DEAR DOCTOR: A relative of mine was recently diagnosed with Parkinson's disease. I read recently that exercise can help slow the progression, so I want to suggest it to him, but I don't know if it's actually true.
DEAR READER: Although Parkinson's disease is a progressive neurologic disorder that increasingly limits a person's ability to move, a robust body of research points to the benefits of exercise for people with the condition. Symptoms of Parkinson's, which typically appear gradually, can include tremors, poor balance, slowed body movement and stiffness. Most cases are diagnosed in people 60 and over. At this time, an estimated 1 million Americans have been diagnosed with Parkinson's. With thousands of baby boomers turning 65 each day, the number of Parkinson's diagnoses is expected to spike.
Older studies have shown that a variety of exercises help with a range of issues common to Parkinson's, including balance, flexibility, strength and motor coordination. For example, the slow, sustained movements of tai chi and yoga help improve gait and balance, while aerobic exercise enhances endurance, agility and coordination. But when it comes to actually slowing the progress of the disease, we think you're referring to a study conducted by researchers at Northwestern University's Feinberg School of Medicine. The results were published in JAMA Neurology in December 2017.
This study, which researchers say is the first of its kind, explored the potential benefit of high-intensity exercise for patients with early-stage Parkinson's disease. Previously, high-intensity exercise was not considered appropriate for Parkinson's patients. Each of the 128 patients enrolled in the study had early-stage disease and had not yet begun taking any medications. This was done to eliminate response to medication as a variable in the study.
The participants were divided into three groups and had their baseline physical condition evaluated according to a Parkinson's disease scale. During the six-month study, one group of patients exercised three times per week at high intensity, which was defined as 80% to 85% of maximum heart rate. A second group exercised three times per week at medium intensity, or 60% to 65% of maximum heart rate. The third group, which served as the control, did not exercise.
After six months, participants were re-evaluated on the Parkinson's disease scale, which ranges from 0 to 108. The lower the number, the less severe the symptoms. For those who did high-intensity exercise, the group's baseline reading of 20 remained unchanged. For the patients who exercised at moderate intensity, their baseline reading of 20 increased by 1.5 points. For the control group, which did no exercise, their baseline reading of 20 increased to 23. As the researchers point out, that 3-point increase translates to a 15% increase in primary signs of the disease. Not only is this statistically significant, it results in a lower quality of life for patients.
If you share this study with your relative, please urge them to check with their doctor before starting any kind of exercise program. Decisions best made with a physician's help include which specific exercises to take part in, which to avoid, and intensity and duration.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.