Jennifer Marie J. Yang, MD

In the last blog post, I discussed how Parkinson’s disease can affect function, i.e., how you get through the activities of your day. In this post, I tackle how exercise – as part of a rehabilitation program – helps in Parkinson’s Disease.

Rehabilitation in Parkinson’s disease is goal-based. What does that mean? It means that the rehabilitation program is created with what the patient (and family) want to accomplish, and the treatments are directed at possibly achieving that goal. Rehabilitation’s purpose is to preserve current function or improve function. For example, a person with Parkinson’s disease has trouble getting from his bed to the toilet, the goals are to improve bed mobility (i.e., getting from laying in bed to a seated position), transfers (getting from a seated position to standing, and vice versa), and ambulation (walking or using a wheelchair; if walking, patient can work on balance and coordination) with our without an assistive device (cane, walker, etc.). Rehabilitation can happen immediately after diagnosis and during the course of the illness. One does not have to wait for worsening disease before getting rehabilitative therapies on board.

How does exercise help people with PD?

Motor learning and plasticity. This simply means “use it or lose it” – keep your muscles moving, and keep the connections between brain and body going efficiently. Plasticity is how your brain and nervous system learn and relearn new pathways of movement. This can slow down the progression of Parkinson’s disease. Big movements (i.e., using the large muscles of the body – legs, arms, trunk) work best.

Retention and carry-over. Repeating regular exercises can also help improve memory. Remembering movements and movement patterns can help with walking and doing activities of daily living like dressing, bathing and eating. Exercises done with external cues – music, a beat or rhythm, or flashing lights/lasers – seem to help better with remembering motions and the coordination of movement.

Posture, gait, balance, spatial awareness. Regular exercise that involves the trunk, arms and legs helps put your body in correct alignment, preventing injury and pain. These exercises also improve the way you walk and your overall balance as you sit, stand, walk or use a wheelchair. Exercises also help with proprioception, a big medical word that means “knowing where you are in space”.

Aerobic conditioning (fitness). Many people with Parkinson’s disease get tired easily – they have fatigue and poor endurance. While some of this may be due to the disease itself, there may also be a component of deconditioning: the opposite of being physically fit. Enhancing and optimizing the condition of your heart and lungs can help with reducing fatigue and improving endurance.

Psychosocial benefits: exercise as an enjoyable activity and source of peer support. While exercising alone helps physically and emotionally as it can combat sadness, exercising with other people may also lift your spirits and make you happier overall. Exercise can boost your physical, mental and emotional health.

All the benefits of exercise listed above are also the benefits of dance – dance is a good form of exercise for people with Parkinson’s disease because it works on big movements and large muscles, accompanied by the external cues of having music and rhythm that can help people move better and remember movements better.

Many studies in the medical literature have shown that dancing is useful in mild to moderate Parkinson’s disease. A short course of several weeks is good, but dancing for months is better. Some genres that have been studied include ballroom dancing (tango, foxtrot, waltz), classes incorporating ballet, jazz, contemporary and dance theatre, and group dances like Irish set dancing and Turo (qi gong + dance). Dancing can be done in group classes, or even as a home dance program. Partnered and non-partnered dance show the same benefits overall, but partnered dancers enjoy the activity more.

Learn more about dance and Parkinson’s disease here – I participated in a panel discussion from April 2021, sponsored by Singapore’s Nanyang Academy of Fine Arts and World Dance Alliance-Singapore. Other experts on the panel were neurologist/movement disorders specialist Dr. Roland Dominic Jamora and dance therapist/founder of Sayaw PD Mr. Novy Bereber in April 2021. Many thanks to Dr. Filomar Tariao for organizing and moderating the discussion.

Key References:

• Abbruzzese, Giovanni, et al. “Rehabilitation for Parkinson’s disease: Current outlook and future challenges.” Parkinsonism & related disorders 22 (2016): S60-S64. •Earhart, Gammon M. “Dance as therapy for individuals with Parkinson disease.” European journal of physical and rehabilitation medicine 45.2 (2009): 231.
• Hackney, Madeleine E., and Crystal G. Bennett. “Dance therapy for individuals with Parkinson’s disease: improving quality of life.” Research and Reviews in Parkinsonism 4 (2014): 17-25. •Heiberger, Lisa, et al. “Impact of a weekly dance class on the functional mobility and on the quality of life of individuals with Parkinson’s disease.” Frontiers in aging neuroscience 3 (2011): 14.
• McGill, Ashley, Sara Houston, and Raymond YW Lee. “Dance for Parkinson’s: a new framework for research on its physical, mental, emotional, and social benefits.” Complementary Therapies in Medicine 22.3 (2014): 426-432.
• Sharp, Kathryn, and Jonathan Hewitt. “Dance as an intervention for people with Parkinson’s disease: a systematic review and meta-analysis.” Neuroscience & Biobehavioral Reviews 47 (2014): 445-456.
• van der Kolk, Nicolien M., and Laurie A. King. “Effects of exercise on mobility in people with Parkinson’s disease.” Movement Disorders 28.11 (2013): 1587-1596.