Let’s talk physical activity and exercise

This blog captures the highlights from a discussion that took place over Zoom, led by Laurel and Andrew who have Parkinson’s.

Read on to meet the group and get the answers to some of Laurel and Andrew’s burning questions.

Laurel Miller

Diagnosed with Parkinson's 7 years ago

Laurel feels strongly that research findings about the benefits of physical activity and exervise should be made clear at diagnosis. Before lockdown she attending regular face-to-face PD Power, yoga, pilates and dance classes. She's found it harder to stay motivated to keep active and exercise at home, and welcomes the gradual return to group activities. 

Andrew Cassy

Diagnosed with Parkinson's 11 years ago

Andrew is an enthusiastic table tennis player who also finds dog walking, regular stretching and physiotherapy sessions helpful. He's a firm believer that physical activity and exercise is vital in the management of Parkinson's and tries to do one of hour of exercise a day. 

Professor Erika Franzén

Physiotherapist and Professor at the Karolinska Institute in Sweden

Erika's research focuses on Parkinson's. She's currently involved in running a clinical trial to understand how an exercise programme that improves balance might help people with Parkinson's, including motor and non-motor symptoms. She is also interested in looking at what happens in the brain after a period of exercise to understand why exercise is beneficial. 

Dr Serene Paul

Physiotherapist and researcher at The University of Sydney

Serene is particularly interested in finding sustainable ways to keep people with Parkinson's active and understanding what activities people enjoy. She's also working with Dr Natalie Allen to find ways to incorporate physical activity and exercise at any stage of the condition. 

Julie Jones

Physiotherapist and researcher at the Robert Gordon University in Scotland and Co-Chair of the National Exercise Club

Julie is currently researching a collaborative exercise intervention called PDConnect, which combines one-to-one specialist physiotherapy, group-based exercise and supported self-management. This approach is being tested to see if it is a feasible and effective way to support people with Parkinson's to engage in physical activity and exercise. This work is being part funded by Parkinson's UK. 

Are there specific symptoms of Parkinson’s that being active and exercising can help with?

Erika: "We have seen a lot of evidence that being active and exercising can help with a range of symptoms and behaviour, for instance helping to increase balance, faster walking and improving various motor symptoms of Parkinson’s.

"There is also some evidence that physical activity and exercise is helpful for non-motor symptoms of the condition, such as mood, cognition and helping with anxiety."

Serene: "There is also emerging evidence that physical activities that involve an element of mindfulness can be beneficial, for example, yoga and tai chi can really help improve mood."

Laurel and Andrew's tips on using physical activity and exercise to help manage symptoms

• Stretching and physiotherapy sessions help with stiffness.
• Walking is a great way to incorporate physical activity, whether that's a short stroll, Nordic walking or a brisker walk to get your heart pumping.
• Hand exercises and table tennis help with fine motor skills.
• The social aspect of being active helps boost your mood.
• Physical activity and exercise can help with fatigue and finding motivation for other tasks.

Does research show certain types of physical activity and exercise to be better than others?

Erika: "We know keeping active and exercising is beneficial but we don’t have that much evidence on which activities are better than others. Generally keeping active in any way is good."

What’s happening in the brain when we exercise?

Erika: "There’s not a lot of research on this topic, but the feeling is that periods of high intensity exercise might be altering the way the brain works, to improve symptoms and even potentially slow the progression of the condition. This is on top of the general benefits for anyone staying physically active. We are looking to better understand exactly what intensity and type of exercise programme might have this effect.

"When we exercise we know this is helping with what is called neuroplasticity: improving brain connections and function. But now we need to understand exactly what is happening when someone with Parkinson’s exercises.

"Our research is hoping to understand how the balance-based exercise programme is changing the way the brain functions in people with Parkinson’s through the use of brain scans and looking at levels of a protective factor called brain–derived neurotrophic factor (BDNF)."

Some studies have shown that exercise can boost levels of BDNF, and regular exercise helps sustain these levels over time. BDNF is what is known as a growth factor, an important set of molecules that play a role in the growth, development and survival of the brain.

So, does exercise boost dopamine levels in the brain?

Erika: "I don’t think exercise is leading to the replacement of the dopamine-producing cells that are lost in Parkinson’s, but it might be strengthening the connections that are still in place. So for instance, helping the brain cells that haven’t been lost to work more efficiently or even boosting alternative pathways that aren’t affected by Parkinson’s."

Could there be an exercise pill in the future?

Erika: "I doubt it would be that easy. I think there is a possibility that various medications could boost and enhance the benefits people with Parkinson’s get from exercise.

"For instance, a medication or therapy that could help the release of protective factors that we believe are being produced during exercise could increase the therapeutic impact for people with Parkinson’s.

"Also, medication to improve motivation and reduce symptoms of depression may also help people to stay active."

When should physical activity and exercise be looked at as a management strategy?

Erika: "As early as possible! It is too late to wait for someone to fall or have trouble walking. It should be encouraged at diagnosis. Just as medication is prescribed and reviewed, physical activity and exercise should also be part of this."

Julie: "Sometimes when people are diagnosed they go through that phase of bewilderment, shock, denial and actually they’re not really in the headspace to be able to go away and find their own management strategies.

"That’s why a team and network needs to support individuals from diagnosis, and physical activity and exercise should be integral to this early management."

Is there any research looking at the best way to deliver exercise programmes?

Julie: "Perhaps not surprisingly there isn’t going to be a one-size-fits-all approach. Physical activity needs to be tailored to the individual.

"We also realise that just telling people that they need to be physically active or participate in exercise is not enough for people with or without Parkinson’s to stick to a consistent management plan.

"We need to give people the tools to develop sustainable physical activity habits and achievable goals. We need a flexible service that can change with people’s circumstances and Parkinson’s to support them to adopt physically active lifestyles."

How can technology be used to encourage physical and exercise activity at home?

Serene: "Our research has shown that if digital tools are going to be used for providing professional support to encourage physical activity, for instance, video calls, then people much prefer to have a face–to–face visit before using these remote methods.

"We also know that not everyone likes to use these types of digital tools and sometimes keeping it simple with people is best."

Another aspect that was highlighted in the discussion was gaming. People have told us how useful gaming platforms such as the Wii Fit are in helping to motivate them to keep active and have an element of competition.

Andrew also shared a specific type of gaming that he finds useful involving virtual reality (VR), where you can put on a VR headset and play sports such as table tennis or bowling.

Are there any recommended devices to encourage people to stay active?

Serene: "Wearable devices can be incredibly useful for an individual to motivate and challenge themselves. A simple step counter, known as a pedometer, is a readily available option. Some of the old style pedometers that are worn on the hip as opposed to the wrist are usually better for people who walk slowly and find themselves shuffling.

"It’s very much about getting the individual to pick something that works for them."

What should the future priorities for physical activity and exercise research be?

The discussion highlighted that more research is needed to understand the evidence for specific physical activity and exercise recommendations for people with Parkinson’s. Specifically focusing on personalised approaches to support and encourage people to stay active. The panel put together their list of what they would like to see addressed in Parkinson’s research:

• Clear evidence of what physical activities and exercise are best for people with Parkinson’s and specific symptoms.
• Larger and longer–term studies, across multiple sites and countries to understand the long–term benefits of physical activity and exercise.
• Tried and tested, multidisciplinary, personalised exercise programmes to support people with Parkinson’s to set goals and monitor progress.
• More funding to invest in supporting people to keep active.

Feeling inspired?

Parkinson’s UK has some great resources to encourage you to stay active. And Laurel and Andrew recommend some great programmes too:

• Browse our exercise hub.
• Find support and exercise classes near you.
• Free online exercise classes for people with Parkinson’s on the Power for Parkinson's website.
• Get support and coaching to stay active with Parkinson’s on the PD Warrior website.

These are not the only resources and classes available, there are lots to choose from. It’s important that you find what works for you in coordination with your healthcare professionals.