The evidence for early intervention having a positive influence on the Parkinson’s journey is striking if you consider that exercise has the potential to slow or even reverse some of the clinical symptoms of the condition and it can do this in two specific ways…
- Improve the sedentary behaviour patterns and physical inactivity that emerge early in the condition. Lord and colleagues, and Van Nimwegan and colleagues are two such papers that propose that people with Parkinson’s are already 30% less active than their healthy aged matched peers at diagnosis. 30% – that is huge, and it quickly becomes a major risk factor for other co-morbidities that can make life even more challenging. Ellis and Motl also suggest that the “profound and prevalent physical inactivity seen in persons with PD may initiate a cycle of deconditioning and worsening of disease consequences, independent of latent disease processes” resulting in a loss of independence and quality of life.
- The second way is by changing the course of the disease progression. This naturally assumes that the course of the disease can be influenced by exercise. Take for example two people, one who takes up neuroactive exercise shortly after diagnosis and one who does not. Assuming all things are equal (type of Parkinson’s, medication, history of exercise etc) it would be safe to say that the person who started the exercise will be in better shape – moving, thinking, feeling better than the person who did not – both at the level of primary impairment and secondary changes. On this point, there is evidence to support scenarios of this with Morris and colleagues looking at progressive resistance training and falls, Ridgel and colleagues looking at impairments specifically after intensive exercise and Frazzitta and colleagues looking at longer term outcomes from exercise after 24 months. Failing that, you only need to ask a PD Warrior coming back from a relaxing holiday how they feel and the response is always – “not good”. I need to get back to my exercise.
Exercise has at best been considered an adjunct to medical therapy and it is a battle to find acceptance within some of the medical profession because exercise can be imprecise when compared to taking a pill, and the research is inherently ‘messy’. It does not make it less important. What we are encountering at the moment is a paradigm shift in how Parkinson’s can be managed better.
Referral for a neuroactive exercise program that offers education, support and a long-term behaviour change model (PD Warrior 4 Pillars) is essential as part of best practice management. I look forward to the work of passionate champions like our PD Warrior coaches and other global licensees and health professionals who are part of the PD Warrior community continuing the crusade so that referral for exercise following diagnosis should become the norm in how Parkinson’s is managed in the future.