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Exercise
The potential benefits of exercise early in the course of Parkinson's disease have been increasingly recognized. It is generally believed that patients who maintain an exercise program from the time of diagnosis throughout the disease course will do better long-term; however, at this time, this supposition is based more on clinical experience than controlled trials. In a review of 39 exercise trials conducted in 1827 Parkinson's disease patients at various stages of the disease, it was demonstrated that most studies reported short-term benefits from exercise, particularly for gait, balance, and disability based on UPDRS scores. It was also noted that there is no definitive evidence that one form of exercise is more beneficial than another. In a randomized, delayed-start study of 31 Parkinson's disease patients ranging from newly diagnosed to disease duration of 10 years, patients who started a structured exercise program 6 months prior to the delayed-start group did not show improvements in UPDRS motor scores; however, the early-start group had significant improvements in depression compared with the delayed-start group. In another study of Parkinson's disease patients at various disease stages, tai chi, resistance training, and stretching were compared in a randomized, controlled, 6-month study with exercise sessions every 2 weeks. Improvements in gait, balance, and motor function were seen with both tai chi and resistance training compared with stretching. In addition, tai chi improved postural instability, stride length, and functional reach to a significantly greater degree compared with resistance training. A follow-up study found significant improvements in quality of life with tai chi compared with both resistance training and stretching. A randomized, 16-month study compared balance, physical function, UPDRS, quality of life and walking economy after supervised flexibility/balance/function exercise, supervised aerobic exercise, and home exercise. The only significant differences after 16 months were improvements in UPDRS ADL scores after flexibility/balance/function exercise compared with home exercise and improved walking economy after aerobic exercise compared with both of the other exercise groups. Finally, a pilot study including four de-novo Parkinson's disease patients diagnosed within 1 year examined dopamine D2 receptor availability using [18F]fallypride PET, postural control, and motor function after intensive treadmill exercise, thrice weekly for 8 weeks (n = 2) compared with no exercise (n = 2). Results indicated that dopamine D2 receptor availability was increased and postural control was improved in the two patients undergoing intensive exercise compared with those that did not exercise. These studies suggest the potential improvements in physical function and the possibility of a disease-modifying effect of exercise in early Parkinson's disease. In addition, it has been shown that occupational therapy is beneficial in improving patient-rated performance of ADLs. Additional, larger, controlled studies are necessary to determine the impact of exercise, physical, and occupational therapy in early Parkinson's disease and to determine the type of exercise or therapy that might be most effective.
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