Parkinson Disease Outcomes Improve With Regular Physical Activity and Exercise

Using data from the Parkinson’s Progression Markers Initiative study, researchers examined the long-term effects of regular physical activity and exercise habits on the course of PD.

Maintaining high regular physical activity levels and exercise habits is robustly associated with slower deterioration in postural and gait function, processing speed, and activities of daily living (ADL) among patients with early Parkinson disease (PD), according to a study published in Neurology.

Previous research has reported how exercise helps motor function, along with how exercise habits, like dance training, helps improve balance and gait performance in patients with PD. However, no data exist on the long-term effects of sustained exercise and regular physical activity in this patient population, according to the researchers.

The objective of the current study was to evaluate the long-term effects of exercise on disease course in PD using data from a large, international multicenter study, Parkinson’s Progression Markers Initiative (PPMI) ( Identifier: NCT01141023), that has been underway since 2012. The PPMI study includes assessments of background factors, motor function, and cognitive function, as well as regular physical activity levels measured with the Physical Activity Scale for the Elderly (PASE) questionnaire.

The data were obtained on April 3, 2021, and included 237 patients with PD (median age, 63.0 years; 30.8% female) and 158 healthy control individuals (median age, 64.0 years; 38.0% female). Participants had a median disease duration of 3 years (interquartile range [IQR], 3-5), and the median follow-up was 5 years (IQR, 4-6 years).

The PASE total score in patients with PD decreased by 4.5 points per year during the follow-up (95% CI, –7.3 to –1.7; Spearman’s rho = –0.08; 95% CI, –0.14 to –0.03; P <.01), and no significant change was observed longitudinally among control individuals (Spearman’s rho = 0.04; 95% CI, –0.03 to –0.11; P =.26).

The average level of overall regular physical activity had significant interaction effects on the Unified Parkinson’s Disease Rating Scale (MDS-UPDRS) postural instability/gait disturbance (PIGD) subscore, Modified Schwab and England ADL (MSE-ADL) score, and symbol digit modalities test (SDMT) score (PIGD subscore, β of the interaction term [βinteraction] = –0.10 [bootstrap 95% CI, –0.14 to –0.06], t value = –5.0, Bonferroni-corrected P <.01; MSE-ADL score, βinteraction = 0.08 [bootstrap 95% CI, 0.04 to 0.12], t value = 4.1, Bonferroni-corrected P <.01; SDMT score, βinteraction = 0.05 [bootstrap 95% CI, 0.03 to 0.08], t value = 3.7, Bonferroni-corrected P <.01).

Moderate-to-vigorous exercise had a preferential interaction effect on the increase in PIGD subscore (βinteraction = –0.09 [bootstrap 95% CI, –0.13 to –0.05], t value = –4.4, Bonferroni-corrected P <.01), as well as a greater interaction effect vs that of household-, work-, and overall leisure-related activities.

Work-related activity levels mostly had an interaction effect on the progression of processing speed decline (βinteraction = 0.07 [bootstrap 95% CI, 0.04 to 0.09], t value = 4.7, Bonferroni-corrected P <.01). The largest interaction effect of housework-related activities occurred with ADL deterioration (βinteraction = 0.09 [bootstrap 95% CI, 0.05 to 0.12], t value = 4.7, Bonferroni-corrected P <.01).

Study limitations included the observational design, as causal relationships could not be assessed. Also, regular physical activity was quantified using the self-reported PASE questionnaire, which is not objective. Furthermore, the PPMI has missing data, and the researchers did not adjust the genetic background of participants.

“We believe that our finding has the potential of changing the attitude of physicians regarding exercise counseling in patients with PD,” stated the researchers. “Furthermore, the present study could serve as a guide for future randomized controlled trials with greater emphasis on sustained exercise in patients with PD.”

Disclosure: PPMI is funded in part by pharmaceutical companies. One of the study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Tsukita K, Sakamaki-Tsukita H, Takahashi R. Long-term effect of regular physical activity and exercise habits in patients with early Parkinson disease. Neurology. Published online January 22, 2022. doi:10.1212/WNL.0000000000013218