Exercise continues to prove beneficial in managing the symptoms of Parkinson’s disease. Some research has shown that consistent exercise — at least 2.5 h/wk — can slow symptom progression and improve overall quality of life.

Dancing is among the most popular forms of exercise in this patient population, along with boxing, balance classes, tai chi, walking, and yoga.

I n a small Canadian study published this month in the Journal of Alzheimer’s Disease, 75-minute weekly dance classes were associated with significantly improved cognitive scores in patients with Parkinson’s disease over 6 years compared with not taking the classes. Each class began with a seated warm-up, followed by barre stretches, then floor-work dances. The group also learned specific choreography for a performance.

Activities that involve rhythm, such as dancing, biking, boxing, or singing, seem to help with Parkinson’s disease, neurologist Abdul Qayyum Rana, MD, director of the Parkinson’s Clinic of Eastern Toronto and Movement Disorders Centre in Toronto, told Medscape News Canada. “We really don’t know why it works, but somehow it does work for Parkinson’s.”

Three Categories

E xercise should be grouped into three general categories for patients with Parkinson’s disease, said Rana, who also founded the World Parkinson’s Program charitable organization.

For mild, early-stage Parkinson’s disease, when patients are most mobile, high-intensity exercises, such as jogging, running, Zumba, boxing, dancing, and biking are helpful, he said.

For moderate Parkinson’s disease, when patients have bilateral disease but good balance and have had the disease for about 5-7 years, walking on a treadmill or riding a stationary bike is appropriate.

As the disease progresses, falls become a large risk, so patients “should exercise in the company of someone,” Rana said, adding that stretching, yoga, walking with a walking aid, and tai chi are good choices.

Dancing has been known to help with Parkinson’s disease for a long time, he said. “Any repetitive high-to-moderate amplitude exercises are good for Parkinson’s patients.”

Rana’s team has developed a 45-minute daily exercise regimen for patients with Parkinson’s disease with a downloadable diary. The free program “is used in about 50 countries and translated into 25-30 languages,” Rana said.

‘As Important as Medication’

“Exercise helps every stage of Parkinson’s disease,” Rana said. “Exercise is as important as medication.” He added, however, that his most challenging task as a Parkinson’s disease specialist is getting patients to exercise regularly.

“I tell patients that every Parkison’s patient should have a treadmill. I also tell them the treadmill should not be in the basement. Do it in a bright place,” Rana said.

Some other earlier studies have shown the benefits of tango dancing, Alfonso Fasano, MD, PhD, chair in neuromodulation and multidisciplinary care at the University of Toronto and University Health Network, both in Toronto, told Medscape News Canada. The social engagement or cultural relevance of the dance might provide the benefit, he said. “As doctors, we always underestimate the role of happiness,” he said. “When you are happy, you do something better, you feel better, you move better.

“From what we know, [the benefit] is not specific to dancing,” he said. For patients in Ireland with Parkinson’s disease, Irish dancing might be helpful, Fasano explained. Elsewhere, the social distance between people may be greater, patients may not engage as actively in that type of dancing, and the benefits “would not be as visible,” he said.

Adding Gaming to Exercise

To improve patients’ adherence to exercise, researchers are “gamifying” it (that is, enhancing the exercise with gaming components), Fasano said. “The issue, though, is the quality of studies. I’m sure these studies will come.” He mentioned that, like the recent dance study, most studies on exercise and Parkinson’s disease lack a true control group and randomization.

He pointed to a study in Lancet Neurology of aerobic exercises that incorporated video games. The exercises were performed at home and supervised remotely and showed promise for patients with mild Parkinson’s disease.

What’s most promising in exercise therapy is that it is now an established treatment, Fasano said. When he was a trainee, it “was all about drugs.” There was little talk about exercise, and it wasn’t mentioned in guidelines, he noted.

Important Part of Treatment

“It’s not debatable anymore that exercise is an important part of treating Parkinson’s disease,” said David Grimes, MD, associate professor of neurology at the University of Ottawa and d irector of the Parkinson’s Disease and Movement Disorders Clinic at Ottawa Hospital, Ottawa. “There’s no question that exercise makes Parkinson’s patients feel better and function better. Pretty much any program that’s been looked at shows benefit,” he said. “But there’s not a lot of head-to-head comparison.”

Exercise intensity and frequency matter, however, Grimes said. Exercising enough to raise your heart rate and to sweat is important, as is exercising a minimum of three times per week, and “preferably four or five times per week.”

“The main message is to find what you like to do and do it,” he said.

What the long-term effects of exercise are and whether exercise affects disease progression remain unanswered questions. Meanwhile, the push to find activities that can help patients manage Parkinson’s symptoms is strong as the disease’s prevalence grows. A recent analysis found that cases of Parkinson’s disease in Canada are likely to rise sharply in the coming decades. “In 2021, the estimated number of Parkinson’s cases in Canada was approximately 153,000. This figure is projected to rise by 69%, reaching 259,000 by 2050,” the report stated.

Rana, Fasano, and Grimes reported having no relevant financial relationships.

Marcia Frellick is an independent healthcare journalist and a regular contributor to Medscape Medical News.