Long-term effects of exercise and physical therapy in people with Parkinson disease

Key Points

  • Most progressive strength and aerobic endurance training programmes have positive effects that last for 12 weeks

  • Extended progressive strength training improves muscle strength for up to 24 months and aerobic endurance training increases walking capacity at 6–16 months

  • Balance training improves balance, gait and mobility, and reduces falls for up to 12 months after completion of treatment

  • Gait training improves gait performance and walking capacity for up to 6 months after training

  • Tai chi and dance improve balance and tai chi reduces fall frequency up to 6 months after training

  • A training period of at least 6 months is effective for achieving clinically meaningful improvement in UPDRS-III scores

Abstract

Parkinson disease (PD) is a progressive, neurodegenerative movement disorder with symptoms reflecting various impairments and functional limitations, such as postural instability, gait disturbance, immobility and falls. In addition to pharmacological and surgical management of PD, exercise and physical therapy interventions are also being actively researched. This Review provides an overview of the effects of PD on physical activity — including muscle weakness, reduced aerobic capacity, gait impairment, balance disorders and falls. Previously published reviews have discussed only the short-term benefits of exercises and physical therapy for people with PD. However, owing to the progressive nature of PD, the present Review focuses on the long-term effects of such interventions. We also discuss exercise-induced neuroplasticity, present data on the possible risks and adverse effects of exercise training, make recommendations for clinical practice, and describe new treatment approaches. Evidence suggests that a minimum of 4 weeks of gait training or 8 weeks of balance training can have positive effects that persist for 3–12 months after treatment completion. Sustained strength training, aerobic training, tai chi or dance therapy lasting at least 12 weeks can produce long-term beneficial effects. Further studies are needed to verify disease-modifying effects of these interventions.

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All authors contributed equally to the researching, discussion writing and review of this manuscript.

Corresponding author

Correspondence to Margaret K. Mak.

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The authors declare no competing financial interests.

Supplementary information

Supplementary information S1 (table)

Study characteristics (DOC 151 kb)

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Glossary

Walking economy

The steady-state aerobic demand for a given sub-maximal speed of walking, as measured by VO2 uptake.

Walking capacity

The distance a person is capable of walking over a period of time, typically measured by 6-min walk distance.

Hoehn and Yahr rating scale

A commonly used scale (from stages 1 to 5) for describing how the symptoms of Parkinson disease progress.

Double-support phase

A phase in the gait cycle when the body weight is supported by both legs.

Set-shifting

The ability to move back and forth between tasks in response to changing goals or environmental experiences.

Limit of stability

A measurement of the maximum centre of pressure displacement with respect to a person's base of support.

Anticipatory postural adjustments

The automatic feedforward postural activities to counteract the destabilizing effects of voluntary movements.

Reactive postural responses

The automatic postural responses against external perturbation with or without a change in a person's base of support.

Supervised programme

Any training that was supervised by either a physical therapist or exercise trainer in a one-to-one or small-group basis.

Progressive resistance training

A style of strength training exercise that involves the steady utilization of resistance via a loading source.

Aerobic endurance training

An exercise training method to improve cardiopulmonary fitness.

Nordic walking

A total body version of walking activity using specially designed walking poles (similar to ski poles).

Minimal detectable change

A statistical estimate of the smallest amount of change that can be detected by a measure that corresponds to a noticeable change in ability.

Exergaming

A term used for video games that are also a form of exercise.

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Mak, M., Wong-Yu, I., Shen, X. et al. Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol 13, 689–703 (2017). https://doi.org/10.1038/nrneurol.2017.128

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