People with Parkinson's disease should be prescribed physical activity

There are currently no pharmacological treatments that can cure or slow the progression of Parkinson's disease. However, based on an extensive literature review recently published in the Journal of Neurology, Neurosurgery & Psychiatry, researchers from Aarhus University conclude that exercise should be an important part of the treatment of patients with Parkinson's disease.

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

He is one of the researchers behind the paper, which collects and summarises the most important studies linking exercise and Parkinson's disease. The conclusion is that exercise can help prevent the disease from developing, potentially slow its progression and be an effective treatment for some of its 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 and vigorous 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 typically 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. This can really improve a 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 of high blood pressure, do cardio. It is important to have an individual exercise plan because we cannot expect a person to know which exercises will improve their symptoms," he says.

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

"The ideal scenario is for a patient to be prescribed an exercise program and be closely 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 patient population and provide updated exercise instructions. The rationale and evidence are there, 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 causes the nervous system to malfunction?

"The evidence that exercise can slow disease progression is less compelling, although very plausible. But Parkinson's studies lack a key sensitive biomarker to predict disease progression in all patients. However, compelling exercise studies have been done in animals suffering from a Parkinson's-like disease. But the effects seen in animals do not always translate to the effects seen in humans," says Martin Langeskov Christensen.

"We're not trying to tout a miracle cure - you can't just eliminate Parkinson's with exercise. But studies show that medication levels can be stabilised with exercise - even reduced by increasing activity levels. Other studies show improvements in the MDS-UPDRS clinical 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 look at the effects of either strength training or cardio. From a bird's eye view, both work, but for different areas, explains Martin Langeskov Christensen.

"If you have Parkinson's, you should do the type of exercise that you enjoy the most. You already suffer 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 doing low-intensity activities at home, such as gardening or daily walks with the dog.

There is no benefit to sitting still, the researcher points out. "When you have a neurological disease like Parkinson's, you may experience fatigue - an overwhelming feeling of tiredness that cannot be relieved by sleep.

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

"The key message is that it's better to do something because the benefits far outweigh any potential harm. Exercise is a safe, cheap, accessible and effective intervention for people with Parkinson's disease. And studies in the general population show that exercise also reduces the risk of related conditions such as high blood pressure, diabetes and osteoporosis."