Does vigorous exercise for Parkinson’s have a neuroprotective effect?

By Sean Sullivan, FNP-C

A growing body of evidence suggests that high levels of moderate to vigorous exercise may be a key interventional and neuroprotective therapy to slow progression of Parkinson’s disease (PD). Likewise, PD experts agree that vigorous exercise for Parkinson’s is beneficial to patients at most stages of their disease, including at early diagnosis.

In animal and human studies, exercise is shown to enhance the release of protective neurotrophins such as Brain Derived Neurotrophic Factors (BDNF) and to increase neuroplasticity, the ability of the brain to reorganize or compensate for injury and disease. These physiological effects may have a positive impact on cognitive function in the aging brain. Among seniors in general, cognitive training, physical activity, and exercise have been reported to improve cognitive performance in older adults. Similarly, midlife exercise prior to developing Parkinson’s disease has been shown to significantly reduce PD risk in humans.

In PD, a progressive disease caused by the loss of dopaminergic neurons in the brain, exercise can have particular benefits. Although exercise does not change the amount of dopamine or neurons in the brain, studies have shown that exercise modifies areas of the brain where dopamine signals are received, improving the efficiency of brain cells to use dopamine, as well as reduces the vulnerability of dopamine neurons to damage. Read more on the Neuroprotective Benefits of Exercise.

When it comes to exercise and PD, researchers believe greater intensity equals greater benefits. Vigorous exercise should consist of an increased heart rate and the need for oxygen. Exercising individuals should work out at a pace where they are not out of breath, but simply breathing more forcefully than when at rest.

A good gauge of this level of activity would be:

  • The individual can hold a conversation with the need to take a breath every three or four words.
  • Being able to complete a full sentence would suggest the individual is not working hard enough, while only being able to get one word out between each breath would suggest they are working out too hard and would be unable to sustain the exercise session.
  • Vigorous exercise will generally result in breaking a sweat, and the effort should be sustained and without breaks for 20 to 30 minutes.
  • Deconditioned individuals might only be able to sustain the activity for several minutes, but continued daily attempts will result in improved exercise tolerability.

A minimum of 2.5 hours of exercise per week is recommended. Exercises such as walking, jogging, swimming, stationary bicycle riding, dancing, aerobic classes, water aerobic classes, raking leaves, digging a garden, or spreading mulch would all produce a sustained elevated heart rate.

Individuals with PD may only be able to perform certain exercises due to poor balance or gait. These individuals should focus on exercises they can perform safely, and try to identify activities that are enjoyable and rewarding. Identifying barriers to exercise and finding solutions will help ensure compliance and success. Read more on how to motivate yourself or a loved one in overcoming barriers to exercise in this article from National Parkinson’s Foundation Medical Director Michael S. Okun, MD.

Learn more about Neurology Solutions’ on-site physical therapy center, Austin Renewal Therapy.

Physical therapy programs should focus on improving fitness levels through instruction, support, guidance, and increasing exercise tolerance for individuals with Parkinson’s disease. Dopaminergic stimulation medications should be optimized, and Deep Brain Stimulation should be considered in appropriate candidates to achieve the maximum capability and motivation to pursue and maintain fitness.

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Sean Sullivan is an Advanced Practice Family Nurse Practitioner. He joined Neurology Solutions in 2006.