishing early exercise habits is essential to overall disease management.

What type of exercise should I do?

To help manage the symptoms of PD, your exercise program should include these key components:

Aerobic Activity
Strength Training
Balance, Agility & Multitasking
Flexibility

The Parkinson’s Foundation, in collaboration with the American College of Sports Medicine, created new Parkinson’s disease exercise recommendations to provide people with PD safe and effective exercise programs and instruction.

The exercise guidelines include recommended frequency, intensity, time, type, volume and progression of exercises that are safe and effective for people with PD. Each recommendation is paired with specific types of activity and special safety considerations for people with PD.

Exercise Recommendations

Recommendations are available in multiple languages.

The four elements of exercises are included in many types of exercise. Biking, running, Tai Chi, yoga, Pilates, dance, weight training, non-contact boxing, qi gong and more are included — all have positive effects on PD symptoms.

What kinds of exercise programs are available?

Many programs can help focus on improvements in functional capacity and mobility. These programs vary according to different aspects of physical training. Examples of PD exercise programs include:

Intensive sports training (non-contact boxing classes)
Treadmill training with body weight support
Resistance training
Aerobic exercise
Alternative forms of exercise (yoga)
Home-based exercise (YouTube videos or PD Health @ Home Fitness Fridays)
Stretching

There is no “exercise prescription” that is right for every person with PD. The type of exercise you do depends on your symptoms and challenges. For those who may be more sedentary, starting with low intensity exercise, such as walking, is beneficial. This can be increased to regular, more vigorous activity as tolerated.

The most important thing is to do the exercise regularly. We suggest find an exercise you enjoy and can stick with!

How To Get Started

First, be safe. Before starting an exercise program, see a physical therapist specializing in PD for full functional evaluation and recommendations.
Use a pedometer (step-counter) and figure out how many steps you take on average each day, then build up from there. Many smartphones or smartwatches have a built-in pedometer feature or an application that can be downloaded.
Exercise indoors and outdoors. Change your routine to stay interested and motivated.
Most importantly, pick an exercise you enjoy.

Find Local PD Exercise Classes

Across the country, dance classes and boxing groups designed specifically for people with PD are growing in popularity. Contact our Helpline at 1-800-4PD-INFO (1-800-473-4636) or Helpline@parkinson.org to find one near you.

Working Out with a Partner

Many people find that they achieve the most success when exercising with a partner. Depending on the stage of the disease, it may be best for people with PD to train in an environment where others who could offer help are available if needed.

A workout partners can help motivate and engage one another in their exercise. People new to exercise programs may benefit with training with an individual or group leader. A physical therapist may be helpful in starting a program for people whose mobility is significantly affected by PD.

Exercise Tips

The best way to see benefits is to exercise on a consistent basis. People with PD enrolled in exercise programs with durations longer than six months, regardless of exercise intensity, showed significant gains in functional balance and mobility as compared to two-week or 10-week programs.
When it comes to exercise and PD, greater intensity may have greater benefits. Experts recommend that people with PD, particularly young-onset or those in the early stages, exercise with intensity for as long as possible as often as possible. The more you do, the more you benefit.
Intense exercise is exercise that raises your heart rate and makes you breathe heavily. Studies have focused on running and bicycle riding, but experts feel that other intense exercise such as swimming should provide the same benefit.
Regardless of your condition, always stretch, warm up and cool down properly.
Exercise in a way that is safe for you. Know your limits.
Many support groups, therapists and exercise programs can help with PD-safe exercises or help you set up your own program.

Challenges to Exercising

People in the early stages of PD tend to be just as strong and physically fit as healthy individuals of the same age. As Parkinson’s progresses, it can lead to the following physical changes:

Loss of joint flexibility, which can affect balance.
Decreased muscle strength or deconditioning which can affect walking and the ability to stand up from sitting.
Decline in cardiovascular conditioning, which affects endurance.

MY PD STORY: Anne Wray

The Parkinson’s Outcomes Project study shows that 2.5 hours of weekly exercise along with medication, can significantly improve quality of life for people living with Parkinson’s.

Exercise & Parkinson’s Research

Exercise is good for the heart and the muscles, but exercise can actually change the brain. Establishing early exercise habits is an essential part of overall disease management, which is why neurologists now recommend exercise as part of most PD treatment plans.

People with Parkinson’s who engaged in at least 2.5 hours of exercise a week had a better quality of life than those who didn’t exercise at all or started exercising later.

Research finding from the Parkinson’s Outcomes Project, the largest-ever clinical study of Parkinson’s

At Rhodes University in Memphis, TN, Dr. Gerecke and team report that exercise may be neuroprotective and have shown that exercise reduces the loss of dopamine-producing neurons after MPTP exposure. MPTP is a neurotoxin that causes loss of the dopamine-producing neurons in the same brain region that degenerates in human Parkinson’s disease. Therefore, MPTP is used to generate an animal model for PD. Dr. Gerecke showed that three months of exercise provided complete protection against MPTP-induced neurotoxicity in mice. If running was limited to one to two months, or if the amount of running daily was decreased, the protective effects of exercise ended. In short, daily, sustained exercise was necessary for full protection.

Dr. Gerecke also found that three months of exercise induced changes in proteins related to energy regulation, cellular metabolism, cytoskeleton dynamics and intracellular signaling events. These changes might be responsible for the neuroprotection.

Other research findings include:
- Out of 14 studies on treadmill training, three show an immediate effect of increased walking speed, longer stride length and improved balance as early as after one treadmill session. Eleven longer-term trials demonstrated safety and positive benefits in gait speed, strike length and related quality of life even several weeks later.
- At the Cleveland Clinic, Dr. Alberts and team found that when people with PD pedaled on a stationary bike 30 percent faster than their preferred rate, they gained in aerobic fitness and showed improvement in motor function and coordination as well as manual dexterity. This improvement was retained for weeks after exercise stopped.
- Evidence in animal models with PD have shown that intensive exercise can alter the way the brain works and promote recovery.
- Mice models have shown that exercise improves that efficiency by modifying some of the areas of the brain where dopamine signals are received (ie, the substantia nigra and basal ganglia).
Research has shown that exercise can improve gait, balance, tremor, flexibility, grip strength and motor coordination. Exercise such as treadmill training and biking have all been shown to benefit, along with Tai Chi and yoga.

Studies have shown that:
- Engaging in any level of physical activity is beneficial for movement symptoms.
- For people with mild to moderate PD, targeted exercises can address specific symptoms. For example: aerobic exercise improves fitness, walking exercises assist in gait, and resistance training strengthens muscles.
- One study showed that twice-a-week tango dancing classes helped people with PD improve motor symptoms, balance and walking speed.
- Exercise may also improve cognition, depression and fatigue. Research is ongoing in these areas.
- People who exercise vigorously, for example running or cycling, have fewer changes in their brains caused by aging.
Many physicians and physical therapists believe that exercise improves mobility, thinking, memory and reduces the risk of falls. In avoiding complications from falls, you can prevent further injuries and emergency hospitalizations.

Neurologists within the Parkinson’s Foundation Center of Excellence network recommend that their patients with Parkinson’s follow a regimented exercise program, along with anyone who may be at a higher risk of developing Parkinson’s.
More and more researchers are dedicating studies to proving that exercise is an essential part of managing Parkinson’s. Ongoing exercise-related studies are also looking to discover therapies that will change the course of the disease. Through our research grants, the Parkinson’s Foundation supports research dedicated to better understanding how exercise can achieve the best quality of life for people with PD.

More research is needed to understand which aspects of exercise are most important, whether the benefits are long-lasting and whether drug and other therapies influence its effects. In studying the underlying molecular mechanisms, scientists may find new targets for drug therapies.In the meantime, intensive exercise helps people with PD walk and move better. Research is beginning to reveal how it reconditions the underlying brain circuits.

Neuroprotective Benefits of Exercise

Neuroprotection is when your brain works to prevent the death of neurons, or brain cells. For people with PD, exercise is not only vital to maintaining balance, mobility and daily living activities, but it has the potential to have a neuroprotective effect.

The Parkinson’s Foundation studied exercise as part of our Parkinson’s Outcomes Project study. Our Center of Excellence network believes that exercise is important to good outcomes in PD, and data supports that. Exercising enhances the sense of wellbeing, even across different disease stages and severities.

We know that in PD, neurons that produce the chemical transmitter dopamine are damaged and lost. There is a period of time between when the loss of neurons begins and when PD movement symptoms start to show. By the time most people are diagnosed, nearly 80 percent of their dopamine neurons are already gone.

During this period, the brain changes, compensating for the loss of dopamine neurons which occurs during the process of neurodegeneration. Scientists call this ability to change and compensate exercise-dependent neuroplasticity . This same process occurs throughout life in response to experience. As children learn motor skills, for example, their brain cells make new connections. This process continues through adulthood.

Exercise may affect the brain by driving this compensation, or plasticity. People with PD who exercise regularly can move more normally than those who do not. We believe that exercise may be contributing to neuroplasticity — helping the brain maintain old connections, form new ones and restore lost ones. This may outweigh the effects of neurodegeneration.
What happens in the brain to produce these benefits? A study conducted by Beth Fisher and her team at the University of Southern California found that on a day-to-day basis, people with PD who exercised moved more normally than those who did not.

The study also found that in looking at mice that had exercised under conditions parallel to a human treadmill:
- Exercising did not affect the amount of dopamine in the brain, but the mice that exercised the brain cells were using dopamine more efficiently and their dopamine signals lasted longer.
- Exercise improves efficiency by modifying the areas of the brain where dopamine signals are received — the substantia nigra and basal ganglia.
Based on these findings, the research team believes exercise may help the brain maintain old connections, form new ones and restore lost ones. In certain situations, the neuroplasticity created from exercise in people with PD may outweigh the effects of neurodegeneration.