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Exercise for Parkinson's prevention?

March/April! 2012 * Volume 30, Number 2

Parkinson's disease is a nenrodegenerative brain disorder that most often progresses slowly--patients with the disease will usually be living with it for twenty years or more from the time of diagnosis. While Parkinson's disease itself is not fatal, the Center for Disease Control rates Parkinson's-related complications as the 14th cause of death in the U.S. There is currently no cure for Parkinson's, but recent studies reveal that vigorous exercise may both prevent and help treat it.

Normally, neurons in the brain produce dopamine. These brain cells concentrate in the area of the brain known as the substantia nigra. Dopamine relays messages between the substantia nigra and other parts of the brain to control movements of the human body, helping humans to have smooth, coordinated muscle movements. Symptoms of Parkinson's appear when approximately 60% or more or the dopamine-producing cells are damaged.

Parkinson's disease, then, is a brain disease that affects the body and how it moves. Yet moving the body--that is to say, exercising--may be one of the best and most underutilized ways of combating the condition.

The current theory of Parkinson's origins (known as Braak's hypothesis) is that the earliest signs of Parkinson's are found in lie enteric nervous system, the medulla, and the olfactory bulb, which controls your sense of smell. Under this theory, Parkinson's only progresses to the substantia nigra and cortex over the years. This theory is increasingly borne out by evidence that non-motor symptoms, such as a loss of sense of smell, hyposmia, sleep disorders, and constipation may precede the motor features of the disease by several years. For this reason, researchers are increasingly focused on these "non-motor" symptoms to both detect Parkinson's disease as early as possible and to look for ways to stop its progression.

But exercising vigorously when you're middle-aged may lessen your chance of getting Parkinson's disease when you're older. And for people who already have the disease, exercise during the early stages when a fair amount of physical movement is still possible--may slow the pace at which the disease gets worse and physical movement becomes increasingly difficult.

Early in the disease, physical therapy can help Parkinson's patients build up strength and maintain range or motion. Treadmill training helps with gait. Various exercises may improve balance and help people avoid falls. Parkinson's patients sometimes benefit from systems that provide external cues to prompt movement. Of course, the goals, as well as the techniques, of physical therapy must change as the disease gets worse.

Parkinson's disease patients probably also benefit from exercise and overall physical fitness, beyond the more specific effects of physical therapy. Many lines of research have shown that exercise, especially if it's aerobic and gets the heart beating faster, has a protective effect on brain tissue. There are also some--not many--findings specific to Parkinson's that suggest cardiovascular fitness has benefits. for example, Parkinson's patients who are in good shape score better on cognitive and muscle control tests. They may also live longer. Early in the disease, no special facilities are needed. Just like anyone else trying to get into shape, people with Parkinson's disease can work out at the local gym or health club.

Several of the large prospective cohort studies that follow tens of thousands of people for many years have shown a fairly strong correlation between exercise earlier in life and a lesser chance of developing Parkinson's later on. Exercising seems to lower the likelihood of getting Parkinson's by about 30%. Exercise habits in people's 30s and 40s decades before Parkinson's occurs--seem to have an influence on the risk.

Dr. J. Eric Ahlskog, a neurologist at the Mayo Clinic who has written extensively about Parkinson's and exercise, noted in an opinion piece in 2011 that for exercise to have a preventive effect, it must be fairly vigorous: 20-to 30-minute bouts of activity that's intense enough to get your heart rate up.

There is the possibility of reverse causation: perhaps it's not that exercise prevents Parkinson's disease, but rather that a very early, "preclinical" form of the disease without clear symptoms makes people less willing or able to exercise. That is as may be, but for Parkinson's patients, it doesn't change the recommendation for vigorous exercise to try and stave off progression of this debilitating and unsettlingly common disease. For example, Dr. Edward Wolpow, a neurologist at Harvard-affiliated Mount Auburn Hospital in Cambridge, MA, urges his patients with early Parkinson's to work on building up their strength, balance, and endurance precisely because they will be needed later on.

April is Parkinson's Awareness Month. If you or someone you know has Parkinson's disease you are not alone. In the United States, 50,000 to 60,000 new cases of Parkinson's disease are diagnosed each year, adding to the one million people w ho currently have Parkinson's disease. Worldwide, it is estimated that four to six million people suffer from the condition.

Harvard Health Letter, March 2012, "Vigorous Exercise May Prevent Parkinson's Disease and Help Treat It,"

National Parkinson Foundation, 2012,
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Publication:Running & FitNews
Geographic Code:1USA
Date:Mar 1, 2012
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