Exercise and Parkinson’s Disease
Exercise Prescription
As you’ve probably heard, exercise is recommended by most doctors for people with PD. When talking about exercise, we should think of it as a prescription to treat Parkinson’s Disease just as much, if not more than, traditional medications (i.e. Sinemet, Rytary, Amantadine, etc.). When a physician prescribes the aforementioned medications to treat your PD, they don’t just state “take Sinemet” and send you on your way. They also describe the following: dosage (amount and strength of each pill), frequency of the medication, and the route by which you take the medication. We now need to think of exercise in the same way by focusing on type, amount, intensity, and frequency.
The Research
According the the ‘Parkinson’s Outcome Project’ exercising 2.5 hours per week results in significantly better quality of life compared to those who do not exercise.
In animal models, exercise has been shown to increase the the brain’s ability to transport dopamine between brain cells, as well as to increase neuroprotective peptides in the brain.
Exercise focused on neck and trunk mobility can help decrease axial rigidity and improve gait and balance in those with PD.
A meta-analysis completed in 2021 demonstrated a reduction in resting tremor (amplitude and/or frequency) immediately after whole body exercise.
The American Heart Association’s recommendation is approximately 150 minutes of moderate intensity exercise per week (equivalent to a brisk walk) for cardiovascular fitness.
There is no “BEST” exercise for PD, although a Randomized Clinical Trial of 3 Types of Physical Exercise for Patients With Parkinson Disease discussed different modes of exercise and which body systems they benefitted most.
For example, those who completed stretching and resistance training over a 3 month period demonstrated increased leg strength compared to those on a low intensity treadmill training program. Also, those who completed the low intensity treadmill training demonstrated improved cardiovascular fitness and improved walking speed/endurance compared to the strength/stretching program. But in the end, all groups improved in all areas, showing that whichever exercise you choose, you will notice beneficial results.
The moral here is that each individual needs to have an exercise tool box to pull from to help all areas of their body which may be affected by PD. This tool box should be stacked with types of exercise you can ENJOY doing, if there is no enjoyment in the exercise, that will significantly limit your motivation to do it.
Types of exercise to include in your routine:
PWR! Moves Exercises
Outdoor Walking (or Indoors!)
HIIT(High Intensity Interval Training)
Yoga
Weight Training
Anything ACTIVE!
LSVT BIG Exercises
Cardio Training - Bike, Elliptical, Treadmill
Stretching Program
Tai Chi
Boxing
Racket Sports(Pickle Ball)
How often should you exercise?
A randomized controlled study published in 2018 described a general guideline for intensity, frequency and types of exercises which may provide beneficial results for quality of life, mobility, balance, walking and strength. Each individual will need to find a starting point based on their current level of health and mobility. A great starting point would be to begin with 10 minutes of exercise per day (choose any of the above suggestions, or your own exercise). As you become more accustomed to the exercise you should notice an improvement in your endurance, to the point where you feel able to add 5 or 10 minutes to your daily routine. A great goal as mentioned above would be to tally up about 250 minutes of exercise (of any intensity) per week.
How do I know what intensity?
There are a two main ways to judge the intensity of your exercise: heart rate monitoring and the rate of perceived exertion scale. Using your heart rate can be a very effective method, however this may not suitable for everyone, as some medications limit your heart rate from increasing such as beta-blocker blood pressure medications (e.g. Metoprolol/Lopressor). Also those who may have autonomic dysfunction associated with their PD may experience an elevated heart rate at rest when their blood pressure is low (e.g. orthostatic hypotension). Due to these factors, we tend to use self-reported intensity scales also known as your ‘Rate of Perceived Exertion’. On the scale below, a great goal for moderate intensity exercise would be a 6-8/10.
Sample exercise program (250 minutes per week total)
Cardio ( 120 minutes total): 30 minute brisk walk 4 days per week.(or ride a recumbent exercise bike)
Strength Training ( 30 minutes total): 3 days per week 10 minutes - e.g. squats, heel raises, lunges, triceps press, low rows, etc.
Balance Training ( 30 minutes total): 10 minutes 3 days per week - e.g. stand on one leg, stand heel to toe, stand feet together eyes closed, etc.
Stretching ( 70 minutes total): 10 minutes every day - e.g. trunk rotations, pectoral doorway stretch, hamstring stretch, etc.
Get an exercise program tailored to your current function:
The above program is just a very basic example of a weekly exercise routine. The best course of action, if you do not have a current exercise routine, would be to make an appointment with a local physical therapist who specializes in Parkinson’s Disease to help determine what program would work best for you currently.