People with Parkinson's disease should be encouraged to exercise

Currently there are no pharmacological drugs that could cure or slow the progression of Parkinson's disease. However, based on an extensive literature review recently published in theJournal of Neurology, Neurosurgery & Psychiatry, researchers from Aarhus University conclude that exercise should be an important part of treatment for patients with Parkinson's disease.

“Based on current evidence, we propose a paradigm shift: exercise should be prescribed as a cure for people with early stages of Parkinson's disease, along with traditional drug treatment,” says Associate Professor Martin Langeskov Christensen from the Department of Clinical Medicine at Aarhus University and the Department of Neurology at the Regional Viborg Hospital.

He is one of the researchers behind the paper, which compiles and summarizes the most important research linking exercise and Parkinson's disease. The bottom line is that exercise can help prevent the disease, potentially slow its progression, and be an effective treatment for a number of more severe symptoms.

Help in restoring quality of life

Exercise is already a mainstay of rehabilitation for patients with Parkinson's disease, but researchers from Aarhus University highlight that exercise may have even more fundamental benefits that could change clinical practice.

In terms of prevention, exercise is a very powerful factor, says Martin Langeskov Christensen. "There is strong evidence that moderate to vigorous intensity physical activity significantly reduces the risk of developing Parkinson's disease. Research shows that high levels of physical activity can reduce the risk by as much as 25%," he explains.

Evidence also suggests that a number of symptoms for which there is usually no pharmacological treatment can also be treated with exercise.

"For example, many people with Parkinson's disease have difficulty walking, and exercise can significantly reduce this problem. It can really improve the patient's quality of life. If you have difficulty getting out of a chair, you may need to focus on strength or balance exercises.

If you are at risk for high blood pressure, do cardio. It's important to have an individualized exercise plan because we can't expect a person to know for themselves which exercises will improve their symptoms," he says.

He therefore believes that patients with Parkinson's disease should receive personalized exercise programs, including regular follow-up examinations, in addition to their pharmacological treatment.

"The ideal scenario is where the patient is prescribed an exercise program and is continuously monitored by physical therapists, exercise physiologists, neurologists and other appropriate specialists. At a minimum, we need better guidelines that recognize the importance of exercise for this group of patients and provide updated exercise instructions Rationality and evidence exist, so in that sense the path is clear,” he says.

Less need for medications

The big question is whether exercise has disease-modifying potential: Can it slow down this debilitating disease that gradually destroys brain cells and leads to nervous system dysfunction?

"Evidence that exercise can slow disease progression is less compelling, although very plausible. But studies of Parkinson's disease lack a key sensitive biomarker to predict disease progression in all patients. However, compelling studies of exercise have been conducted in animals suffering from the disease, similar to Parkinson's. But the effects observed in animals cannot always be equated with the effects in humans,” says Martin Langeskov Christensen.

"We're not trying to advertise a miracle cure—you can't just eliminate Parkinson's disease with exercise. But research shows that medication levels can be stabilized with exercise—even reduced by increasing activity levels. Other studies show improvements in clinical the MDS-UPDRS test, which is currently the best marker of disease progression,” he says.

Should I play football or do strength training?

Most studies on Parkinson's disease and exercise examine the effects of either strength training or cardio training. From a bird's eye view, we can say that both work, but for different areas, explains Martin Langeskov Christensen.

"If you have Parkinson's disease, you should do the type of exercise you enjoy most. You're already suffering from low dopamine levels, so even finding motivation can be difficult," he says, pointing out that patients who have difficulty performing high-intensity exercise due to complications from Parkinson's can still achieve positive results by engaging in low-intensity activities at home, such as gardening or daily walks with the dog.

There is no benefit from sitting still, the researcher emphasizes. “When you have a neurological disease such as Parkinson's disease, you may experience fatigue—an overwhelming feeling of tiredness that sleep cannot relieve.

If you suffer from fatigue, you should be aware that in the early stages it can get worse as you increase your exercise program. But research on multiple sclerosis shows that exercise can actually help combat fatigue, and new research on how exercise affects fatigue in patients with Parkinson's disease is under development, he says.

"The main message is that doing something is better because the benefits far outweigh any potential disadvantages. Exercise is a safe, cheap, accessible and effective intervention for people with Parkinson's disease. And research in the general population shows that exercise also reduces the risk of comorbidities such as high blood pressure, diabetes and osteoporosis."