Everyone needs to exercise – it is good for our general health and wellbeing, and for people with Parkinson’s disease it affords extra benefits. It has been shown to improve mobility, balance, fitness and muscle strength, and in people with mild to moderate disease it reduces falls. It might even slow the progression of the disease. But what exercise should you do? And how can people with Parkinson’s disease get started and maintain an exercise habit over the long term?

The question of what type of exercise is best for people with Parkinson’s disease has been a hot topic for several years. Research suggests that all forms of exercise are beneficial, and that there is no one type of exercise that is better than another. This implies that people with Parkinson’s disease are free to pick and choose whatever exercise they would like to do. BUT there is a caveat.  Different types of exercise come with different benefits: to get fitter we need to do aerobic exercise; to get stronger, we need to do strength exercise; to walk better we need to practice walking etc. This means that people with Parkinson’s disease should be aiming to include a variety of different types of exercise into their program – though they can choose specifically what form of exercise to do for each type (e.g. walking overground versus walking on a treadmill). The Parkinson’s Foundation’s Parkinson’s Exercise Recommendations, is a great resource to start thinking about the different types of exercise to include. Broadly speaking, the guideline recommends aiming for at least 150 minutes of moderate to vigorous intensity exercise per week. This includes: aerobic exercise (e.g. brisk walking, cycling on an exercise bike) for 30 minutes per session 3 days per week; strength training on 2 to 3 non-consecutive days; balance, agility (e.g. tai chi, dance, general exercise that includes elements of balance and agility such as standing on one leg) and (where appropriate) multi-tasking training 2 to 3 days per week; plus stretching on at least 2 to 3 days per week. These guidelines can then be adapted to suit the individual’s preferences, goals and symptoms. After all, exercise is like medicine, and needs to be prescribed for the individual, in the right combinations, at the right dose, with the prescription updated over time.

Exercise information can feel overwhelming – especially for anyone who is not currently exercising. For most people, it is best to start off by choosing one or two things to incorporate into their weekly routine and build up from there. Remember, some exercise is always better than nothing! Getting the right support and advice can make a big difference too. This is where consulting a health professional (eg, physiotherapist or exercise physiologist) with expertise in exercise prescription for people with Parkinson’s disease comes in. They can help people with Parkinson’s disease to develop the exercise self-management knowledge, motivation and skills they need to start and sustain an exercise program. This includes knowledge about the benefits of exercise, goal setting, problem solving, self-monitoring (e.g. using a pedometer) and finding social support. Health professionals can progress programs over time as needs change, and ensure people know when and where to seek help.

Part of the challenge in supporting long term exercise programs (i.e. over the entire course of the disease) is ensuring equitable access to the right professional support. Associate Professor Terry Ellis from Boston University has suggested an approach based on the ‘dental model’ of care (Ellis et al 2021, Semin Neurol). Just like we have regular dental check-ups and treatment as needed from a young age, optimally people with Parkinson’s disease should be referred to an appropriate exercise professional from the time of diagnosis, and have regular (e.g. 6 to 12 monthly) check-ups with short bursts of treatment, supplemented by independent exercise (with the support of family and friends) in between.

Dr Allyson Flynn, a recently completed PhD student from The University of Sydney and an academic at The University of Canberra, has been researching ways to implement this ‘dental model’ of sustainable exercise management for people with Parkinson’s disease. Her work has shown that a hybrid approach (combining in-person sessions in the clinic with home-based telehealth sessions and independent exercise) is effective, sustainable and resource efficient. Dr Flynn completed a systematic review that found home-based exercise that is prescribed, monitored and progressed improves balance-related activities and walking speed, and is just as effective as similar centre-based programs (Flynn et al 2019, JoP). Restrictions associated with the Covid pandemic gave Dr Flynn the opportunity to explore the use of telehealth after in-person therapy.  She found telehealth (using both telephone and videoconferencing calls) to be feasible and acceptable, with high adherence to the exercise, no serious adverse events and less therapist time required than in-person sessions (Flynn et al 2021 and 2022, Clinical Rehab). Telehealth was even found to effectively support people to maintain their activity levels during a Covid-19 lockdown (Flynn et al 2021, Mov Disord published abstract).

In summary, exercise is an important part of long-term management for people with Parkinson’s disease. There is no ‘one size fits all’ exercise prescription. There are guidelines to aspire to, but great flexibility about the exercise that is performed within those guidelines. To begin and sustain exercise over the course of the disease, people should consult a health professional with expertise in exercise for people with Parkinson’s disease to equip them with exercise self-management skills as well as prescribe and monitor their program. Using the ‘dental model’ with a hybrid approach can enable individuals to have effective programs that are prescribed, monitored and sustainable over the course of the disease.

Natalie Allen, PhD, is an associate professor of physiotherapy at the University of Sydney. She will be a speaker at the WPC 2023 in Barcelona where she will speak about “Enabling people with PD to exercise.” View the Scientific Program here.

Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not necessarily reflect the opinions of the World Parkinson Coalition®