Can Exercise Help People with Parkinson’s Disease? 4 Things to Know

Exercise is good for everyone, but it may be particularly beneficial for people with Parkinson’s disease. Recent studies suggest that exercise may help slow the progression of the condition.

Experts estimate that up to one million people in the United States have Parkinson’s disease, a movement disorder that affects the nervous system. It occurs when the brain doesn’t produce enough dopamine, a neurotransmitter that helps deliver messages from the brain to nerve cells.

Insufficient dopamine means that the messages the brain sends through the nervous system to the muscles become disrupted, leading to movement issues. For instance, an individual’s hands may shake uncontrollably. Or, they may slow down and feel wobbly and unstable when they walk. They may also experience muscle stiffness. Parkinson’s disease can cause a variety of other symptoms as well, including fatigue, weakness, anxiety, depression, cognitive issues, and sleep difficulties.

There is no cure for Parkinson’s disease. “We can’t stop the neurodegenerative process or even reverse it,” says Sule Tinaz, MD, PhD, a Yale Medicine neurologist who specializes in movement disorders, including Parkinson’s disease. “But we’re starting to understand how exercise can help change the plasticity of the brain, creating new pathways and strengthening existing ones, thereby changing the functioning of the brain.”

Below, Dr. Tinaz discusses four things to know about exercise and Parkinson’s disease.

A number of studies suggest that a variety of exercises may help people with Parkinson’s disease in different ways.

According to a study that tracked 237 patients over a five-year period, those with early-stage Parkinson’s disease who were more active had better physical outcomes than less active people with the disease. “Higher physical activity levels were strongly associated with better functioning in activities of daily living, cognitive processing speed, posture stability, balance, and gait,” Dr. Tinaz says.

Other research shows that high-intensity exercise appears to slow the progression of Parkinson’s disease. Researchers asked patients to engage in high-intensity exercises (cycling or using treadmills) three times a week for six months. They assessed the study participants’ motor symptoms before and after the six-month period. They also compared the participants’ progress to other Parkinson’s patients who didn’t participate in the high-intensity exercise program.

“They found that the disease in the exercising group did not progress much based on their neurological exam findings,” Dr. Tinaz says. “That’s what we call ‘slowing down clinical disease progression.’”

Taking it one step further, Dr. Tinaz and her colleagues conducted a small research study to see if engaging in high-intensity exercise (reaching 80% of a person’s age-appropriate maximum heart rate) would not only slow disease progression but could improve neuron function in the brains of patients with Parkinson’s disease. Their work suggests that it does.

“We knew from human clinical studies that high-intensity exercise can slow down the clinical disease progression for Parkinson’s patients, but it had not been shown whether it actually protects the human Parkinsonian brain,” Dr. Tinaz says. “We found that high-intensity interval training three times a week for six months did increase the dopaminergic signal in the brain, which suggests it might actually improve neuron function. Whatever dopamine-producing neurons still exist in Parkinsonian brains seemed to become more viable and healthier—and they produced more dopamine.”

Because the findings of this small-scale, proof-of-concept study were encouraging, Dr. Tinaz and colleagues plan to conduct more research using a larger cohort of patients with Parkinson’s to confirm whether high-intensity exercise is neuroprotective.

Dr. Tinaz suggests exercises that are recommended by the Parkinson’s Foundation:

• Aerobic activity, like walking, cycling, or swimming. Aim for 30 minutes per day at least three times a week, either at a vigorous or moderate pace. “Aerobic exercise improves overall cardio-respiratory fitness,” Dr. Tinaz says. According to the Centers for Disease Control and Prevention (CDC), one way to understand and measure the intensity of aerobic activity is by understanding how physical activity affects heart rate and breathing. They recommend using the “talk test” to help gauge how intensely you’re exercising. At a moderate pace, you should be able to talk but not sing. At a vigorous pace, you should only be able to say a few words before pausing to breathe.
• Strength training, like handheld weights, weight machines, or resistance bands. Try to get 30 minutes of strength training two or three times a week, spacing out the workouts so they aren’t on back-to-back days. “Resistance training improves muscle strength,” says Dr. Tinaz. (Some research shows that muscle strength decreases among people with Parkinson’s disease.)
• Balancing, agility, and multitasking activities, like yoga, tai chi, or boxing. Aim to include balance exercises in your schedule at least two or three times a week and as often as seven times per week. “Exercises focusing on balance—such as yoga and tai chi—improve balance, posture, and postural stability. These exercises also protect against falls,” says Dr. Tinaz. (People with Parkinson’s disease are at a greater risk of falls than those without the condition.)
• Stretching activities, like dynamic stretching or deep breathing. Try to stretch at least two or three days per week; if you can do it daily, that’s even better. “Stretching exercises improve muscle stiffness,” says Dr. Tinaz. (Muscle stiffness or rigidity is a common symptom of Parkinson’s disease.)

Explosive exercises, such as jumps, squats, push-ups and boxing, improve power and strength, and complex exercises—dancing, for example—improve coordination and motor skills, she adds.

The Parkinson’s Foundation also provides an infographic and one-sheet with recommended exercises for those with the disease.

Dr. Tinaz also recommends signing up for a Parkinson’s-specific exercise program. “The trainers in these programs can assess your needs and safety concerns,” Dr. Tinaz says. “Since you do it with people like yourself, it gives a sense of social bonding and camaraderie. It’s really important for you to feel a connection, because it increases the likelihood that you will continue with that program.”

It’s important not to put off starting an exercise program after a Parkinson’s diagnosis. “There might be the misconception: ‘I have very mild symptoms, so I can take it easy,’” Dr. Tinaz says. “On the contrary, if you’ve been diagnosed with Parkinson’s disease, now is the time to engage in a vigorous exercise program, because the sooner you start exercising while you have the capacity, the better.”

Some people with Parkinson’s disease may worry that their symptoms will interfere with their ability to exercise. For instance, if they have balance issues, they may worry about falling and getting injured. If they shuffle slowly while walking, they may be discouraged from going on long walks. If their hands shake, they may hesitate to lift weights—even light dumbbells. But there are ways for people at any stage of the disease to engage in physical activity, notes Dr. Tinaz.

For instance, patients with more advanced Parkinson’s disease may be too unsteady on their feet to exercise while standing, but they can still do exercises from a seated position or even while lying down. A physical therapist may personalize such an exercise routine for patients, focusing on lifting the arms in various positions. The exercises may be done with or without weights.

How intensely you should exercise may depend on how advanced your Parkinson’s is, but everyone benefits from incorporating more movement into their lives.

“Because of advanced disease and its associated symptoms, some people cannot and some people should not do high-intensity exercise,” Dr. Tinaz says. “If you do moderate-intensity exercise for longer periods of time more frequently, it would most likely be equivalent to the benefit that you would get from high-intensity exercise. Ask your doctor what level of exercise is most appropriate for you.”

It’s also important to note that for those who are unable to do moderate-intensity exercise, “any body movement is considered physical activity,” Dr. Tinaz says. “If you’re doing laundry, that’s physical activity. If you’re walking your dog, that’s physical activity. The cumulative effect of physical activity is beneficial across your lifespan.”