Exercise for Parkinson's

Each individual with Parkinson’s disease (PD) requires their own unique treatment plan. The only method of symptom management proven universally effective and essential for all people with PD is exercise. Physical activity is known to promote healthy brain function, as well as improve motor function. Recent studies have also found the potential for exercise to slow the progression of Parkinson’s, and help older adults maintain their cognitive ability. Many people with PD benefit from the support of physiotherapists to design custom exercise plans that fit their mobility level, and build their strength, flexibility, balance, and agility in a safe and controlled way. But even for those without access to the guidance of allied healthcare professionals, it is possible – and important – to add exercise to your Parkinson’s treatment plan.

The type of exercise that works best for you, as well as the intensity, will vary based on your individual preference and abilities. It is important to note that any level of exercise will be beneficial to some degree rather than remaining sedentary. Overall, there are many general benefits to exercise, specifically for PD, these include:

Preventing or slowing progression of Parkinson’s: There may be a connection between exercise and delayed progression of PD, due to exercise preserving brain health.
Symptom management: Exercise can help manage symptoms such as balance and constipation, while also improving overall strength.
Sense of community: For some, living with Parkinson’s can feel like an isolating experience, but it doesn’t need to be. A benefit of exercise is that it does not have to be done alone – getting your body moving with a supportive group of friends and/or family helps make exercise a social activity, as well as foster a sense of community, which in turn lowers stress.

In a study started in 2009, that involved over 13,000 participants in 5 countries, called the Parkinson’s Outcomes Project, it was determined that “people with PD who start exercising earlier in their disease course for a minimum of 2.5 hours per week experience a slowed decline in quality of life compared to those who start later. Establishing early exercise habits is essential to overall disease management” (Parkinson’s Foundation, n.d.).

Neuroprotective Benefits of Exercise

The brain is malleable, and can change at a cellular level in response to one’s health, environment, lifestyle, and other factors. This property, called neuroplasticity, allows the brain to adapt and repair functions that are impacted in PD, through healthy habits like regular exercise. Exercise builds and strengthens neural pathways in the brain, and stimulates the production of chemicals such as dopamine, oxytocin, serotonin, and endorphins. Dopamine, in particular, plays an important role in Parkinson’s. It is a chemical released by brain cells (neurons), in order to communicate with other nerve cells throughout the brain and body. It plays a role in motor function, hormone release, and decision-making. Parkinson’s symptoms are caused by a lack of dopamine in the brain.

Types of Exercise

Any form of movement and physical activity that challenges you outside your regular routine can be considered exercise. Currently, there is no specific type of exercise that has been proven the most beneficial for Parkinson’s. Any form of exercise is better than none, though the most comprehensive exercise routines share the following common elements:

Moderate to high intensity (to increase heart rate)
Aerobic component (can be continuous, or intervals)
Strength component
Balance component
Flexibility and stretch component
Cognitive stimulating component (eg. Dual-tasking or navigating obstacles)
Behaviour change component (eg. sense of social motivation, support, and team camaraderie)

High-intensity Interval Training

High-intensity interval training (HIIT) involves short periods of intense exercise, along with intervals to rest, and has been shown to be more beneficial for respiratory, cardiovascular, metabolic, and mechanical functions, than continuous moderate exercise (Ryerson, 2015). It normally consists of 30 to 60 seconds of exercise at the limit of an individual’s physical ability which is then followed with easy activity for rest and recovery. This usually lasts for up to 20 minutes (Ryerson, 2015).

In healthy individuals, the intensity of physical activity can be measured by comparing your heart rate during exercise to your maximum heart rate, which can be calculated by subtracting your age from 220. High-intensity exercise will raise your heart rate to 70-85% of your maximum heart rate. Many people in the early stages of PD have a normal heart rate, however as the disease progresses, some may experience difficulty bringing their heart rate up due to impaired nerve function in the heart. Where heart rate may be impaired, the best measure of intensity in Parkinson’s is perceived exertion. High-intensity exercise will cause sweating and breathlessness. To avoid overexertion, ensure that you are still able to control your breathing enough to talk in full sentences.

Finding an Exercise Program

Adults aged 18+ should aim for 150 minutes of moderate to vigorous intensity aerobic exercise per week, in bouts of 10 minutes or more. Guidelines also recommend adding muscle and bone strengthening activities at least two days per week. For those who have mobility problems, or a higher fall risk, exercises that train balance and coordination are also recommended.

Parkinson’s symptoms vary greatly from person to person, and there is no “one size fits all” approach to exercise. Your routine should be based on your individual interests, and should fit your lifestyle. For example, if you dislike the gym, then try walking outdoors, or take a dance class. The key is finding what types of exercise you most enjoy doing, and doing it regularly.

If you’re not sure where to start, Parkinson Society British Columbia (PSBC) offers many Parkinson’s-specific exercise programs. Visit www.parkinson.bc.ca/events for listings of our upcoming events.

Virtual Physiotherapy Service

Physiotherapists (PTs) play an important role in holistic care as they utilize evidence-based approaches to movement and exercise that support people with Parkinson's in managing symptoms and maintaining wellbeing.

Unfortunately, physiotherapy is inaccessible to many British Columbians living with Parkinson's due to financial constraints and/or geographic barriers. Furthermore, some physiotherapists lack the appropriate training and experience for effective treatment of people with PD. To increase access to Parkinson's-specific therapies, Parkinson Society British Columbia (PSBC) has launched a virtual physiotherapy service. PSBC's own neuro physiotherapist, Shelly Yu, will be accepting people with Parkinson’s disease (PD) for phone or video-conferencing sessions. For people meeting certain criteria, this service will be available free of charge. Sessions will be available one day per week, on Mondays (8:30am – 4:30pm).

This service is for people with Parkinson’s disease in BC who:

have a confirmed Parkinson’s/Parkinson’s plus diagnosis, OR are a caregiver seeking advice on how to safely transfer/mobilize a person with PD;
are not currently seeking physiotherapy elsewhere;
have limited finances and are unable to pay for physiotherapy services, OR are unable to find a suitably trained physiotherapist in their community.

To sign-up or learn more, please contact us at 1-800-668-3330 or info@parkinson.bc.ca.

Sources

Boyum, A. (2018, March 6). Exercise improves cognition in Parkinson's disease. Retrieved from https://www.michaeljfox.org/news/exercise-improves-cognition-parkinsons-disease

Creel, T. (2015, January 5). How do I know if I'm doing the right exercise for Parkinson's disease? Retrieved from https://www.michaeljfox.org/news/how-do-i-know-if-im-doing-right-exerciseparkinsons-disease

Parkinson’s Foundation. (n.d.). Exercise. Retrieved from https://www.parkinson.org/living-withparkinsons/treatment/exercise

Ryerson, N. (2015, January 29). Exercising with Parkinson's disease: Should it be high-intensity? Retrieved from https://www.michaeljfox.org/news/exercising-parkinsons-disease-should-it-behigh-intensity?exercising-with-parkinson-disease-should-it-be-high-intensity=

This content was published in the October 2022 edition of our monthly support group newsletter, GroupLink. The content was accurate as of this publication date.

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