Physical Activity and Parkinson’s Disease

It is common knowledge that the brain directs physical activity. For example, most people know that paralysis from a stroke is due to damage to the brain. It is only in recent years, however, that scientific investigators have begun to appreciate the other direction of this relationship, namely the role of physical activity in promoting brain health. This recognition has turned out to have enormous implications for the treatment of Parkinson’s disease.

Over the past decade, numerous research studies have documented the benefits of a wide variety of physical activities for people with Parkinson’s disease, including many forms of exercise, dance and sports. Regardless of the type of activity, formal study of people with Parkinson’s disease has shown that participants invariably do measurably better than non-participants. Benefit appears to be realizable for everyone, regardless of the severity of the disease.

This body of research has limitations. A major problem has been the lack of coordination among investigators. Thus the literature produced to date consists mainly of a large number of studies from single centers, each enrolling small numbers of individuals from their own clinics and following a different protocol of study. Smaller numbers of recruits produce less robust statistics from which to draw conclusions. Inconsistent research designs make it hard to compare or combine findings from different studies. The result is that it is difficult to make specific recommendations regarding how frequent, how prolonged and how intense any exercise needs to be in order to be effective.

Nevertheless, virtually every one of dozens of studies has concluded that physical activity is beneficial, and this is true across a wide variety of activity types. Even exercise and dance programs based on video game platforms (such as Wii Fit) have shown benefits. Together, these observations provide powerful evidence that any type of physical activity is better than none at all. Aside from expected improvement in motor performance (mobility, endurance, strength, balance, etc.), physical activity has shown additional benefits for mental function, mood, social interactions, and overall quality of life. Some people report noticeable improvement immediately after a period of exertion, almost like taking a rapidly acting medication. More often, however, the benefit is felt in a more general, ongoing way.

The medical community has come around to the notion that engaging in regular physical activity is one of the most useful things that patients with Parkinson’s disease can do for themselves. Although doctors have traditionally advised their patients to exercise, we now have a large amount of scientific data upon which to base that recommendation. The evidence has become so compelling that neurologists have begun to see physical activity as part of the treatment of Parkinson’s disease. People still need to take their medication, of course, but they must supplement that with some degree of physical activity. It is now the duty of neurologists to convince their patients of this message.

That may prove to be a greater challenge than it might seem at first glance. Despite the obvious advantages to seeing exercise as a form of treatment (low cost, convenience of exercising at home, low rate of “side effects”), we have trouble getting people with Parkinson’s disease to do it regularly. In surveys, people have cited factors such as low expectation of benefit, lack of time, and fear of falling as major reasons they did not participate. In exercise studies, measures such as older age, poorer general health and mood disorders (anxiety, depression) have been associated with lack of persistence with the programs. Granted, more research needs to be done in order to arrive at more precise recommendations, but this should not serve as an excuse to wait for further developments. The message we need to spread is that the evidence that exercise is beneficial is already overwhelming, and that everyone can benefit to some degree. We need to convince people with Parkinson’s disease to make physical activity a priority, and that they therefore must make time for it.

Here at InMotion, we have tried to remove as many barriers to our physical activity sessions as we can. Our classes are free of charge and open to everyone with movement disorders, as well as their spouses and other carepartners. We have daytime and evening sessions to accommodate different schedules. Our instructors are experienced in conducting classes that encourage appropriate exertion for all levels of physical ability. We have tried to appeal to a wide range of tastes and interests by offering a variety of activities including exercise designed specifically for people with Parkinson’s disease, tai chi, yoga, modern dance, ballroom dancing, cycling and boxing. Our expectation is that everyone should be able to find something they enjoy, or at least don’t mind, doing on a regular basis. Then it is simply a matter of making up one’s mind to do it.

David E. Riley, M.D.

Based on a talk given at InMotion on April 2, 2015

What My Patients Tell Me:

These are additional anecdotes patients and spouses have told me that illustrate some of the points discussed above.

One woman with PD said she was pleasantly surprised at how much she has gained from physical activity. She said “I never liked to exercise. I hated gym in school. But I’m changing my ways. I can’t believe how flexible I feel since I started exercising.”

Another woman with PD told me that, after exercising, “I feel 100% normal.”

But resistance to exercise remains strong:

I asked a woman with PD if she had been exercising. She replied “no, but I’m contemplating it.” (Of course, we all know that it’s the thought that counts, and therefore thinking about exercising is almost as good as actually doing it. Besides, contemplation is a form of meditation, and we know that relaxation is good for people with Parkinson’s disease.) She has found a yoga class that meets at 11:30 AM on Sundays. She said “I can do that.” I asked her if she had gone yet. She replied “no, but I’ve got the phone number”. She added “I’ve got a plan.”

Posted in Dr. David Riley, For Care Partners, For Clients, For Referral Partners, What I tell my Patients.
Dr. David Riley

Dr. David Riley

Dr. David Riley has been active in the field of movement disorders for over 30 years. He retired as director of the Movement Disorders Center at University Hospitals in Cleveland in 2013 and as Professor in the Department of Neurology of Case Western Reserve University School of Medicine in 2014. A native of Montreal, Quebec, Riley received his M.D. from McGill University School of Medicine. Following a fellowship in Movement Disorders at Toronto Western Hospital under Dr. Tony Lang, Dr. Riley returned to Cleveland in 1988 to establish Cleveland's first movement disorders clinic at Mt. Sinai Medical Center.