There is increasing empirical evidence that a life style that includes at least moderate, consistent exercise improves cognitive and health outcomes as we age.   It seems logical that exercise would be helpful to improve outcomes of those with neurodegenerative diseases such as Parkinson’s disease where there is progressive loss of neuromuscular abilities.  Fortunately there is an encouraging review that serves as the basis for this article: “An evidence based exercise regimen for patients with mild to moderate Parkinson’s disease” (Brain Sciences, 2013, 3, 87-100 http://qxmd.com/r/24961308)

Parkinson’s disease is, by some accounts, the second most common neurodegenerative disorder and affects 4-5 million of those over 50.  The primary symptoms involve motor control: resting tremor, slow response initiation (called bradykinesia), muscular rigidity, and postural instability.  It is now clear that exercise improves physical function, self-reported quality of life, strength, and gait speed as well as prolongs life in Parkinson’s disease.

Prospective studies have demonstrated neuroprotective effects of exercise in Parkinson’s disease.  Moderate to strenuous but not light exercise reduces the incidence of Parkinson’s disease in population studies.  The exercises that were beneficial included swimming, running, tennis, basketball, and cycling.   It appears that exercising patterns of those between 35-39 are especially helpful in the long run.

Three general types of exercises should be included: cardiovascular/aerobic training, balance training, and strength training.  Increasing amounts/intensity of cardiovascular exercise produces better results.  High intensity treadmill or cycling improved gait, balance, and quality of life more than conventional therapy in mild to moderate Parkinson’s disease.  Intense cardiovascular exercise also improved brain plasticity, language, and cognitive functioning in Parkinson’s disease.

Balance training is also an essential component of exercise in Parkinson’s disease.  Dopamine replacement medications are insufficient to control postural instability and balance.  Balance and strength training improve gait, ambulation, and equilibrium.  Motor controlled video games may also be helpful.  Finally, there is clear evidence that Tai Chi is more effective in preventing falls than conventional physical therapy for balance in mild to moderate Parkinson’s disease.

The third component of exercise is strength training.   Parkinson’s disease not only induces motor dysfunction but also affects strength.  Indeed, the benefits of resistance  training include improved strength, endurance, and response initiation.  It is also clear that there are greater gains from three sets of each exercise when compared to only one set.

In summary, the prescription for exercise in mild to moderate Parkinson’s disease should include:

  1. Cardiovascular exercise such as treadmill, cycling, running, tennis at high intensity for up to 30 minutes three times per week.
  2. Strength training with 3 sets of each exercise with high load 2-3 times per week.
  3. Balance training such as Tai Chi for an hour 1-2 times each week.