Exercise Is Crucial for Managing Parkinson’s Disease

Intense exercise may enhance brain circuitry

There’s some evidence that increased exercise in people who have Parkinson’s may interfere with the underlying disease processes that cause these symptoms.

Though the research is still in the early stages, there are some positive signs that exercise affects neuroplasticity. Simply put, neuroplasticity is the brain’s ability to change and adapt in response to learning, experiences or injury. That means that even in the face of a disease that is killing cells in the brain, the brain can still change in response to the positive effects of exercise.

Parkinson’s disease involves a loss of the brain cells that produce dopamine, a chemical messenger that is critical to movement and mood, among other functions. “There are a few studies, using PET scans of the brain, that show that after six months of aerobic exercise, dopamine levels increase in the brain,” Langeskov-Christensen says.

One small study, published in npj Parkinson’s Disease in 2024, found that high-intensity exercise might slow the neurodegeneration that PD causes. In the study, 10 people with mild and early PD participated in the Beat Parkinson’s Today exercise program, which involved high-intensity workouts, including cardio and strength training at least three times a week for six months. Participants wore heart monitors to ensure their hearts were beating at around 80 percent of the max capacity for their age. Signs that you’re pushing yourself hard enough include sweating, heavy breathing and an inability to say more than a few words without taking another breath.

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Brain MRI and PET scans taken before the program began and six months later showed signs in 9 out of the 10 participants that the dopamine-producing brain cells probably became healthier.

“We knew that exercise was good for symptoms, but this study shows that it’s actually neuroprotective,” says study coauthor Sule Tinaz, M.D., associate professor of neurology at Yale School of Medicine. Tinaz and her colleagues hope to replicate the results of this study in a larger randomized controlled clinical trial. 

What kind of exercise works best?

By now you may have put on your sneakers and are ready to get started. So what kind of exercise helps people with PD?

Much of the research on this topic is on aerobic exercise. Also known as “cardio,” it’s the kind of exercise that gets your body moving and your heart pumping, like dancing, jogging, swimming, tennis, cycling, brisk walking and stair climbing. The emphasis here is on getting your heart rate and breathing up above your general resting state. “You want to make sure people are pushed,” Gilbert says. Taking a brief stroll around the block without raising your heart rate is probably not as good as really getting a workout in, she adds. The Parkinson’s Foundation’s exercise guidelines call for at least 90 minutes of cardio as part of 150 minutes of moderate to vigorous exercise each week. The Foundation recommends that everyone with PD see a physical therapist specializing in PD for a full functional evaluation and recommends exercise during “on” periods, when taking medication.

According to the Parkinson's Foundation, your weekly 150 minutes of moderate to vigorous exercise should include:

• Aerobic activity: 3 days/week, at least 30 minutes per session of continuous or intermittent movement at moderate or high intensity
• Strength or resistance training: 2-3 nonconsecutive days/week for at least 30 minutes per session
• Balance, agility and multitasking: At least 2-3 days/week — every day, if possible — of exercises that rely on these skills
• Stretching: At least 2-3 days/week; every day, if possible. 

Start where you are…with a push

How to raise your heart rate, and how much, depends on your current fitness level and abilities, your medical history, your medications and other individual health factors. If you’re not a regular exerciser yet, it might not take much to get your heart rate up, or you may take medications that mean you shouldn’t increase your heart rate past a certain point. But if you’ve been working out regularly for a while, you may need more intense physical activity to get your heart pumping harder. 

No matter where you start, exercise that gets the heart pumping harder has benefits for people with PD.

In the study that tracked 237 people with early Parkinson’s for five years, people benefited from exercise regardless of their fitness level or physical abilities at the start of the study.

This shows it’s never too late to start exercising to get long-term benefits — no matter your fitness level or your disease stage. Start with whatever is a challenge for you and work your way up to 150 minutes of exercise activity per week, Gilbert says.

“Exercise is one of the best things we can do for ourselves, especially when living with Parkinson’s. Knowing that, many people ask not just ‘what’s the best exercise?’ but also ‘how much should I exercise?’ That’s a balance each person has to find for themselves. Exercise should feel hard. It should challenge you and make you sore and somewhat fatigued. But not so sore that you are injured or so exhausted that you can’t do your normal activities," neurology and lifestyle medicine physician and movement disorder specialist, Rachel Dolhun, M.D., principal medical advisor at The Michael J. Fox Foundation wrote on LinkedIn in May in response to a recent report on the possibility of overexercise with Parkinson's.

Choose exercises that challenge your brain

What was that about dance and learning new skills? You may get more benefits from exercise that challenges your brain to think and learn while you move your body, Gilbert says, like dance.

“Learning something new, learning how to move in a new way, can change the biology of the brain,” she says. Animal studies, she says, have shown that a moderate-intensity but mentally challenging exercise may improve blood flow to the brain more than a high-intensity but familiar exercise would.

So, given the choice between the same daily brisk walk and your first-ever tango class, choose tango.

Dancing, in fact, may not only raise your heart rate and teach you something new, but it may also benefit your mood. For some people with PD, depression takes a greater toll on quality of life than movement problems do.

In a study published in 2024 in the Journal of Medical Internet Research, 23 people with PD took weekly dance classes at Canada’s National Ballet School for eight months. Building on previous research that showed dance classes helped with movement, mood and functions of daily living, this study found that after the dance classes, participants reported fewer symptoms of depression, and MRIs showed fewer biological signs of depression.

Besides the exercise and learning components, dance classes also give you a chance to socialize, which can help reduce symptoms of depression. 

Boxing has gotten support from Parkinson's research studies as well. Several small studies have shown that boxing can improve motor and non-motor symptoms of the disease. Researchers suggest it’s the aerobic and strength training, along with balance and footwork and stretching that’s beneficial. Group boxing classes, like dance classes, also come with camaraderie built in.

Whether it’s tango, pickleball or ping-pong, pick something you’ll enjoy so that you stick with it. “When you have Parkinson’s disease,” Langeskov-Christensen says, “it becomes more difficult to motivate yourself. You should really do ... what motivates you.”