The impact of exercise on Parkinson’s

Keep yourself active and you will help to keep yourself fitter. It seems almost too obvious these days even to bother stating it.

The value of exercise as a means to modify disease and reduce susceptibility to certain illnesses is well supported by research. We now know that participation in physical activity throughout life can be a predictor of many conditions which occur in older age, such as dementia and heart disease.

So well is the link understood that it can be seen everywhere in public health messages aimed at encouraging all walks of society to embrace physical activity and to embed this within our everyday culture. This is even more strongly advocated for those living in society with long-term conditions, with clearly defined benefits in both physical and mental health.

But what if you find yourself locked in a vicious cycle of having a condition that could be helped by exercise - but at the same time makes it much harder for you to do it?

Alongside my role at RGU, I have developed a clinical interest in Parkinson’s over the past decade and am fortunate to have been awarded £250,000 for a Clinical Academic Fellowship from the Chief Scientist Office and Parkinson’s UK to progress work on exercise provision for people living with the chronic condition.

Parkinson’s results in a complex array of both physical and non-physical symptoms, all of which culminate in people becoming more sedentary and subsequently experiencing a lower quality of life.

Most typically physical symptoms centre upon four key features; tremor, slowness of movement, rigidity and postural instability. These ultimately effect a wide range of everyday tasks, with the impact on walking being one of the greatest factors of a declining quality of life.

The progressive nature of Parkinson’s limits participation in exercise and initiates that vicious cycle of inactivity – leading to reductions in muscle strength, flexibility, balance, aerobic fitness, and an increased risk of falls. This is compounded further by symptoms that do not affect movement, such as fatigue and depression, which reduce the motivation to be active. The long-term result is that that the body loses fitness and muscle tone, not only as a result of Parkinson’s but also due to physical inactivity.

By 2030, the global prevalence of Parkinson’s is predicted to rise by 50%, highlighting the clear need for effective, sustainable and accessible services to optimise quality of life, and allow people to lead meaningful lives as valuable contributors to society.

Despite large-scale investment and significant breakthroughs in our understanding of the underlying mechanisms behind Parkinson’s, scientists have yet to find a long-term medication which limits the rate of decline, and hence disability within this population. Instead, people living with Parkinson’s are given regular medication to augment their falling levels of dopamine - the chemical responsible for communicating information around the brain essential for everyday functions, such as walking.

While science seeks to develop a cure to the condition, there has also been a substantive movement from within the Parkinson’s community itself to be involved in the management of their condition, allowing them to assert control.

A large part of this has been a recognition of the potential value of exercise in the management of Parkinson’s. Recent reviews into Parkinson’s treatment indicate that participation in regular exercise correlates with improved symptoms, such as improvements in strength, balance, fitness, function, and walking, as well as reducing depression and fatigue. Those who regularly participate in exercise have experienced an enhance sense of confidence, and by exercising as part of a group they have benefited from a network of community support and group empowerment.

Perhaps of greater significance is the emerging evidence suggesting that engaging in regular high-intensity exercise brings about physiological changes within the brain, creating new neural pathways and blood vessels that may have a disease modifying effect. Consequently, this has resulted in a growing consensus that exercise is a key ingredient and integral component of Parkinson’s management – not solely as complementary to medication, but of equal importance. This has formed a central part of my research.

There is a fantastic opportunity for physiotherapists to take a greater role in ensuring that exercise forms the cornerstone of clinical practice. Physiotherapists today possess a range of skills in health improvement and promotion, behavioural change and coaching, which makes them ideally placed to provide impactful support to people living with Parkinson’s. They are able to prescribe individualised exercise programmes which meet the needs of the individual, whether this is chair-based exercise, more intensive exercise specially designed for those with Parkinson’s, or community-based exercise such as dance, tai chi, or boxercise. Physiotherapists can also manage and treat any specific problems which impact movement while accommodating any other co-existing health conditions to maximise function, and ensure those with Parkinson’s are able to lead healthier and happier lives.