How effective is exercise and physical therapy in patients with Parkinson disease (PD)?

Updated: Jan 24, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Exercise therapy in patients with Parkinson disease using a variety of physiotherapy interventions may play a role in improving gait, balance and flexibility, aerobic capacity, initiation of movement, and functional independence. Studies generally have suggested improvement in functional outcomes, but the observed benefits were small in magnitude and were not sustained following discontinuation of the exercise. [77]

A systematic review of 33 randomized trials involving 1518 patients evaluated various physiotherapy interventions, including general physiotherapy, exercise, treadmill training, cueing, dance and martial arts. There were significant improvements for walking speed, walking endurance and step length, mobility (the Timed Up & Go test), and balance. Unified Parkinson’s Disease Rating Scale (UPDRS) scores were also improved with physiotherapy. There was no benefit observed for falls or patient-rated quality of life, and there was no evidence that one type of physiotherapy was superior to others. [118]

There has been a resurgence of interest in the potential benefit of exercise in Parkinson disease, including a possible neuroprotective effect. [119] Vigorous exercise in mid-life is associated with a reduced risk of subsequent Parkinson disease. In animal models, vigorous exercise provides a protective effect against a variety of toxins that cause parkinsonism. In addition, in healthy people, serum brain-derived neurotrophic factor (BDNF) increases after exercise, in proportion to the intensity of the activity. In Parkinson disease, BDNF levels in the substantia nigra are reduced, and in animal models of Parkinson disease, BDNF provides a neuroprotective effect. This is an area of active research.

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