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

The Importance of Physical Activity

The message that is reiterated most frequently is that any positive effects of physical rehabilitation are transient without the maintenance of physical activity or (ideally) ongoing physical therapy. Additionally, at least one large epidemiological study has demonstrated that physically active patients had a lower mortality rate, better quality of life, and increased function in activities of daily living than did less active individuals with PD (despite control of age, sex, and disease duration).[25]

Unfortunately, convincing individuals with PD to engage in reasonable, safe physical activity is often difficult. For some individuals with PD, intense physical activity results in a qualitative reduction in the duration of medication effect due to the fact that many people with PD absorb levodopa more slowly and less completely when exercise is started at the time of or just before levodopa ingestion.[26] Furthermore, some individuals with PD avoid physical activity due to concerns over their symptoms; for example, those with reduced endurance and impaired gait parameters are hesitant to hike, those with reduced reaction time and range of motion are reluctant to engage in racquet sports, and those with an overall increased fatigue tend to avoid physical activity across the broader spectrum.[27] From a physiological perspective, individuals with mild to moderate PD have a largely normal exercise capacity, demonstrating nonsignificant peak oxygen consumption and peak workloads when compared with healthy controls,[28] provided that periods of exercise are of short duration and provide frequent intervals for rest.[29] Furthermore, medication absorption and effectiveness are not significantly affected by normal exercise, provided that acute exercise is not started for a period of 1 hour after levodopa ingestion.[26]

Sunvisson et al.[30] suggest that gait rehabilitation can be as simple as increased walking. In a small sample of Swedish patients, 1 week of daily 4 km walks produced significant improvements in movement time, as measured using computer-controlled opto-electronic cameras. Despite the fact that this experimental group was highly self-selected, participants demonstrated a significant incremental effect over conventional physical therapy and pharmacological therapy, with effects lasting for approximately 4 months after treatment.

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