Exercise and Parkinson's Disease

  •   April 1, 2015
  •  Leanne Loranger, PT


Parkinson’s disease is a chronic neurological condition (disease of the brain) that affects more than 100,000 Canadians.1 Although the disease is most commonly seen in those over 60, people as young as 30 or 40 can also be diagnosed. Dopamine, a chemical that carries signals between the cells in our brains, helps to control the movement of our bodies. Parkinson’s disease occurs when the cells that make dopamine die.1

The most common signs and symptoms include:

  • Slowness (bradykinesia)
  • Stiffness (rigidity)
  • Tremor at rest
  • Poor balance (postural instability)2


Other symptoms can include:

  • Fatigue
  • Soft speech
  • Writing problems
  • Stooped posture
  • Sleep disturbances
  • Constipation
  • Depression
  • Memory (cognitive) changes1


The severity of signs and symptoms and the speed at which symptoms progress can vary between people with Parkinson’s disease. It is also important to know that Parkinson’s disease can be treated and that treatment will help with the symptoms. The first step is to see a neurologist (a doctor who specializes in diseases of the brain and nerves), and discuss your medication and treatment options.


How exercise and physiotherapy can help

The next step is to see a physiotherapist! A growing pile of research shows that exercise, and especially targeted exercise, can help manage or improve the symptoms. Exercise can take many forms, for example:

  • Strength training2
  • Balance exercises (in a physiotherapist-led group exercise class or a community tai chi class2)
  • Large-amplitude movements (LSVT-BIG3 is an exercise treatment program designed specifically for those with Parkinson’s)
  • Walking with poles (nordic walking)3
  • Dancing2,4
  • Kayaking2
  • Boxing5


These exercises have all been shown to decrease the symptoms of Parkinson’s disease, offering improvements in both the ability to do daily tasks and in quality of life. Other benefits of exercise in Parkinson’s disease include decreased fatigue, improved mood, pain relief, improved walking speed, improved walking quality (less freezing and shuffling), and fewer falls.

A recent summary of literature concluded that “the choice of treatment technique was unlikely to have a significant bearing on patient outcomes”2 and therefore treatment plans “should be flexible and based on individual patient goals and preferences, therapist expertise and local service availability.”2  For example, if you feel that your balance is poor then this should be a focus of your exercise program, if you are stiff through your torso some authors suggest that kayaking might help to decrease that stiffness. It’s important that the exercise be tailored to fit the unique symptoms and preferences of the individual. However, if the goal is to decrease falls, the “strongest evidence is for specific balance training or tai chi.”2

Participating in a group exercise class designed for individuals with Parkinson’s disease can be a good place to start and can provide additional benefits, such as general education about the disease, support, and increased motivation to participate.2 There is also some evidence that if you have been involved in and graduated from a Parkinson’s disease exercise group in the past, returning for a ‘booster shot’ of exercise can help to prolong the benefits of that initial training.2

At present, it is not known how much exercise is enough to garner a benefit,2,5 with conflicting reports from different researchers, what is known is that if you enjoy the activities that you are doing, this increases the chances that you will continue to participate, and this may lead to long-term benefits, slowing the progression of symptoms.3,5

Although Parkinson’s disease is a chronic and progressive condition, there is clear scientific evidence that exercise tailored to your individual needs can decrease your symptoms, improve the quality of your life, and may slow the progression of symptoms. Click here to find a physiotherapist who can provide you with a tailored exercise program.


References:

  1. Parkinson Society of Canada. Parkinson’s: The facts. Available at http://www.parkinson.ca/atf/cf/%7B9ebd08a9-7886-4b2d-a1c4-a131e7096bf8%7D/FACTSBROCHURE2011_EN.PDF  Accessed March 18, 2015.
  2. Goodwin LS, Lan L. Evaluation and delivery of ambulatory rehabilitation for people with Parkinson’s disease. Reviews in clinical Gerontology 2014; 24:122-138
  3. Ebersbach G, Ebersbach A, Gandor F, Wegner B, Wissel J, Kupsch A. Impact of physical exercise on reaction time in patients with Parkinson’s Disease-Data from the Berlin BIG study. Archives of Physical Medicine and Rehabilitation 2014; 95: 996-999.
  4. Parkinson Society Canada. Exercises for people with Parkinson’s. Available at http://www.parkinson.ca/atf/cf/%7B9ebd08a9-7886-4b2d-a1c4-a131e7096bf8%7D/EXERCISEMAR2012_EN.PDF  Accessed March 18, 2015.
  5. Combs SA, Diehl MD, Staples WH, Conn L, Davis K, Lewis N, Schaneman K. Boxing training for patients with Parkinson Disease: A case series. Physical Therapy 2011; 91: 132-142.