How Exercise Can Improve Life with Parkinson's

March 10, 2016

Research demonstrates the importance of maintaining an active lifestyle for people who live with Parkinson’s disease (PD). We know, for example, that certain exercise programs can improve strength, balance, flexibility and aerobic capacity — all of which are important in PD. We also have early, though not conclusive evidence from animal studies that vigorous exercise may actually protect against the death of brain cells that underlies PD.

But which type of exercise is best, and how intensive and frequent should it be? There’s no standard “exercise prescription” for PD; the right program may be different for each person, and should be adjusted as PD progresses. The good news is that many types of activity are beneficial, so people with PD can choose the ones they enjoy and that best meet their needs. The single most important piece of advice is to get active, and stay active!

What Changes as PD Progresses?

People who are in the early stages of PD tend to be just as strong and physically fit as healthy individuals of the same age. But as PD progresses, so do the physical challenges. In addition to the movement symptoms of the disease — tremor, slowness, freezing of gait — people with PD commonly lose some of their range of motion, especially in the neck and back. This can interfere with their ability to twist and look over the shoulder (when driving, for example), and can affect balance.

It is also common for muscle strength to decrease in the course of PD. In one study, people with moderate PD symptoms — that is, those who scored higher than 30 on the standard Unified Parkinson’s Disease Rating Scale — exhibited just one-half of the strength exhibited by a group of healthy individuals in their quadriceps (the thigh muscles that are important to walking and to standing up).

Other common consequences of PD are declines in cardiovascular conditioning, which supports a person’s physical endurance, and in the ability of the nervous system to get the body going. This can mean that even in the early stages of Parkinson’s disease, a person may need to breathe more oxygen when walking — that is, he or she may need to put in more effort than the average person to go for a walk. One question is whether this inefficiency in oxygen use contributes to the fatigue that is so common in Parkinson’s disease.

The good news is that exercise can help to lessen the impact of these changes. People with PD who stay active and exercise feel better, and do better, over time.

Organized Exercise vs. Physical Activity

When it comes to physical activity in PD, we are really talking about two things — structured exercise, and general physical activity. Each provides its own benefits, and people with PD need both. What’s the difference?

One difference is that structured exercise programs, such as cardio or strength training regimens, are often carried out under the supervision of a physical therapist or other health professional. General physical activity, on the other hand, is a matter of how we move around throughout the day, whether walking, gardening or dancing, typically without supervision. Recent studies indicate that everyday activity is just as important to living well with PD as are structured exercise regimens!

The Benefits of Structured Exercise

Exercise is still a fairly new area of research in PD, and we are only now beginning to understand its effects.

Structured exercise, research shows, can ease the movement symptoms of PD that put people at risk of falls. For example, programs focused on improving flexibility, aerobic endurance and strength, can help with balance; some studies also show benefits for fall prevention. Additionally, programs involving physical therapy, treadmill exercise, dance and martial arts can help a person with PD to take bigger steps, walk more quickly, extend the arms farther, rise more easily from a chair and improve balance. In addition, exercise in general can lessen the severity of nonmotor symptoms such as depression, cognitive changes and sleep difficulties.

Even when the benefit is small, exercise can improve the daily life of a person who lives with PD. Considering that PD is progressive, such improvements are even more remarkable; simply maintaining the same level of strength requires making gains against the advancing disease.

Based on these findings, how can a person with PD find the right exercise program? The right type of structured exercise for a person with PD will depend on his or her goals and symptoms. A key component is finding a physical therapist who can tailor a program to meet your needs. If you struggle with balance, for example, a therapist might develop a program aimed at improving it, through flexibility and strength training as well as activities to challenge balance such as dance, boxing and/or postural control exercises. But if your balance is steady, other types of exercise — such as aerobic conditioning and lower extremity strengthening — might be more useful in improving overall cardiovascular and strength fitness.

Activities such as boxing, martial arts, tai chi, challenging hiking and vigorous dance can provide a combination of improvements in balance, strength, flexibility and cardiovascular fitness. Yoga can be helpful for improving range of motion and flexibility of certain muscle groups.

One important note: in order to maintain the gains made from exercise, a person with PD needs an ongoing, long-term program. Just as you lose the benefits of a PD medication if you stop taking it, you lose the effects of exercise if you stop the regimen.

The Benefits of Staying Active

Research shows that people with PD become more sedentary as the disease progresses. According to one study, people with PD were one-third less active than older adults generally. Yet studies also suggest that staying active is critical as we age, whether or not we live with PD. Sitting less, doing household chores, or taking a stroll in the neighborhood might all significantly improve life with PD. Staying active can also help people with PD maintain the gains they achieve through organized exercise. So how can people with PD change their habits?

In addition to physical therapy, researchers have found that setting goals can be helpful. What is your current level of activity? Can you set a goal to walk a bit more, or move more during the day? Even modest goals — for example, getting up to take a pill rather than asking someone to bring it to you, or taking a stroll around the neighborhood after dinner — can improve well-being.

It also helps to get encouragement. You might want to ask family and friends to join you in an activity or to support you by asking about your progress.

Lastly, be sure to monitor your activity levels. There are many tools available to measure activity, including how many steps you take each day. When I started wearing a simple pedometer, I was amazed to find that I had increased my own steps per day from 3,000 to 10,000! Many of these tools also offer apps for mobile devices, which allow you to share your progress with friends and family, providing a social aspect to the experience that can keep you motivated.

The Big Question: Can Vigorous Exercise Slow PD?

We all would like nothing better than to find a way to slow or reverse the progression of PD. Recent research suggests that vigorous exercise may be one of these ways. In one small study, overall PD symptoms improved remarkably among participants who were pushed to bicycle 30 percent more intensely than usual. Animal studies suggest that intensive exercise can protect the brain. And we know that regular exercise reduces cognitive difficulties among older people.

The jury is still out, however, on whether exercise can protect the brain cells that are lost in PD. Studies are under way to determine the best “dose” of exercise, and how effective it can be early in PD. It may be, for example, that in early-stage PD, certain types of exercise can be as effective as medications in reducing symptoms.

Conclusion: Keep Moving!

Getting into the habit of exercising and being active, and cultivating those habits over the long term, are important for anyone, but are especially important for someone who has PD. We are still learning about the effects of exercise on PD, and we know that there is no “one-size-fits-all” prescription. For sedentary people, just getting up and moving is beneficial. More active people can build up to regular, vigorous activity. But there is no doubt that many approaches to exercise work well. So choose ones that you enjoy, and keep moving!

Dr. Schenkman is Associate Dean for Physical Therapy Education, and Director, Physical Therapy Program, University of Colorado School of Medicine.

By Margaret Schenkman, P.T., Ph.D., F.A.P.T.A.

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