[This is a guest post by Christian Fortin. Christian is passionate about strength and conditioning and enhancing sports performance through evidence-based coaching. He recently completed the Athletic Lab Coaching Mentorship Program.]
What is Parkinson’s disease?
Parkinson’s Disease (PD) is a neurological disorder that affects muscle movements and brain function. The part of the brain it attacks is the basal ganglia, which is important for the initiation and control of subconscious, gross body movements. It also plays a key role in regulating the intensity of movement parameters. PD mainly affects the production of dopamine in this region, which leads the brain to struggle with regulating movement. Not only is motor function affected, but it can also affect sleep, digestion, an increase in depression and anxiety, and cognitive issues. There is currently no known cure for Parkinson’s, but research has been pointing to physical activity as a great way to slow down the effects of Parkinson’s (1).
The research
One study, conducted in the Parkinson’s Environment and Gene study in California, followed 555 PD patients and examined sedentary, moderate, and strenuous exercise. People with Parkinson’s who participated in strenuous physical activity exhibited lower C-protein levels. This is important because having higher levels of C-protein can lead to motor deterioration. Another benefit is increased Fc receptor-like 2 (FcRL2) expression, which may regulate B-cell activity and help improve immune function. Participants in the moderate physical activity group also experienced reduced brain inflammation. Meanwhile, sedentary patients had higher levels of inflammation than those in the moderate and strenuous physical activity groups. (7) From this data, we can see that physical activity reduces chronic inflammation in patients with PD.
Another study followed 237 patients who had early signs of Parkinson’s disease over five years. Over that period, they used the Physical Activity Scale for the Elderly (PASE) questionnaire to track leisure-time exercise and household work. When it came to the clinical side of the study, they looked at motor function, specifically postural and gait stability, activities of daily living, and cognition, which was measured by processing speed. They found that people who maintained regular exercise over that time could counteract the effects of PD and preserve higher levels of coordination, balance, and gait control(1). Right now, modern medicine is only able to provide symptomatic relief, but has yet to show a slowing of neurodegeneration like exercise can. Another area where physical activity shines is with automaticity where medicine doesn’t have any real effect on this, skill training can help rewire the brain. (12) This shows that high regular physical activity should not be thought of as a secondary component to fighting PD, but as a part of a patient’s long term plan to help fight their battle with PD.
Working out
If you have PD, it is essential to consult a doctor before starting exercise to ensure you’re cleared to be physically active. Another recommendation is to ensure you exercise as directed by your medication to increase its effectiveness. Finally, although any form of exercise is good, make sure you choose programs tailored to PD (7).
When examining the overall effects of aerobic fitness on PD, studies show that it can significantly alleviate symptoms. Moderate aerobic exercise, such as brisk walking, stationary biking, or activities where you can still speak in full sentences, is most effective during the first six years of the disorder. The reason that depression is so high in Parkinson’s patients has to do with changes that occur with the neurotransmitter system in the brain, which is responsible for dopamine, norepinephrine, and serotonin. Aerobic exercise has been shown to significantly enhance the function of these neurotransmitters. Exercise can reduce inflammation in the brain, including interleukin-1, which is responsible for immune system function, and tumor necrosis factor alpha, a systemic inflammatory marker. Improvements were shown to affect overall mood within less than 12 weeks, but greatly improve at the 12-week threshold and beyond. Once this threshold is met, some patients notice a cumulative pattern: longer periods lead to greater improvements in neurotrophic factors and neurotransmitters. Moderate aerobic intensity was shown to have greater effects on the brain than vigorous intensity did. The goal is to exercise three or more times a week, with 60-minute sessions, to achieve greater improvements (7).
Although moderate aerobic activity is shown to be more effective than vigorous, studies still show that activities that require working at a higher intensity have their benefits. A smaller study of 10 participants who had only been diagnosed with PD for less than four years, followed three workout routines weekly for a 6-month program called “Beat Parkinson’s Today,” supporting the idea that vigorous exercise helps combat the effects of Parkinson’s. They ensured their heart rates remained above 80-85% of their maximum heart rate for their age using heart rate monitors. After this program ended, they found a significant increase in 9 out of 10 patients in both dopamine transporters and neuromelanin (9). This research supports the importance of vigorous activity for patients with Parkinson’s in increasing dopamine system efficiency.
It’s essential to challenge the brain by acquiring new skills that involve diverse motor movements. Learning these new movements can help form new connections in the brain or restore previous neural pathways. This is important because it can activate the basal ganglia, which will help restore subconscious gross body movements. Another important principle when looking at the brain is the “use it or lose it” principle. When patients become sedentary and aren’t constantly working the brain, these pathways worsen, leading to increased stiffness and slowness. Learning these new skills can work out the brain and lead to changes to decrease the effects of Parkinson’s (11). Some of these activities may include boxing, pickleball, and golf. These activities challenge the brain while also increasing heart rate to decrease symptoms and depression.
In boxing, the constant movement and coordination required to dodge and punch are shown to have many benefits for people with the disorder. Unlike walking on a treadmill, boxing allows the brain to make rapid adjustments, requiring it to constantly adjust the body’s center of mass, which can help strengthen neural pathways. Another benefit is improved strength in stabilizer muscles from the constant shifting of weight required when loading for a punch. All of these factors helped boxers achieve significant improvements in balance tests, including: Berg Balance Scale, Mini-BESTest, and the single-leg stance test. Gait and overall mobility also showed significant improvements in participants’ walking speed and cadence during walking tests. Another massive benefit of boxing is that it’s a safe way to exercise while boosting adherence and overall mood in patients (3).
Pickleball is a sport that can greatly improve the health of patients with Parkinson’s disease. Creighton University’s Jamie Nesbit and Suzanne O’Neal conducted a small study examining patients with Parkinson’s who began playing pickleball and the effects on their coordination, hand function, and quality of life. Some of the biggest improvements in pickleball are its use of big, fast movements, its combination of fine hand skills, and its inclusion of a reaching movement. (4) Fine hand movements are important for patients because they usually struggle with sizing movements correctly, which can make small tasks like buttoning their shirts or grabbing objects very slow. This is usually due to an issue with the sensory feedback system, which assesses the size, shape, and weight of an object so the body can react accordingly (2). Training these fine motor skills will help the brain better process this sensory information. The quick, large movements from one side of the court to the other help with balance and gait control, which are among the biggest concerns with Parkinson’s. Finally, the reaching movement is essential because it can trigger dopamine hits in the brain. When examining the impact on the brain, these dopamine receptors are also influenced by the game’s social aspects. The participants in the sport with Parkinson’s claim to “almost forget they have Parkinson’s disease.” This quote is important because, while impacting their physical health, it gives them a new outlet to be social and form clubs and team building, along with critical decision-making.(4)
With golf’s popularity increasing over the past couple of years and its common association with older populations, it became a topic of discussion about how it can positively affect PD. Research shows that golf can lead to improvements in postural instability and bradykinesia (slowness of movement). When swinging a golf club, people must rotate their torsos extensively, allowing for less rigid, more fluid motions. Swinging a golf club also requires greater balance and coordination, which helps engage the brain while strengthening the body’s stabilization muscles. When swinging a golf club, the body is designed to shift weight quickly from one foot to the other, which can improve movement speed and help reduce the chance of falling. Golfers can play alone, but it is most often played in groups of four, which creates a social atmosphere with friends. (8)
Don’t forget to stretch!
In a review of seven studies, researchers found significant improvements in motor function after stretching. The quality of life for individuals also improved, along with enhanced motor abilities. Some other forms of movement, like Tai chi and qigong, were found to be more effective than stretching. Stretching is a simple skill to learn and add at the end of exercise, providing easy benefits.(5)
The guidelines for physical activity that the Parkinson’s Foundation recommends:
- Aerobic activity: Three days a week with a minimum of 30 minutes per session of moderate intensity
- Strength/ resistance: 2-3 days a week for at least 30 minutes per session
- Balance, agility, and multitasking: at least 2-3 days a week, using exercises that rely on these skills (7)
Conclusion
Parkinson’s disease affects many people in the United States, and with medication being expensive and only able to accomplish so much, it is important to find other alternatives. Exercise is shown to reduce chronic inflammation and enhance coordination, balance, and gait control, extending body function in ways that regular medicine can’t consistently achieve. When looking at the brain, research has shown improved function of dopamine receptors, which can help slow down the overall effects of the disease. Finally, it can help decrease depression and anxiety, helping lead to a better, happier life. Whether it’s golf, boxing, strength training, or running, all these forms of exercise can help patients with Parkinson’s lead fuller, longer lives.
References
- https://www.neurology.org/doi/pdf/10.1212/WNL.0000000000013218
- https://neuyourehab.com.au/fine-motor-symptoms-parkinsons/#:~:text=Relying%20on%20a%20highly%20developed,one%20of%20our%20finest%20features!
- https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2025.1505326/full?utm_source=chatgpt.com
- https://www.youtube.com/watch?v=6UtC8BrXd30
- https://www.sciencedirect.com/science/article/pii/S1353802025005371?utm_source=chatgpt.com
- https://www.sciencedirect.com/science/article/pii/S2666354625000729?via%3Dihub
- https://www.aarp.org/health/conditions-treatments/exercise-for-parkinsons-disease.html?utm_source=chatgpt.com
- https://pmc.ncbi.nlm.nih.gov/articles/PMC8224548/#:~:text=Swinging%20a%20golf%20club%20offers,to%20impact%20PD%20symptoms%20positively
- https://medicine.yale.edu/news-article/high-intensity-exercise-can-reverse-neurodegeneration-in-parkinsons-disease/
- https://gemini.google.com/app/70e4d5a0362eaa19
- https://www.youtube.com/watch?v=HLOQ9Q3-IIw
- https://jnnp.bmj.com/content/95/11/1077
