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How might physical activity benefit patients with Parkinson disease?

Nature Reviews Neurology volume 7, pages 528534 (2011) | Download Citation

This article has been updated


Parkinson disease (PD) is a neurodegenerative disorder characterized by progressive motor and nonmotor impairments. These impairments incline many patients towards a sedentary lifestyle, which has many deleterious consequences. Accumulating evidence suggests that patients with PD might benefit from physical activity and exercise in a number of ways, from general improvements in health to disease-specific effects and, potentially, disease-modifying effects (suggested by animal data). Many issues remain to be addressed, including the need to perform clinical trials to demonstrate these presumed benefits of physical activity and exercise in patients with PD. These trials must also address safety issues, such as an increased risk of falls and cardiovascular complications in more-active patients. Identifying ways to induce a sustained behavioral change, using specifically tailored programs that address potential barriers such as depression, apathy and postural instability, may lead to an improved quality of life in individuals with PD.

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Change history

  • 16 August 2011

    In the version of this article initially published online, reference 35 was cited alongside the statement "changes in physical activity did not reduce levels of fatigue." A different reference (Wiborg et al.) should have been cited at this point, which has now been added to the article. The error has been corrected for the print, HTML and PDF versions of the article.


  1. 1.

    et al. Physical activity and sports in patients suffering from Parkinson's disease in comparison with healthy seniors. J. Neural Transm. Park. Dis. Dement. Sect. 5, 157–161 (1993).

  2. 2.

    et al. Physical inactivity in Parkinson's disease. J. Neurol. doi:10.1007/s00415-011-6097-7 [Advance online publication].

  3. 3.

    et al. A meta-analysis of six prospective studies of falling in Parkinson's disease. Mov. Disord. 22, 1892–1900 (2007).

  4. 4.

    et al. Be smart, exercise your heart: exercise effects on brain and cognition. Nat. Rev. Neurosci. 9, 58–65 (2008).

  5. 5.

    et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med. Sci. Sports Exerc. 41, 1510–1530 (2009).

  6. 6.

    et al. Prevalence and characteristics of dementia in Parkinson disease: an 8-year prospective study. Arch. Neurol. 60, 387–392 (2003).

  7. 7.

    et al. Cognitive profile of patients with newly diagnosed Parkinson disease. Neurology 65, 1239–1245 (2005).

  8. 8.

    et al. Benefits of physical exercise on executive functions in older people with Parkinson's disease. Brain Cogn. 69, 435–441 (2009).

  9. 9.

    et al. Exercise and Parkinson's: benefits for cognition and quality of life. Acta Neurol. Scand. 2010).

  10. 10.

    et al. Effect of physical activity on cognitive function in older adults at risk for Alzheimer disease: a randomized trial. JAMA 300, 1027–1037 (2008).

  11. 11.

    et al. Exercise is associated with reduced risk for incident dementia among persons 65 years of age and older. Ann. Intern. Med. 144, 73–81 (2006).

  12. 12.

    et al. Physical activity and enhanced fitness to improve cognitive function in older people without known cognitive impairment. Cochrane Database Syst. Rev., Issue 3. Art. No.: CD005381. doi:10.1002/14651858.pub3 (2008).

  13. 13.

    et al. Bone mass in elderly patients with Parkinson's disease. Acta Neurol. Scand. 116, 248–254 (2007).

  14. 14.

    et al. Osteoporosis in Parkinson's disease. Parkinsonism Relat. Disord. 15, 339–346 (2009).

  15. 15.

    et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam Study. Bone 34, 195–202 (2004).

  16. 16.

    et al. Risk factors for hip fracture among elderly patients with Parkinson's disease. J. Neurol. Sci. 182, 89–93 (2001).

  17. 17.

    et al. Management of osteoporosis in the elderly. Curr. Med. Res. Opin. 25, 2373–2387 (2009).

  18. 18.

    et al. Exercise and bone mass in adults. Sports Med. 39, 439–468 (2009).

  19. 19.

    et al. Reduced risk factors for vascular disorders in Parkinson disease patients: a case–control study. Stroke 37, 1184–1188 (2006).

  20. 20.

    et al. Parkinson disease and comorbid cerebrovascular disease. Nat. Rev. Neurol. 5, 533–541 (2009).

  21. 21.

    et al. Physical activity intervention studies: what we know and what we need to know: a scientific statement from the American Heart Association Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity); Council on Cardiovascular Disease in the Young; and the Interdisciplinary Working Group on Quality of Care and Outcomes Research. Circulation 114, 2739–2752 (2006).

  22. 22.

    et al. Exercise prescription and primary prevention of cardiovascular disease. Circulation 121, 2601–2604 (2010).

  23. 23.

    et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med. Sci. Sports Exerc. 39, 1423–1434 (2007).

  24. 24.

    et al. The ABC of Physical Activity for Health: a consensus statement from the British Association of Sport and Exercise Sciences. J. Sports Sci. 28, 573–591 (2010).

  25. 25.

    and Walking and primary prevention: a meta-analysis of prospective cohort studies. Br. J. Sports Med. 42, 238–243 (2008).

  26. 26.

    et al. Exercise performance in those having Parkinson's disease and healthy normals. Med. Sci. Sports Exerc. 31, 761–766 (1999).

  27. 27.

    et al. How effective are physical activity interventions for alleviating depressive symptoms in older people? A systematic review. Clin. Rehabil. 23, 873–887 (2009).

  28. 28.

    et al. Frequency of dementia, depression, and other neuropsychiatric symptoms in 1,449 outpatients with Parkinson's disease. J. Neurol. 257, 1073–1082 (2010).

  29. 29.

    et al. Randomized controlled trial of the Alexander technique for idiopathic Parkinson's disease. Clin. Rehabil. 16, 695–708 (2002).

  30. 30.

    et al. A randomised controlled cross-over trial of aerobic training versus Qigong in advanced Parkinson's disease. Eura. Medicophys. 42, 231–238 (2006).

  31. 31.

    et al. Qigong exercise for the symptoms of Parkinson's disease: a randomized, controlled pilot study. Mov. Disord. 21, 543–548 (2006).

  32. 32.

    et al. The effectiveness of exercise interventions for people with Parkinson's disease: a systematic review and meta-analysis. Mov. Disord. 23, 631–640 (2008).

  33. 33.

    et al. Sleep disorders associated with Parkinson's disease: role of dopamine, epidemiology, and clinical scales of assessment. CNS Spectr. 13, 6–11 (2008).

  34. 34.

    et al. Impact of an exercise program on physical, emotional, and social aspects of quality of life of individuals with Parkinson's disease. Mov. Disord. 21, 1073–1077 (2006).

  35. 35.

    et al. Moderate-intensity exercise and self-rated quality of sleep in older adults. A randomized controlled trial. JAMA 277, 32–37 (1997).

  36. 36.

    et al. Major nutritional issues in the management of Parkinson's disease. Mov. Disord. 24, 1881–1892 (2009).

  37. 37.

    et al. Parkinson's disease and the gut: a well known clinical association in need of an effective cure and explanation. Neurogastroenterol. Motil. 20, 741–749 (2008).

  38. 38.

    et al. Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract. Gut 48, 435–439 (2001).

  39. 39.

    et al. Is fatigue an independent and persistent symptom in patients with Parkinson disease? Neurology 63, 1908–1911 (2004).

  40. 40.

    et al. Fatigue in patients with Parkinson's disease. Mov. Disord. 14, 237–241 (1999).

  41. 41.

    et al. Is impact of fatigue an independent factor associated with physical activity in patients with idiopathic Parkinson's disease? Mov. Disord. 24, 1512–1518 (2009).

  42. 42.

    and How does cognitive behaviour therapy reduce fatigue in patients with chronic fatigue syndrome? The role of physical activity. Psychol. Med. 40, 1281–1287 (2010).

  43. 43.

    et al. Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst. Rev., Issue 3. Art. No.: CD003200. doi:10.1002/14651858.CD003200.pub2 (2004).

  44. 44.

    et al. The effect of exercise on levodopa absorption. Neurology 42, 2042–2045 (1992).

  45. 45.

    et al. Blood levodopa levels and unified Parkinson's disease rating scale function: with and without exercise. Neurology 43, 1040–1042 (1993).

  46. 46.

    et al. The effect of a clinically practical exercise on levodopa bioavailability and motor response in patients with Parkinson disease. Clin. Neuropharmacol. 33, 254–256 (2010).

  47. 47.

    et al. The effect of exercise on pharmacokinetics and pharmacodynamics of levodopa. Mov. Disord. 15, 862–868 (2000).

  48. 48.

    et al. Exercise improves efficacy of levodopa in patients with Parkinson's disease. Mov. Disord. 22, 427–430 (2007).

  49. 49.

    et al. Changes in dopamine availability in the nigrostriatal and mesocortical dopaminergic systems by gait in Parkinson's disease. Brain 124, 784–792 (2001).

  50. 50.

    and Effect of exercise on reactivity and motor behaviour in patients with Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 81, 747–753 (2010).

  51. 51.

    et al. Premotor Parkinson's disease: clinical features and detection strategies. Mov. Disord. 24 (Suppl. 2), S665–S670 (2009).

  52. 52.

    et al. Physical activities and future risk of Parkinson disease. Neurology 75, 341–348 (2010).

  53. 53.

    et al. Recreational physical activity and risk of Parkinson's disease. Mov. Disord. 23, 69–74 (2008).

  54. 54.

    et al. The effects of an exercise program on fall risk factors in people with Parkinson's disease: a randomized controlled trial. Mov. Disord. 25, 1217–1225 (2010).

  55. 55.

    et al. A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson's disease. J. Neurol. Neurosurg. Psychiatry 78, 678–684 (2007).

  56. 56.

    et al. Cueing training in the home improves gait-related mobility in Parkinson's disease: the RESCUE trial. J. Neurol. Neurosurg. Psychiatry 78, 134–140 (2007).

  57. 57.

    et al. Best practices for physical activity programs and behavior counseling in older adult populations. J. Aging Phys. Act. 13, 61–74 (2005).

  58. 58.

    and Testing a theoretical model of exercise behavior for older adults. Nurs. Res. 52, 80–88 (2003).

  59. 59.

    et al. Interventions for promoting physical activity. Cochrane Database Syst. Rev., Issue 1. Art. No.: CD003180. doi:10.1002/14651858.CD003180.pub2 (2005).

  60. 60.

    and The transtheoretical model of health behavior change. Am. J. Health Promot. 12, 38–48 (1997).

  61. 61.

    et al. The effects of loading and unloading treadmill walking on balance, gait, fall risk, and daily function in Parkinsonism. NeuroRehabilitation 20, 307–322 (2005).

  62. 62.

    et al. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson's disease. Arch. Phys. Med. Rehabil. 84, 1109–1117 (2003).

  63. 63.

    & Is physical exercise beneficial for persons with Parkinson's disease? Clin. J. Sport Med. 16, 422–425 (2006).

  64. 64.

    et al. Evidence-based analysis of physical therapy in Parkinson's disease with recommendations for practice and research. Mov. Disord. 22, 451–460 (2007).

  65. 65.

    et al. Impact of physical therapy for Parkinson's disease: a critical review of the literature. Parkinsonism Relat Disord. 13 (Suppl. 3), S478–S487 (2007).

  66. 66.

    et al. Treadmill training for patients with Parkinson's disease. Cochrane Database Syst. Rev., Issue 1. Art no.:CD007830. doi:10.1002/14651858.CD007830.pub2 (2010).

  67. 67.

    and Exercise and neuroplasticity in persons living with Parkinson's disease. Eur. J. Phys. Rehabil. Med. 45, 215–229 (2009).

  68. 68.

    et al. Exercise builds brain health: key roles of growth factor cascades and inflammation. Trends Neurosci. 30, 464–472 (2007).

  69. 69.

    and Fitness effects on the cognitive function of older adults: a meta-analytic study. Psychol. Sci. 14, 125–130 (2003).

  70. 70.

    et al. Neurobiology of exercise. Obesity (Silver Spring) 14, 345–356 (2006).

  71. 71.

    et al. Aerobic exercise training increases brain volume in aging humans. J. Gerontol. A Biol. Sci. Med. Sci. 61, 1166–1170 (2006).

  72. 72.

    et al. Increase in prefrontal cortical volume following cognitive behavioural therapy in patients with chronic fatigue syndrome. Brain 131, 2172–2180 (2008).

  73. 73.

    et al. Motor reorganization in asymptomatic carriers of a single mutant Parkin allele: a human model for presymptomatic parkinsonism. Brain 128, 2281–2290 (2005).

  74. 74.

    et al. Heterozygous carriers of a Parkin or PINK1 mutation share a common functional endophenotype. Neurology 72, 1041–1047 (2009).

  75. 75.

    et al. Design and baseline characteristics of the ParkFit study, a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patients. BMC Neurol. 10, 70–79 (2010).

  76. 76.

    et al. Neuroprotective effects of prior limb use in 6-hydroxydopamine-treated rats: possible role of GDNF. J. Neurochem. 85, 299–305 (2003).

  77. 77.

    et al. Exercise induces behavioral recovery and attenuates neurochemical deficits in rodent models of Parkinson's disease. Neuroscience 119, 899–911 (2003).

  78. 78.

    et al. Forced limb-use effects on the behavioral and neurochemical effects of 6-hydroxydopamine. J. Neurosci. 21, 4427–4435 (2001).

  79. 79.

    et al. Restorative effect of endurance exercise on behavioral deficits in the chronic mouse model of Parkinson's disease with severe neurodegeneration. BMC Neurosci. 10, 6–20 (2009).

  80. 80.

    et al. Effects of treadmill exercise on dopaminergic transmission in the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine-lesioned mouse model of basal ganglia injury. J. Neurosci. 27, 5291–5300 (2007).

  81. 81.

    et al. Physical activity increases mRNA for brain-derived neurotrophic factor and nerve growth factor in rat brain. Brain Res. 726, 49–56 (1996).

  82. 82.

    et al. Physical activity elicits sustained activation of the cyclic AMP response element-binding protein and mitogen-activated protein kinase in the rat hippocampus. Neuroscience 107, 219–229 (2001).

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The research work of M. Munneke and B. R. Bloem is supported by grants from ZonMw, The Netherlands Organization for Health Research and Development (75020012), The Michael J. Fox Foundation for Parkinson's Research, and the National Parkinson Foundation.

Author information


  1. Department of Neurology, Nijmegen Centre for Evidence Based Practice, Radboud University Nijmegen Medical Centre, PO Box 9101, 6500 HB Nijmegen, The Netherlands

    • Arlène D. Speelman
    •  & Marlies van Nimwegen
  2.  Department of Neurology, Donders Institute for Brain, Cognition and Behavior, PO Box 9101, 6500 HB Nijmegen, The Netherlands

    • Bart P. van de Warrenburg
    •  & Bastiaan R. Bloem
  3.  Department of Neurology, Scientific Institute of Quality of Healthcare, PO Box 9101, 6500 HB Nijmegen, The Netherlands

    • Marten Munneke
  4.  Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, MCA-241, CA 90033, USA

    • Giselle M. Petzinger


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A. D. Speelman, B. P. van de Warrenburg, and G. Petzinger researched data for the article and wrote the manuscript. A. D. Speelman, B. P. van de Warrenburg, M. Munneke and B. R. Bloem made substantial contributions to discussions of the content. All authors contributed to review and/or editing of the manuscript before submission.

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The authors declare no competing financial interests.

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Correspondence to Bastiaan R. Bloem.

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