Exercise therapy for Parkinson’s disease

Does exercise alone improve symptoms of Parkinson's disease?

Parkinson’s disease (PD) is a progressive neurological disease caused by the reduction in dopaminergic neurons in the in the brain, leading to both motor and non-motor symptoms. Common motor symptoms include: tremor, balance deficits and postural instability. Non-motor symptoms are for instance cognitive deficits, autonomic dysfunction, pain and fatigue, as well as sleep and mood disturbances.

Medical management of PD often involves medication, such as Levodopa. Long-term use of medication can have a ceiling effect. Other medical management such as deep brain stimulators are sometimes used, but can limited benefits compared to the cost and associated medical risks. Thus, exercise is often used as part of treatment to address deficits with the peripheral and central nervous systems.

The authors found that patients in the exercise groups showed greater improvement in the overall motor symptoms associated with PD compared to patients in the groups that only performed regular activity or just used medication.

They were not able to draw conclusions, however, on the improvement in other areas such as non-functional symptoms of PD, or to establish whether exercise influenced these symptoms positively. Other considerations are also needed for participants who have progressed postural stability as they are more at risk of falls when performing balance exercises.

The broad nature of exercise reviewed in this meta analysis highlights that physical activity of all kinds has additional benefits over just medication or daily activity alone. Further individual tailoring of the exercise programme is helpful to address the patient's specific needs and interests. Finding a programme that is safe and meets the activity goals of a patient with PD is essential. Nevertheless, further integration with prescribed medication alongside exercise may yield the best overall outcomes. 

> From: Choi et al., Parkinsons Dis 2020 (2020) 2565320 (Epub ahead of print). All rights reserved to The Author(s). Click here for the online summary.

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