Exercise is an important part of healthy living for everyone, however, for people with Parkinson’s disease (PD) exercise is not only healthy, but a vital component to maintaining balance, mobility and daily living activities, along with a potential neuroprotective effect. The Parkinson’s Foundation Quality Improvement Initative studied exercise as part a Parkinson's Outcomes Project study.
Every Center of Excellence agrees that they believe 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. There is a growing consensus among researchers about the short and long-term benefits of exercise for people with PD.
How Can I Benefit from Exercise?
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. So far, studies have shown:
- Engaging in any level of physical activity is beneficial, rather than being sedentary — this is associated with improved motor 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, 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, but the research is still ongoing in these areas.
One study showed that people with PD who exercised regularly for 2.5 hours a week had a smaller decline in mobility and quality of life over two years. Research is ongoing to discover therapies that will change the course of the disease.
There is a strong consensus among physicians and physical therapists that improved mobility by exercising may improve thinking, memory and reduce risk of falls. By avoiding complications from falls you can prevent further injury. At this time, we know that people who exercise vigorously, for example running or cycling, have fewer changes in their brains caused by aging. Studies in animals suggest exercise also improves PD symptoms.
Neurologists within the Parkinson’s Foundation Center of Excellence network recommend a regimented exercise program to their patients and also to people who are worried about getting PD due to family connection.
How Does Exercise Change the Brain?
What happens in the brain to produce these visible benefits? Researchers at the University of Southern California looked at the brains of mice that had exercised under conditions parallel to a human treadmill and discovered that:
- Exercising did not affect the amount of dopamine in the brain, but the mice that exercised the brain cells were using dopamine more efficiently.
- Exercise improves efficiency by modifying the areas of the brain where dopamine signals are received — the substantia nigra and basal ganglia.
Scientists at University of Pittsburgh found that in animal models, exercise induces and increases the beneficial neurotrophic factors, particularly GDNF (glial-derived neurotrophic factor), which reduces the vulnerability of dopamine neurons to damage.
At the molecular level, at least two things happen to make dopamine use more efficient:
- Dopamine travels across a space between two adjacent brain cells called a synapse. This process is called signaling and it is essential for normal functioning. To end the signal, a protein complex called the dopamine transporter normally retrieves dopamine from the synapse. The first thing Fisher et al. found is that animals that had exercised possessed less of the dopamine transporter, meaning that dopamine stayed in their synapses longer and their dopamine signals lasted longer.
- They found the cells receiving the dopamine signal had more places for the dopamine to bind in animals that exercised, and could receive a stronger signal. This binding site is the D2 receptor.
They also studied the D2 receptor in a subset of the human subjects who were within one year of diagnosis and not on any medications, using an imaging technique called positron emission tomography (PET). They found that exercise increased the expression of D2 receptors in humans.
What Kinds of Exercises Are Helpful for People with PD?
- Any exercise is beneficial. Our tip sheet and podcast episode are specifically helpful for people with PD.
- Any form of physical exercise you do without injuring yourself will provide benefit. Before beginning any new exercise, consult with your physician and, if available, a physical therapist that understands PD.
- Formal exercise programs balance several different aspects of fitness including strength, balance, coordination, flexibility, and endurance.
- Each of these areas provide a benefit to people with PD. Achieving a balance that works and engages you in a program you can start, maintain and expand upon is the goal.
Many programs target the rapid gains that can be achieved through a focus on improvements in functional capacity and mobility. These programs vary according to different aspects of physical training. Examples of exercise programs for people with PD include:
- Intensive sports training
- Treadmill training with body weight support
- Resistance training
- Aerobic exercise
- Alternative forms of exercise (yoga)
- Home-based exercise (YouTube videos)
- Practice of movement strategies
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.
- 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.
When Should I Start Exercising?
Right now! Everyone should exercise more, whether they have PD or not.
In PD, a special kind of neuron (brain cell) that produces the chemical transmitter dopamine gets damaged and lost. However, there is a lag between the time when neuron loss begins and when PD movement symptoms start to show. By the time most people are diagnosed, as much as 40 to 60 percent of their dopamine neurons are already gone. The reason people with PD don’t experience symptoms until they reach this point is that the brain can compensate for the loss of dopamine neurons by adapting. In fact, the brain reshapes itself throughout life in response to experience. Scientists call this ability to change and compensate "experience-dependent neuroplasticity."
- 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, have shown significant gains in functional balance and mobility as compared to programs of only two-week or 10-week durations.
- 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. Your doctor might recommend an hour a day three or four times a week, but most researchers think that 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 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.
To find exercise classes in your area call the Parkinson’s Foundation Helpline at 1-800-4PD-INFO (473-4636).
Page reviewed by Dr. Bhavana Patel, Movement Disorders Fellow at the University of Florida, a Parkinson’s Foundation Center of Excellence.