Clinical applications of exercise in Parkinson’s disease: what we need to know?

ABSTRACT

Introduction

Exploring the potential of exercise in the rehabilitation process of patients with Parkinson’s (PD) may be an interesting treatment perspective. Exercise-induced responses derived from neurotrophic elements appear to ameliorate the decline in neurodegeneration. Despite this understanding, the literature needs to be updated.

Areas covered

Our review focuses on: a) the key mechanisms of exercise on PD, highlighting mainly the responses related to neuroplasticity; b) the effects induced by different traditional types of exercise, also highlighting the effects of complementary therapies related to movement; c) the volume of exercise required to support efficient results are explored in the context of PD. Additionally, the proposition of new clinical application strategies in the context of PD will also be determined.

Expert opinion

It is suggested that different intensities of aerobic exercise be explored for the treatment of PD. The results associated with high intensity seem promising for performance, physiological and clinical parameters, such as BDNF production and cognition. On the other hand, the diversification of tasks and repetition of motor gestures appear as consistent arguments to exercise prescription. Finally, for future investigations, the neuromodulation strategy in association with aerobic exercise appears as a potential inducer of benefits on gait and cognitive function.

KEYWORDS:

• Balance
• exercise
• mobility
• parkinson’s disease
• strength

Article highlights

• Exercise induces neuroplasticity, as well as the expression of neurotrophins capable of repairing function in patients with PD;

• The reduction of oxidative stress appears to play a significant role in attenuating the progression of PD;

• A multimodal exercise approach is recommended for patients with PD. Multiple tasks in a training program seem effective in improving sensorimotor and mobility deficits, mainly tasks with functional exercises;

• Considering the decline in cardiorespiratory capacity in patients with PD, HIRT appears as a promising proposal for the development of aerobic fitness and a tolerable strategy for patients with PD. However, a larger evidence base is needed;

• tDCS seems to be an adjunctive strategy in the treatment of patients with PD, alone or in conjunction with aerobic exercise.

Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.