From celebrity diagnoses to viral internet challenges raising money for scientific research, every so often neurodegenerative disorders make their way into the news, our social media feeds, and conversations with friends and family. Neurodegenerative disorders are those in which the cells in our brain or spinal cord—also known as the central nervous system—no longer function or die (1), with symptoms often worsening over time. Examples include Parkinson’s disease, Alzheimer's, Lewy body dementia, and amyotrophic lateral sclerosis, better known as ALS or Lou Gehrig's disease (2;3).
Parkinson’s comes with a host of motor and non-motor symptoms and complications, which impact mobility, function, speech, and the quality of one’s life. These include tremors, involuntary and slow movements, muscle rigidity and painful contractions, difficulty balancing, depression, anxiety, sleep disorders, and cognitive issues like the development of dementia (2;4-10). In addition, disability and death are rising more quickly from Parkinson’s than any other kind of neurodegenerative disorder (10).
Unfortunately, no cure currently exists for Parkinson’s. However, treatments such as medication and surgery are available to help people obtain some relief from their symptoms (2;11;12). Non-drug and non-surgical treatments, such as physiotherapy and other forms of exercise, are also garnering more research interest. But with so many exercises available, are some better than others? More clarity lies in a recent systematic review that compares how a variety of exercise types impact movement, quality of life, and the development of negative side effects in adults living with Parkinson’s (2).
What the research tells us
Good news! The review found that various types of structured and supervised exercise may enhance movement and quality of life in adults living with Parkinson’s compared to no physical exercise. Our confidence in the evidence ranges from high to very low certainty depending on the exercise type and outcome.
First, let us look at the evidence for movement. High certainty evidence shows that dance moderately improves movement. Low certainty evidence shows that aqua-based training, gait/balance/functional training, and training that combines multiple exercises may moderately improve movement, while endurance training and mind‐body exercises may enhance movement by a small amount. Unfortunately, flexibility training may have little to no positive impact on movement, and it is unclear if strength/resistance training and the Lee Silverman Voice training BIG (LSVT BIG)—a form of therapy specific to Parkinson’s—have any impact on movement.
Second, let us look at the evidence for quality of life. Moderate certainty evidence shows that aqua‐based training likely moderately improves quality of life, whereas low certainty evidence shows that gait/balance/functional training and combined exercises may enhance it by a small amount. Unfortunately, it is unclear if dance, mind‐body training, strength/resistance training, flexibility training, LSVT BIG, and gaming have any impact on quality of life.
Third, we need to consider if these interventions have side effects. While the evidence is very uncertain and not all studies reported on side effects, those that did reported falls and pain as the most common. Despite the risk of falls and pain, the review authors note that overall, exercise for people with Parkinson’s appears to be “relatively safe.”
All in all, there appears to not be much difference between the exercise types. This means that if you are living with Parkinson’s, you have an array of exercises to choose from! Accordingly, you can work with your healthcare team to develop a safe exercise routine that matches your interests and needs, will help you fulfill what you want to achieve through exercise, and is adaptable to any limitations you may have. More research is needed to increase the certainty of the evidence base and our confidence in the results (2).
