Parkinson's disease: Intensive exercise helps ease symptoms

• Researchers are reporting that high intensity exercise can help ease symptoms of Parkinson’s disease.
• Experts say the benefits are apparent in both the early and later stages of disease.
• They add that exercise helps people with Parkinson’s disease by improving brain function, balance, and mobility.

Intensive exercise might slow the course of Parkinson’s disease (PD), according to research published on July 14 in the journal Science Advances.

In their research involving laboratory rodents, neuroscientists from the Faculty of Medicine of the Catholic University, Rome Campus, and A. Gemelli IRCCS Polyclinic Foundation identified a new mechanism responsible for the positive benefits of exercise on brain plasticity.

The scientists reported that activities performed in the early stages of the disease can induce beneficial effects on movement control — even after discontinuing the exercise routine.

They said they believe that humans could potentially enjoy the same benefits.

Dr. Alessandro DiRocco, a neurologist at Northwell Lenox Hill Hospital in New York, not involved in the research, told Medical News Today:

“While the benefits of exercise in Parkinson’s disease are well established, this important study suggests that exercise may be effective in delaying this progression, diminishing the aggregates of the abnormal protein alpha-synuclein in the brain. While there [currently] are a number of medications and treatments that can alleviate the symptoms of the disease, there is no known treatment to delay the inevitable progression of the disease. Exercise can therefore have an especially important role in the overall treatment of Parkinson’s disease.”

How does exercise reduce symptoms of Parkinson’s?

Experts say exercise plays a vital part in maintaining an overall healthy lifestyle. They also believe it can improve specific symptoms of some diseases, such as Parkinson’s.

Early symptoms of Parkinson’s disease include tremors, a shuffling gait, and an overall slowing of physical movement.

Exercise might be one of the best ways of combating the condition, according to Harvard Health Letter.

How does it help?

“Exercise has been shown to stimulate the production of neurotrophic factors, such as brain-derived neurotrophic factor (BDNF). These factors play a crucial role in the growth, survival, and maintenance of neurons. These play a crucial role in the growth of new neurons, protect existing neurons, and enhance synaptic connections,“ said Jennifer Prescott, RN, MSN, CDP, the founder of Blue Water Homecare and Hospice.

“Exercise has been shown to improve mitochondrial function and promote their biogenesis (formation of new mitochondria). Healthy mitochondria are crucial for energy production and overall neuronal health,” Prescott told MNT.

Dr. Daniel Truong, a neurologist and the medical director of the Parkinson’s and Movement Disorder Institute at MemorialCare Orange Coast Medical Center in California, shared other ways exercise helps with Parkinson’s:

Reduction of alpha-synuclein aggregates

Intensive exercise reduces the spread of pathological alpha-synuclein aggregates in the brain. These aggregates are a hallmark of Parkinson’s disease and lead to the dysfunction and death of neurons.

Preserving motor control and visuospatial learning

The research suggests that exercise can help conserve motor control and visuospatial learning, which often decline in Parkinson’s disease due to the degeneration of specific brain areas (the substantia nigra pars compacta and the striatum).

BDNF and NMDA interaction

The study discovered that BDNF, whose levels increase with exercise, interacts with the NMDA receptor for glutamate, a neurotransmitter involved in learning and memory. This interaction allows neurons in the striatum to respond more efficiently to stimuli, which has benefits that last beyond the exercise practice.

Anti-inflammatory effects

Exercise has been known to have anti-inflammatory effects, which could benefit Parkinson’s disease.

What type of exercises are best for Parkinson’s?

“Regular exercise helps maintain motor function in [Parkinson’s] patients and may slow the progression of the disease,” said Dr. Andrew Feigin, the executive director of the Marlene and Paolo Fresco Institute for Parkinson’s and Movement Disorders at NYU Langone Health in New York.

“We routinely recommend regular exercise to all our Parkinson’s patients. Of course, patients have different capacities for exercise depending on many factors, including the severity of Parkinson’s, but we do encourage exercise,” Feigin told MNT.

“Our team recommends exercise to all our [Parkinson’s] patients,” added Dr. Melita Petrossian, a neurologist and director of the Pacific Movement Disorders Center and Pacific Neuroscience Institute in California.

“In the past, exercise recommendations may have been vague, e.g., take a walk at times. With a new understanding of exercise’s benefits, we are providing more specific guidance: this study and others before it emphasizes that exercise needs to be high intensity, with prior studies recommending intensity to accomplish 80 to 85 percent of maximum heart rate for 30 minutes 3 or 4 times per week,” she told MNT.

“We, of course, advise patients to consult with their physicians or cardiologists prior to embarking on a high intensity program,” Dr. Petrossian added.

Dr. Petrossian said she typically advises exercises that are low or zero impact while maintaining high intensity. Examples of this type of exercise include:

• power walking
• swimming
• water aerobics
• exercise bikes

“Also, in keeping with prior studies, we recommended progressive resistance exercises with increased weights or repetitions in strength training twice a week,” Dr. Petrossian continued.

“We also advise patients on stretching, balance exercises, core strengthening, and skill-based exercises such as yoga, dance, boxing, ping pong, and Pilates.”

“Exercise can help reduce the symptoms of [Parkinson’s] in the short term, improve energy, improve stride length and balance, prevent falls, improve sleep and mood, and improve cognition,” she continued.

“These symptom benefits are added to the long-term preventative benefits. In addition to the new study showing reduced propagation of alpha-synuclein, the release of BDNF is neuroprotective. Exercise can also improve brain blood flow via angiogenesis.”

Is exercise safe in the later stages of Parkinson’s?

In their new study, the researchers looked at exercise in the early stages of the disease and reported specific and substantial benefits.

Exercise might also be beneficial in the later stages as well as have different objectives, experts note.

“In the later stages of Parkinson’s disease, the primary benefits of exercise could potentially shift toward the maintenance of mobility, strength, balance, and flexibility, and improvement in the quality of life,” Truong said.

“As we know exercise might also help manage symptoms such as constipation, improve mood and sleep. Balancing exercise reduces the risk of falls.”

“However, it’s important to note that people in the later stages of Parkinson’s disease often have more severe symptoms and may also have other health issues. Therefore, any exercise program must be carefully designed to ensure safety and effective[ness] for the individual’s specific condition and needs.”

— Dr. Daniel Truong, neurologist

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