Exercise in Parkinson’s disease

Parkinson’s disease (PD) is a progressive neurodegenerative disorder characterized by motor symptoms (e.g., slowness of movement, rigidity, resting tremor) and nonmotor symptoms (e.g., mood disturbance, cognitive decline, sleep, and autonomic impairment). As there are no treatments to slow or forestall the progression of PD, the care of patients involves a multidisciplinary approach, using pharmacological and nonpharmacological methods, to alleviate symptoms and improve quality of life. Among various nonpharmacological approaches, there is now growing evidence to support the use of exercise in PD for the management of motor and nonmotor symptoms. Here, we review the literature investigating the effects of cardiorespiratory and resistance exercise on motor and nonmotor outcomes in PD, including cognition, mood, sleep, and autonomic dysfunction. We review known and possible mechanisms underlying the effects of exercise in PD, drawing from animal and human literature, including the ways in which exercise may promote adaptive neuroplastic changes in the PD brain. We conclude by providing recommendations for clinical practice, including the parameters of exercise (e.g., intensity, duration), as well as safety and adherence considerations.