WHAT TYPES OF EXERCISE ARE BEST FOR PEOPLE WITH PARKINSON’S DISEASE?

(Editor’s Note: Exercise comes up a lot when we talk about Parkinson’s. It’s always worthwhile to refresh yourself on the reasons exercise plays such a big role in the treatment of Parkinson’s. And don’t forget – PRO offer several varieties of exercise classes virtually via Zoom and on our YouTube channel!)

Which types of exercise are best for Parkinson’s?

It is important to state upfront that there is no one best type of exercise for people with PD. It is most important to choose an exercise regimen that you enjoy, and will continue to do.

However, beyond doing exercise that you will stick with, there are some additional concepts to consider when designing an exercise program for someone with PD. 

The basic elements of exercising with Parkinson’s

There are four core elements of exercise that are important for people with PD:

• Aerobic – e.g. brisk walking, stationary cycling – activities that get the heart pumping
• Strengthening – e.g. using weights or resistance bands to improve muscle strength
• Balance – e.g. tai chi, dance to help you be more steady on your feet
• Stretching – e.g. mat exercises, yoga to provide flexibility

Including all four of these elements in your exercise regimen is ideal.

Aerobic activity or high-intensity exercise may be particularly important for Parkinson’s and general health

High-intensity exercise has been formally studied in PD with impressive results. The Study in Parkinson Disease of Exercise Phase 2 (SPARX2) enrolled 128 people with early PD, who were not yet on dopaminergic medication (i.e., levodopa) into three groups:

• a high-intensity treadmill exercise group, in which people exercised at 80-85% of their maximum heart rate
• a moderate-intensity treadmill exercise group, in which people exercised at 60-65% of their maximum heart rate
• a wait-list control group

After six months, the high-intensity group had essentially no change in their motor scores, whereas the control group had a three-point worsening of their motor scores.

The aerobic exercise component that you chose to do should be sufficient to increase heart rate and need for oxygen. It should also be sustained (more than 10 minutes at a time) and repeated throughout the week. Here are some practical guidelines for aerobic activity:

The CDC recommends 150 minutes of moderate intensity exercise or 75 minutes of vigorous intensity exercise per week for all older adults (who are generally fit).

As defined by the Centers for Disease Control (CDC), during moderate intensity exercise, you should be winded enough so that you are able to talk but not sing.

During vigorous-intensity exercise, you should only be able to say a few words before pausing for a breath.

Forced exercise

Forced exercise is a mode of aerobic exercise in which the rate is mechanically set above what the participant would achieve on their own. One example is tandem cycling in which a trainer sits in the front of the cycle and sets the rate of the cycling for the rear participant. The idea of forced exercise for people with PD is gaining traction.

Cognitive challenges in exercise

There is evidence that introducing a cognitive component to exercise, such as learning a new motor skill, may be beneficial in Parkinson’s. This concept supports the idea of adapting skill-based activities for people with PD, such as boxing, dance, tai chi, or yoga and may be one reason why these programs have taken off (more on these below). This paper reviews the evidence behind integrating cognitive challenges into exercise. You may also want to review our previous posts about boxing and dance for more information about those modalities.

How to start exercising if you’re living with Parkinson’s

Safety is key. The first thing you need to do is talk with your neurologist and primary care doctor to make sure that the exercise regimen that you embark upon is safe for you.

Next, ask for a referral for physical therapy. A physical therapist will be able to figure out what movement challenges you may have and design a program to help you improve. There are certain physical therapists with additional training in Parkinson’s. Your physical therapist will work with you for your allotted sessions, and then can help you plan your ongoing exercise regimen that is tailored to you. 

Additionally, physical therapy can help counteract the tendency for people with PD to reduce the size of their movements.  The Lee Silverman Voice Technique (LSVT) has designed a program called LSVT-BIG which trains participants to make big movements. You can search for an LSVT-trained professional near you.

Choosing the right exercise class for Parkinson’s

When trying to find an exercise class to join, it can be hard to know which ones to try because there are many different types of classes that are marketed to people with PD. When you are evaluating a class, it is important to remember the following:

It is the components of the exercise class that are important (strength training, aerobic, balance, etc). You do not need to specifically do boxing or dance (or any other modality or class) if you can achieve these elements of exercise in other ways.

The class should be adaptable for people of different abilities and mobility. Many classes will offer seated options or other modifications.

Tips and Takeaways

• Consult your doctor before starting any exercise regimen.
• Consider physical therapy as a first step in getting your exercise regimen safely underway. Choose a physical therapist who has expertise in Parkinson’s.
• Choose exercise modalities that you will enjoy and stick with. Consider exercising with friends for added motivation.
• Aerobic, strengthening, balance and stretching are very important elements of exercise for people with PD. Try to incorporate all these elements into your weekly exercise.
• In addition, consider exercise in which you will learn a new motor skill as this can add potential cognitive benefits.