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The Necessity Of Exercise For People With Parkinson’s Disease: External Movement And Internal Factors Of The Disease

Written by Adrian Choy, Exercise Physiologist at Blacktown. Article from January 2019

The Necessity Of Exercise For People With Parkinson’s Disease: External Movement And Internal Factors Of The Disease

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Parkinson’s disease (PD) is a progressive, chronic and neurodegenerative movement disease. Specifically, what has been historically considered a motor disorder, it is characterized by both many motor and non-motor symptoms such as balance decrements, bradykinesia (slow movement), resting tremor, gait disruption and reduced quality of life. PD patients also tend to display a stooped posture when walking, rigidity and postural instability with reductions in speech volume. An iceberg can describe the clinical status of PD; motor symptoms represent the visible portion whereas the various non-motor manifestations represent the most non-visible portion (1). In Australia, approximately 80,000 people are living with this disease (2).
It seems the neurological deficits of freezing gait, rigidity, balance disturbances and bradykinesia are, unfortunately, unable to be completely reduced through pharmacological and surgical treatments (3, 4). Thus, there is a need for therapies of alternative nature capable of reducing PD secondary complications and improving functional autonomy. As the literature strongly suggests, physical exercise fills this necessity as it slows the progressive nature and prevents the onset of PD, hence why it is strongly recommended by Accredited Exercise Physiologist’s (AEP’s) and other Allied Health Professionals. (3). Given the associated decline in physical function and progressive nature of PD, expectations of derived benefit from exercise would be low in people with PD. This is actually one of the most prominent barriers identified in this population (5). However, proper education plays an important role here as AEP’s should be educating the elderly on the major health benefits from regular exercise participation, thus altering exercise outcome expectations.
It is well-established that proper exercise participation affects brain plasticity as different exercise modes have been identified to affect various brain regions. Specifically, aerobic-based exercise demonstrates greater benefit in the areas of the brain that are involved in daily life functioning and cognition in those with PD. This comes as vital information as cognitive decline greatly affects the quality of life in this population as well as their caregivers. Aerobic exercise of moderate-intensity performed at least 3x50min sessions per week promoted adequate improvement in language, cognitive memory and praxis tests (engagement or practising) after a 6-month training period with a follow-up after 18 months (1). The beneficial effects of aerobic exercise are also immediate in improving balance, gait and motor action in people with PD (6).

As mentioned, postural and gait issues are characteristics of PD. As the disease progresses long term (after 10 years), it is common for falls risk to become more of a problem. Generally, forward flexed trunks and necks are presented which can alter one’s trunk rotation range, which impairs functional activities eg. Rising from a chair and turning. As this posture progresses with the disease, arm movements and step length decrease (shuffling) as pelvic and trunk movements decrease, which leads to increased falls risk due to poor balance, and secondary injuries. To combat this, people with PD should be strengthening their extensor muscles to counteract hip flexion, cervical flexion and shoulder internal rotation through resistance-based exercises. Muscles targeted can include the upper traps, latissimus dorsi, posterior deltoid, triceps, erector spinae and glutes. Through such postural correction, functional movement is also improved eg. Turning around ability (4, 7). By combining resistance exercises with balance focused training, as compared to balance training alone, postural stability and balance are greatly improved (4). There is also the option of a low weight-bearing environment in a hydrotherapy pool if land-based exercise is a challenge. Water-based exercise therapy can assist in the mentioned factors whilst also improving PD patients quality of life (3).

It is evident that exercise, as an alternative therapy to pharmacological and neurological treatment, promotes significant and positive effects on PD secondary complications, functional autonomy and quality of life.

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Figure 1: “Effects of exercise on Parkinson’s disease. Schematic representation of how exercise intervention may help to break the cycle of decline for both motor and nonmotor symptoms of PD as well as the sequelae of secondary comorbidity and mortality that result from a sedentary lifestyle.” (van der Kolk, and King, 2013, p. 1592)

Reference list:

1. Silva, F.C.D. et al., 2018. Effects of physical exercise programs on cognitive function in Parkinson’s disease patients: A systematic review of randomized controlled trials of the last 10 years. Plos One, 13(2).

2. Betterhealth.vic.gov.au. (2019). Parkinson’s disease. [online] Available at: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/parkinsons-disease [Accessed 8 Jan. 2019].

3. Pérez, C.A. and Cancela, J.M., 2014. The effectiveness of water-based exercise in people living with Parkinson’s disease: a systematic review. European review of aging and physical activity, 11(2), p.107.

4. van der Kolk, N.M. and King, L.A., 2013. Effects of exercise on mobility in people with Parkinson’s disease. Movement Disorders, 28(11), pp.1587-1596.

5. Ellis, T., Boudreau, J.K., DeAngelis, T.R., Brown, L.E., Cavanaugh, J.T., Earhart, G.M., Ford, M.P., Foreman, K.B. and Dibble, L.E., 2013. Barriers to exercise in people with Parkinson disease. Physical therapy, 93(5), pp.628-636.

6. Shu, H.F., Yang, T., Yu, S.X., Huang, H.D., Jiang, L.L., Gu, J.W. and Kuang, Y.Q., 2014. Aerobic exercise for Parkinson’s disease: a systematic review and meta-analysis of randomized controlled trials. PloS one, 9(7), p.e100503.

7. Kim, J.H., Lee, J.U., Kim, M.Y., Kim, I.H., Kim, B. and Kim, J., 2012. The effect of standing posture-enhancing exercise on Parkinson’s disease patients’ turning around motion. Journal of Physical Therapy Science, 24(10), pp.1047-1050.

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