Parkinson’s Physical Therapy Should Include Vigorous Exercise, Doctor Says

In a new editorial published in JAMA Neurology, Dr J. Eric Ahlskog argues that ongoing aerobic exercise should be included in the physical and occupational therapy component of Parkinson’s disease (PD) treatment, since substantial evidence has suggested vigorous exercise is of considerable benefit to patients.

Dr. Ahlskog, a neurologist at the Mayo Clinic, in Minnesota, addressed the results of a study published in the same edition of the journal that critically evaluated the cost-effectiveness of the conventional occupational and physiotherapy given early stage PD patients in the U.K.’s National Health Service (NHS). Half of 700 PD patients in this study were randomized to the standard therapy and researchers observed that, compared to the control group, the therapy failed to meaningfully improve either daily living activities or quality of life measures. Dr. Ahlskog argued that this study should be interpreted carefully due to certain limitations, and said it further supported other studies that found more vigorous and aerobic exercise might be a significant addition to PD therapy by slowing disease progression.

“Aerobic exercise means vigorous exercise, which makes you hot, sweaty and tired,” he said.

Previous studies have shown that vigorous exercise and aerobic fitness might exert a neuroprotective effect, namely through the exercise-related release of neurotrophic factors, small proteins responsible for the development and maintenance of neurons. Moreover, more vigorous exercise has been proven to significantly increase memory, improve cognitive scores, and lead to a reduced later frequency of PD, dementia, and mild cognitive impairment. In light of existing literature and the sedentary lifestyle of developed countries, the author defended the inclusion of these exercises, saying “That is where a physical therapist might serve a crucial role in helping to counter Parkinson’s disease progression. The physical therapist could identify the type of exercise that would appeal to the individual, initiate that plan and serve as exercise coach.”

Dr. Ahlskog offered tips for a safe and thoughtful exercise program, for both PD patients and healthy individuals, such as setting goals, starting slowly, pushing yourself, and finding an enjoyable exercise routine. Importantly, he also highlighted an important component of a Parkinson’s disease-specific exercise program: the optimization of medication, namely carbidopa/levodopa, to facilitate exercise and, he said, improve a patient’s quality of life.