Researchers propose prescribing exercise as medicine in Parkinson’s

Physical exercise may reduce risk of disease and ease symptoms: Review

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by Andrea Lobo |

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A person sporting a ponytail and holding a water bottle in one hand is seen walking vigorously.

Physical exercise may reduce the risk of developing Parkinson’s disease, as well as effectively control patients’ symptoms, according to a review analysis by researchers in Europe.

Moreover, some studies suggest that exercise might be a potential disease-modifying treatment, working to slow disease progression and stabilizing, or even reducing, the amount of medication needed to control the disease symptoms.

“Based on current evidence, we propose a paradigm shift: Exercise should be prescribed as medicine for people with early-stage Parkinson’s alongside conventional medical treatment,” Martin Langeskov Christensen, PhD, associate professor at Aarhus University, in Denmark, and first author of the study, said in a university press release.

“[Exercise] can really improve the patient’s quality of life,” Christensen added.

The review article, “Exercise as medicine in Parkinson’s disease,” was published in the Journal of Neurology, Neurosurgery & Psychiatry.

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Exercise as medicine may be a disease-modifying therapy

Parkinson’s is caused by the dysfunction and death of dopaminergic neurons, nerve cells in the brain responsible for producing dopamine — a signaling molecule neurons use to communicate. The loss of these neurons causes problems with nerve signaling, ultimately leading to the disease’s symptoms.

To date, there are no available medicines that can prevent or revert disease progression, although there are therapies that can help control some of Parkinson’s symptoms. According to the researchers, the “identification of interventions that prevent, slow, halt or mitigate the disease is therefore pivotal.”

One of the most promising interventions is exercise, with early studies showing it can help control the disease’s symptoms. Also, more recent studies propose exercise may be disease-modifying by slowing Parkinson’s progression — and may even reduce the risk of developing the neurodegenerative condition. Such findings indicate that treating exercise as a medicine for Parkinson’s may have more beneficial effects that might change clinical practice.

To learn more, a team from Denmark and Sweden reviewed the existing evidence on the effects of exercise in Parkinson’s disease. Their focus was on disease prevention, symptom control, and slowing disease progression.

Two review studies reported that exercise is generally considered safe, considering the very limited number of reported adverse events. These events included transient pain, joint inflammation, dizziness, falls, or tiredness, although only a few were found to be related to the exercise intervention.

Moreover, evidence supports that people practicing high levels of moderate to high-intensity physical activities, particularly in middle or later life, have a lower risk of having Parkinson’s disease. It also can potentially delay the time of disease diagnosis.

“There is strong evidence that moderate to high-intensity physical activity significantly reduces the risk of developing Parkinson’s,” said Christensen, also a researcher at Viborg Regional Hospital.. “Existing studies show that high levels of physical activity have been found to reduce the risk by as much as 25 percent.”

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Researchers suggest personalized exercise programs tailored to patient needs

Regarding Parkinson’s symptoms, current evidence suggests that several disease manifestations — particularly those for which there is no available medicine or specific treatment — may be controlled with exercise. According to the researchers, patients should receive personalized exercise programs according to their particular needs, together with their standard-of-care medications, and be continuously monitored by healthcare professionals.

“For example, many people with Parkinson’s disease have difficulty walking, and exercise can minimize that significantly,” Christensen said. “If you struggle getting up from your chair, you may need to focus on strength or balance exercises. If you’re at risk of high blood pressure, do cardio.”

Christensen noted that “it’s important to have a tailored exercise plan because we can’t expect the individual to know which exercises will improve their symptoms.”

The core message is that it’s better to do something, because the benefits far outweigh any potential downsides. Exercise is a safe, cheap, accessible and effective intervention.

The researchers also noted that several studies have shown that exercise may have a preventative effect on disease progression, as assessed by improvements seen in the MDS-UPDRS part III, which assesses motor signs of Parkinson’s disease. Other studies have shown that physical activity may stabilize, or even reduce, the amount of medication patients take.

Evidence on whether exercise may help slow down disease progression associated with the loss of dopaminergic neurons is less robust, although it is probable.

As for exercise modalities, both weight training and cardio training function for different disease manifestations.

“If you have Parkinson’s disease, you should do the type of exercise you like best,” Christensen said. “You’re already hampered by low levels of dopamine — so even finding the motivation might be difficult.”

Patients who have difficulty performing high-intensity exercise can still achieve positive results by performing low-intensity activities, the team noted.

“The core message is that it’s better to do something, because the benefits far outweigh any potential downsides. Exercise is a safe, cheap, accessible and effective intervention,” Christensen said.