July 2017 Issue

Focus on Fitness: Exercising With Parkinson's Disease
By Jennifer Van Pelt, MA
Today's Dietitian
Vol. 19, No. 7, P. 58

Approximately 1 million Americans have Parkinson's disease, a chronic and progressive movement disorder. The exact cause is unknown; symptoms result from a breakdown of nerve cells in the brain that make dopamine, a chemical that contributes to the control of movement and coordination. As Parkinson's disease progresses, the amount of dopamine decreases, and the individual is unable to control body movements.

Primary symptoms of Parkinson's disease include the following:

• tremor in the arms, hands, legs, face, and jaw;
• slowness of movement (bradykinesia);
• impaired balance and coordination;
• postural instability; and
• stiffness or rigidity of the torso and limbs.

The disease is progressive—meaning that these symptoms worsen over many years. Currently, there's no cure for Parkinson's disease, but medications and surgery are available to treat symptoms and improve quality of life.

Exercising regularly also helps with symptom management and possibly in slowing disease progression. The National Parkinson Foundation refers to exercise for Parkinson's patients as a "vital component to maintaining balance, mobility, and daily living activities." In addition to increasing or maintaining strength, cardiovascular fitness, and flexibility, exercise also may be neuroprotective for those with Parkinson's disease. Animal studies have shown that exercising increases the efficiency of the remaining brain cells that produce dopamine, possibly slowing disease progression, or at least minimizing symptoms related to dopamine loss.

Parkinson's disease experts recommend that individuals with Parkinson's exercise as much and as intensely as their symptoms allow. Younger adults and those in the early stages of the disease should especially focus on intensity, because vigorous exercise has been found to slow the effects of aging in general. This, combined with its possible neuroprotective benefit in Parkinson's means starting or maintaining an exercise program is essential as soon as possible after diagnosis.

Aside from the usual benefits of increasing and maintaining strength, cardiovascular fitness, and flexibility, exercise improves gait, balance, tremor, grip strength, and motor coordination for the Parkinson's patient. For patients who can't exercise intensely (ie, increasing heart rate to the higher end of aerobic range), lower intensity exercise also has been shown to improve functionality, quality of life, and well-being. For additional information on the benefits of exercise in Parkinson's disease, visit the National Parkinson Foundation website at www.parkinson.org/understanding-parkinsons/treatment/Exercise/Neuroprotective-Benefits-of-Exercise and www.parkinson.org/understanding-parkinsons/treatment/Exercise.

Exercise and Parkinson's disease is a research area of high interest and activity. There are hundreds of studies on different activities and their beneficial effects for Parkinson's patients. The National Parkinson Foundation notes that numerous research studies have found a range of exercise types to be beneficial for Parkinson's patients, including cycling, walking, running, tai chi and qigong, yoga, Pilates, dancing, group exercise classes and exercise DVDs, exergaming (ie, video games that provide a form of exercise, such as Wii activities), weight training, and water exercise. Your clients with Parkinson's disease have several opportunities and a variety to choose from.

Selecting only a few research studies to summarize on exercise and Parkinson's disease is challenging because there are so many. The following either are large systematic reviews confirming an important finding or report on an interesting exercise activity:

• A January 2017 study of Ai Chi (water-based tai chi) in 40 patients with mild-to-moderate Parkinson's disease showed significantly greater improvements in dynamic balance, functional mobility, and quality of life compared with land-based exercises.1

• A large December 2016 systematic review and meta-analysis of 10 studies on mind-body exercise (eg, yoga, tai chi, dance) in Parkinson's disease showed significant benefit on motor symptoms, postural instability, and functional mobility for patients with mild-to-moderate disease.2 Another study in 100 Parkinson's patients found that qigong significantly improved gait performance, functional mobility, and sleep quality in older adults with Parkinson's disease.3

• Two recent studies demonstrated both physical and psychosocial benefits associated with participation in adapted dance programs, improving quality of life, mobility, social interaction, communication, self-identity, and positive attitude in older adults with Parkinson's disease.4,5

• A 2014 systematic review of six studies showed that exergaming improved balance and reduced the severity of motor symptoms associated with Parkinson's disease. The researchers noted that some commercial exergames may be too fast and complex for Parkinson's patients, but the use of exergaming is an emerging and interesting area of rehabilitation research for Parkinson's disease.6

So, those with Parkinson's disease have a wide variety of exercise activities to choose from when designing a regular program. As with any exercise program, regularity and variety are good things—activities that address cardiovascular fitness, strength, flexibility, and balance should be included weekly. For your clients in the early stages of Parkinson's disease who already exercise, their program may not need to change much. For those whose symptoms interfere with daily functioning or movements, exercise routines may need to be adapted, and they may need to have a partner or trainer supervise them. For Parkinson's patients who are new to exercise, supervised exercise with an instructor or physical therapist experienced in Parkinson's disease is recommended. Many hospitals offer community exercise programs for Parkinson's patients, which would be appropriate for new exercisers, depending on the activities performed. My local hospital offers both a balance exercise class and a tai chi class for Parkinson's patients with experienced instructors.

As their disease progresses, exercisers may get discouraged and be inclined to stop exercising. Those who previously enjoyed going to a gym may feel self-conscious about tremors or coordination difficulties. Symptoms may make some activities no longer possible or safe. The progression of Parkinson's disease most likely will be the most difficult challenge—especially for those who are used to being active and independent. Encouragement and support are essential in maintaining a regular exercise program as Parkinson's disease progresses. If your client can no longer safely ride his bike around the neighborhood due to tremor and balance problems, suggest a stationary cycle with a sturdy seat and handlebars for home exercise. If walking without support isn't possible anymore, recommend they try water walking or water yoga/tai chi. Chair exercise also is a good option, and many gyms and senior centers offer chair fitness classes for older adults that can be adapted for Parkinson's patients. With so many exercise options, your clients can keep moving as their Parkinson's progresses.

— Jennifer Van Pelt, MA, is a certified group fitness instructor and health care researcher in the Reading, Pennsylvania, area.


1. Kurt EE, Büyükturan B, Büyükturan Ö, Erdem HR, Tuncay F. Effects of Ai Chi on balance, quality of life, functional mobility, and motor impairment in patients with Parkinson's disease [published online January 13, 2017]. Disabil Rehabil. doi: 10.1080/09638288.2016.1276972.

2. Kwok JY, Choi KC, Chan HY. Effects of mind-body exercises on the physiological and psychosocial well-being of individuals with Parkinson's disease: a systematic review and meta-analysis. Complement Ther Med. 2016;29:121-131.

3. Xiao CM, Zhuang YC. Effect of health Baduanjin Qigong for mild to moderate Parkinson's disease. Geriatr Gerontol Int. 2016;16(8):911-919.

4. Zafar M, Bozzorg A, Hackney ME. Adapted tango improves aspects of participation in older adults versus individuals with Parkinson's disease [published online October 21, 2016]. Disabil Rehabil. doi: 10.1080/90638288.2016.1226405.

5. Bognar S, DeFaria AM, O'Dwyer C, et al. More than just dancing: experiences of people with Parkinson's disease in a therapeutic dance program. Disabil Rehabil. 2017;39(11):1073-1078.

6. Barry G, Galna B, Rochester L. The role of exergaming in Parkinson's disease rehabilitation: a systematic review of the evidence. J Neuroeng Rehabil. 2014;11:33.