For people with Parkinson’s Disease (PWP) the things we do every day automatically or habitually – such as swinging our arms when we walk, getting out of bed, and getting up off the floor – become more difficult. The progressive neurological disorder can be a devastating and life-changing diagnosis. The good news is that evidence suggests that exercise slows the progression of Parkinson’s Disease.
What is Parkinson’s Disease?
First described by British surgeon, James Parkinson in 1817, Parkinson’s Disease (PD) is a neurodegenerative disorder that results from the death of dopamine cells in the basal ganglia of the brain. The diagnosis requires a neurologist to identify the cardinal motor symptoms:
- Bradykinesia is defined as the “slowness of movement” and is the most highly correlated symptom with dopamine. It is a force-regulation problem where the brain is not driving enough force for the needs of the task.
- Rigidity is the co-contraction of muscle groups resulting in tightness and stiffness in the joints, limiting one’s balance and mobility.
- A tremor, defined as an involuntary quivering movement or shake, may be present at rest.
- An individual may have postural instability, or balance problems that help to confirm the diagnosis.
The basal ganglia are a group of neurons in the brain that are responsible for everyday “habitual” and “automatic” movements related to our walking, postural control, gesturing, breathing and eye movements.
There are various factors that increase the cell death of dopamine for people with Parkinson’s Disease. People with Parkinson’s Disease are known to have low neurotrophic levels, mitochondrial dysfunction, and more oxidative stress in their cells. Exercise alone has been proven to help increase neurotrophic factors, improve the energy production and mitochondrial function, and reduce oxidative stress in these cells. What this tells us is that if you can exercise you can help slow cell death and slow disease progression.
Exercise Prescription for Parkinson’s Disease
There is evidence that the earlier you start exercising, the better your quality of life will be – but it is never too late to get started. A study from the National Parkinson’s Centers of Excellence surveyed 3000 people with Parkinson’s Disease on their quality of life (QOL) each year they attended a conference. Each subsequent year they would return, they would complete the survey again.
What they found was that those who exercised at baseline, and continued to exercise every year, had no change in their QOL. Those who did no exercise at baseline, and continued so year after year, indicated that their QOL was worse. Most encouragingly, those groups who did no exercise at baseline, but who began exercising later on, were able to catch up and make improvements in terms of QOL.
Simply put, because Parkinson’s Disease is a progressive neurological disorder, seeing no change in one’s QOL after 2 years’ time demonstrates that exercise was protective in slowing disease progression for study participants. They were therefore able to maintain their baseline state of function in life over the course of the study.
More studies demonstrate that for the greatest benefits, individuals with Parkinson’s Disease should participate in exercise that is:
- Beyond the intensity that one would self-select for themselves
- Progressive in nature; physical activity that continuously challenges the individual
- Incorporates repetitive large amplitude movements to combat one’s bradykinesia
Related story: Physiotherapy Helps Symptoms of Parkinson’s Disease
Parkinson’s Disease Medication Dosage and Exercise
PWP are prescribed medications such as Levodopa, Sinemet and Carbo-dopa to substitute for the loss of dopamine in their nervous systems. In 2014, Dr. G. Frazzitta studied the effects of intensive rehabilitation treatment in early PD to determine if exercise could alter the dosage of one’s medication.
His participants received Parkinson’s Disease-specific physiotherapy, occupational therapy and speech therapy for three hours per day, five days per week, for a whole month, once a year. Two years later the participants were taking either the same dosage of medication from 2 years prior, or had been weaned off some of their dopaminergic medications because their function had improved.
Exercise Improves Non-Motor Symptoms of Parkinson’s Disease
Not only does exercise target the cardinal symptoms of Parkinson’s Disease such as bradykinesia, rigidity and incoordination, but exercise is helpful in targeting many of the non-motor symptoms of PD:
- Cognitive: attention, executive function
- Emotional: depression, anxiety, apathy
- Autonomic: sleep, constipation, pain
PWRMoves! Parkinson’s Wellness Recovery Program
Here at Propel Physiotherapy we offer Parkinson’s Group Exercise Classes called PWRMoves! The evidence-based program focuses on functional skill training that is most affected by bradykinesia. The program also incorporates various exercises to target symptoms of rigidity, and incoordination to help improve postural stability and reduce the risk of falls.
The aim of PWRMoves! at Propel Physiotherapy is to provide PWP targeted rehab and coaching for life and to slow and stop the progression of Parkinson’s. Learn more about the classes and find out if it is suitable for you, your client or loved one.
 Corcos, D. M., Robichaud, J. A., David, F. J., Leurgans, S. E., Vaillancourt, D. E., Poon, C., … Comella, C. L. (2013). A two-year randomized controlled trial of progressive resistance exercise for Parkinson’s disease. Movement Disorders, 28(9), 1230-1240. https://doi.org/10.1002/mds.25380
 Turla, M., Comi, C., Pezzoli, G., Ghilardi, M.F., Boveri, N., Perini, M., Uccellini, D. (2014). Intensive Rehabilitation Treatment in Early Parkinson’s Disease: A Randomized Pilot Study With a 2-Year Follow-Up. Neurorehabil Neural Repair, 29(2). DOI: 10.1177/1545968314542981
 Farley, B. G. (2019). PWR!Moves Therapist: Training & Certification Workshop. NeuroFit Networks, Inc.
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