The disease-modifying effect of exercise on Parkinson's disease

Exercise is a repetitive physical activity aimed at improving fitness, said Professor Terry Ellis, Boston, MA. Not only can it lower the risk of developing PD,^1–3 but it can also improve both motor and cognitive symptoms for people with PD and can slow progression of the disease.^4–10

Regular physical exercise lowers the risk of developing PD

Aerobic and resistance exercises are safe and feasible for people with PD, and high-intensity exercise is safe and improves motor symptoms for people with early and middle stages of PD,¹⁰ added Professor Ellis. It is recommended that they are initiated with physiotherapy support for all patients soon after a diagnosis of PD.

A lower risk of developing PD

Exercise has beneficial effects on neuroplasticity

Physical exercise can modify the risk for developing PD, confirmed Dr Priya Jagota, Bangkok, Thailand. Evidence to support this effect includes:

• the finding that people who do regular physical exercise in college have a lower risk of developing PD¹
• mice that exercise on a running wheel have significantly less α-synuclein aggregation in the brain but significantly higher plasma concentrations of monomer α-synuclein compared to control mice² 

Animal models have further revealed that exercise has beneficial effects on neuroplasticity at the level of circuits and synaptic connections,³ said Dr Jagota.

Improves motor symptoms and cognition

Exercise improves cognitive skills

Studies have shown that exercise not only has a beneficial effect on the motor symptoms of PD, but also improves cognitive skills, said Professor Ellis:

• for people with moderate PD, aerobic exercise improves cognition and walking capacity⁴
• for people with mild-to-moderate Parkinson’s disease, 24 months of progressive resistance exercise or modified Fitness Counts (mFC)— stretching, non-progressive strengthening, balance, and breathing exercises, recommended by the National Parkinson Foundation—improved attention and working memory⁶

Resistance training also significantly increased muscle strength in patients with PD compared to control groups.⁵

Slows PD progression

Resistance exercise has a disease-modifying effect

Resistance exercise also has a disease-modifying effect, said Professor Ellis

• progressive resistance exercise results in a statistically and clinically significant reduction in Unified Parkinson’s Disease Rating Scale-III scores compared to mFC⁷
• resting functional magnetic resonance imaging after resistance training shows increased activity in the substantia nigra, suggesting increased dopaminergic activity⁸

As well as improving clinical symptoms, exercise has a beneficial effect on neurogenesis and synaptogenesis by inhibiting oxidative stress and through the production of growth factors,⁹ concluded Professor Ellis.