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 (11).
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;12;13). 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 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 moderate to very low certainty depending on the exercise type and outcome.
First, let’s look at the evidence for movement. Moderate certainty evidence shows that dance and gait/balance/functional training likely improve movement by a moderate amount, while combined exercises improve it by a small amount. Additionally, low certainty evidence suggests that aqua-based training, strength/resistance training, endurance training, and mind‐body exercises may enhance movement by a small amount. Unfortunately, it’s unclear whether flexibility training and the Lee Silverman Voice Training BIG (LSVT BIG)—a form of therapy specific to Parkinson’s—have an impact on movement.
Second, let’s look at the evidence for quality of life. Moderate certainty evidence shows that aqua‐based training likely improves quality of life by a large amount, whereas low certainty evidence suggests that gait/balance/functional training, dance, mind body exercises, and combined exercises may enhance it by a small amount. Unfortunately, it’s unclear whether strength/resistance training, endurance training, flexibility training, and gaming have an impact on quality of life.
Third, we need to consider whether these strategies 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 these risks, the review's authors note that, overall, exercise for people with Parkinson’s appears to be “relatively safe.”
All in all, it appears that if you’re 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).
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