The Impact of Exercise Rehabilitation and Physical Activity on the Management of Parkinson's Disease

A.M. Johnson, PhD; Q.J. Almeida, PhD

Disclosures

Geriatrics and Aging. 2007;10(5):318-321. 

In This Article

Abstract and Introduction

Although medication therapy is generally effective in the clinical management of Parkinson's disease (PD), additional improvement of some gross motor symptoms may be achieved through the use of nonpharmacological treatments, such as physical therapy and exercise rehabilitation. Despite the fact that PD is a neurological disorder, successful rehabilitation has been demonstrated with treatments that combine cognitive and physical approaches. While the exact mechanism through which these therapies obtain successful outcomes is still largely unknown, it is worthwhile to explore these adjunctive approaches to treating the motor output symptoms of PD.

Parkinson's disease (PD) is the most common form of parkinsonism, constituting almost 80% of all parkinsonism. It is produced by lesions in the basal ganglia, particularly in the substantia nigra,[1] that result in marked dopamine depletion. The predominant strategy for medical management of the symptoms of PD is levodopa therapy (with either levodopa-replacement medications or dopamine agonists), and most symptoms are highly responsive to this treatment. It is well-established, however, that both longevity (i.e., the duration of "on" periods) and overall effectiveness (i.e., the quality of improvement demonstrated during these "on" periods) diminish with chronic levodopa usage.[2,3] Furthermore, long-term utilization of levodopa may lead to an increased risk of dyskinesia, in which the patient engages in involuntary writhing movements during "on" periods.[4,5,6] While it is unlikely that physical or cognitive treatment strategies will supplant pharmacological treatments, many such techniques have been demonstrated to show incremental improvement when combined with levodopa therapy. Furthermore, recent animal studies have suggested that exercise rehabilitation may stimulate the production of brain-derived neurotrophic factors,[7] normalize dopamine production,[8] and protect the nigrostriatal neurons that usually deteriorate in PD.[9] It is plausible, therefore, that effective nonpharmacological treatment strategies might lead to lower therapeutic levels of dopaminergic medications for some patients, thereby improving the long-term prognosis.

The notion of treating the overt motor symptoms of PD through physical interventions is not new. Despite the fact that PD is a neurological disorder, many of its primary physical symptoms (bradykinesia, postural instability, and rigidity) are motor sequelae that are frequently found among otherwise healthy older adults. Accordingly, rehabilitation has traditionally focused on musculoskeletal strategies that have been successful in other (non-PD) populations. However, more recent research has focused on the development of therapies that leverage motor control hypotheses of PD, employing more of a "neurological" approach to treating motor symptoms.10 While both strategies have demonstrated some benefit in patient populations, taken as a whole, the literature suggests that combined approaches obtain the greatest success.

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