Almost All Forms of Exercise can Help with Parkinson's, Study Suggests

Most types of physical exercise can help to ease motor symptoms in adults with Parkinson’s disease and improve their quality of life, according to a review study.  

“Our review highlights the importance of physical exercise in general, while the exact exercise type may be secondary,” Elke Kalbe, PhD, the study’s senior author and a professor of medical psychology at the University of Cologne in Germany, said in a press release.

“Therefore, the personal preferences of people with Parkinson’s Disease should be given special consideration to help motivate them to adhere to an exercise program,” Kalbe added. “Any exercise counts.”

The study, “Physical exercise for people with Parkinson’s disease: a systematic review and network meta‐analysis,” was published in Cochrane Database of Systematic Reviews.

Clinically meaningful motor symptom changes seen with most exercise forms

Physical exercise has a number of well-established health benefits, ranging from improving mobility to boosting mood. An increasing body of evidence also suggests that exercise, along with physiotherapy, can be of clinical benefit for people with Parkinson’s.

Still, “it has been unclear whether some types of exercise work better than others. We wanted to find out what exercise works best to improve movement and quality of life,” Kalbe said.

She and colleagues at German institutions conducted a systematic review of studies published up to mid-May 2021 reporting results of adequately controlled trials comparing physical exercise either with no exercise or with another type of exercise in adults with Parkinson’s.

A total of 156 trials — involving 7,939 patients — were included in the meta-analysis, in which researchers pool data from multiple published studies and analyze findings collectively.

Patients’ average age was between 60 and 74, and most had mild-to-moderate disease and no major cognitive symptoms.

The trials were conducted in several countries, but most commonly in the U.S. (21.8%). Most included studies were small, with an average of 51 participants (range, 10–474). Data covering changes in motor symptom severity or life quality with exercise were available in less than half of these studies.

Findings in 71 studies suggested that most forms of exercise had a beneficial effect on Parkinson’s motor symptoms, the researchers noted.

“We observed clinically meaningful improvements in the severity of motor symptoms for most types of exercise. These included dancing, training to improve gait, balance and movement, multi-exercise training, and mind-body training,” said Nicole Skoetz, a university professor and doctor with University Hospital Cologne.

The small number of patients in most studies, and the absence of information on participants’ motor symptoms across studies made it difficult to determine whether improvements were clinically meaningful and to compare with certainty the effects of different forms of exercise.

“We saw similar benefits in the severity of motor symptoms for water-based training, strength and resistance training, and endurance training, but the estimates of improvement were rather imprecise, meaning that we are not as confident in saying that these improvements are clinically meaningful,” Skoetz said.

Flexibility training was the only exercise form appearing to have minimal or no effect on motor symptom severity, the researchers noted.

Life quality analyses, based on data from 55 studies, showed similar results. Most forms of exercise were associated with a generally positive effect in patients’ quality of life, but the imprecision of estimates made comparisons difficult.

“For the effects on quality of life, we observed clinically meaningful beneficial effects for water-based training, and effects that are probably clinically meaningful for several types of exercise, such as endurance training, mind-body training, training to improve gait, balance and movement and multi-exercise training,” Skoetz said. “Again, these estimates were rather imprecise.”

Exercise programs designed for Parkinson’s may be most beneficial

Overall, the researchers noted “little evidence of differences between exercise types” in terms of helpful changes in motor symptoms or life quality.

“We think that our results are good news because they indicate that people with Parkinson’s Disease can benefit from various structured exercise programs to improve the severity of motor symptoms and quality of life,” Kalbe said.

“It is important to point out that our conclusions do not rule out that certain motor symptoms may be treated most effectively by programs, such as physiotherapy, that are designed specifically for people with Parkinson’s disease,” Kalbe added.

Safety data from 85 studies suggested that the exercise-based interventions were “relatively safe,” the team wrote, but evidence here “is very uncertain.”

Larger studies and “well‐conducted studies are needed to increase confidence in the evidence,” the researchers concluded.  “Additional studies recruiting people with advanced disease severity and cognitive impairment might help extend the generalizability of our findings to a broader range of people” with Parkinson’s.