Dr. Joseph Jankovic advises
There is growing evidence that exercise is beneficial for Parkinson's patients. And after more than three decades in practice and following thousands of patients with Parkinson's disease, there is no doubt in my mind that patients who exercise do better than those who don't. They seem to have slower progression of disease and a better prognosis.
Although I think there is a general consensus among neurologists that exercise is beneficial, we need some long-term clinical trials to prove it. In the meantime, there are some animal studies that suggest that exercise may actually protect nerve cells that are damaged by the disease.
So far, no one has figured out how this works. It's possible that exercise may make brain cells less vulnerable to stresses that lead to cell death. This is one of the mechanisms that causes damage in Parkinson's disease implicated in nerve cell death. It's also possible that exercise may increase the production of trophic factors—proteins produced by the brain that are designed to nurture nerve cells—and that this may cause some restoration of cells that might otherwise die.
Beyond this, I have seen patients improve without any change in medications just because they started exercising. There are a number of reasons to think exercise could help.
First, exercises that focus on range of motion— like yoga, Pilates, and tai chi—help patients overcome rigidity and become more limber. And hopefully this will prevent long-term disability that results from deformities caused by rigidity, such as contractures. These are deformities of the hands and other parts of the body, often wrongly diagnosed as arthritis. The joints that attach the fingers to the hand can become bent and even the wrists can become bent.
Second, aerobic exercise can help with endurance. One of the most common complaints in patients with Parkinson's is fatigue. In one of our studies we showed that whereas normal individuals can exercise 15 to 20 minutes before they reach their greatest degree of exertion, Parkinson's patients often become exhausted and short of breath within five or 10 minutes. Patients who exercise regularly don't get tired as quickly. And with this added energy and stamina, they are able to accomplish more in their daily lives.
One thing that is important for people to understand is that an exercise program needs to be individualized to each patient. In the early stages of the disease, patients are capable of doing more than those in the later stages. In the early stages, I might suggest walking two to three miles a day or swimming a few laps, for example. In the later stages, I place more emphasis on range-of-motion exercises that prevent deformities.
To increase endurance, I recommend conditioning exercises like water aerobics and walking. Water aerobics is especially good because it doesn't stress the joints while the patient builds up cardiovascular conditioning.
Unfortunately, even though exercise can be beneficial, it can be very difficult for patients to get motivated when they feel tired all the time. And this can lead to a vicious cycle: Patients feel fatigued and they don't want to exercise and then they become more fatigued and are even less likely to exercise. That's why it's important to get started on an exercise program in the early stages, so you will have the motivation to keep going. If you can afford it—or have insurance to cover it— having a personal trainer can also help in that regard.
Another strategy is to join a support group. In Houston, for example, Parkinson's support groups help people organize into small exercise groups. These smaller groups, I think, increase motivation. And, the groups are more likely to be able to afford to hire a professional physical or occupational therapist to lead them through their exercises.
Patients also need to be aware of safety concerns. For example, I would not recommend exercise on a treadmill for Parkinson's patients who have a problem with balance. For these patients, I usually recommend stationary bicycles and weightlifting.
Joseph Jankovic, M.D.
Professor of neurology and director, Parkinson's Disease Center and Movement Disorders Clinic, Baylor College of Medicine