1. Basic science research utilizing animal models of PD have begun to explore the molecular mechanisms of exercise-induced changes on the pathophysiology of PD. The timing of exercise intervention is critical to determining whether protective or restorative mechanisms will be induced and where in the CNS these structural and functional changes will be located.
   • For example, in animal models of PD without overt motor symptoms (i.e., similar to the premotor period in human PD), exercise may be prophylactic (preventative) and capable of protecting DA neurons from toxic events, but the degree of protection is dependent upon baseline fitness levels and how early exercise is started.
   • In animal models with overt early motor symptoms (i.e., similar to early post diagnosis period), studies suggest that a continuous maintenance threshold of exercise may be required to provide the trophic support necessary to maintain the growth and survival in the remaining viable DA neurons.
   • In more advanced animal models of disease severity, exercise has been shown to produce molecular changes within the damaged basal ganglia pathways, but progressively higher intensity, velocity, longer duration practice, and task-specific paradigms may be required.
   • In contrast, inactivity and failure to engage damaged systems (impairment-related or self-imposed) may be pro-degenerative contributing to further degradation of function and a downregulation of endogenous neurotrophic factors.
   • Altogether, these data suggest a need for exercise interventions that are intensive, available at diagnosis, that promote continuous exercise (normal use), and that avoid inactivity.
     • At the very least, access to early exercise may delay motor deterioration, maintain symptoms at bay longer, and contribute to continuing to be able to work and engage in normal activities.

1. Epidemiologic studies and case studies suggest that 1) a history of regular moderate or vigorous levels of physical activity are associated with a lower risk of developing Parkinson’s disease, and that 2) regular physical exercise may increase survival rate and delay the motor deterioration in persons already diagnosed with PD.
   • Supportive data in animals and humans has reached national recognition and a large National Institutes of Health human trial on exercise in early PD is forthcoming See: This e-mail address is being protected from spambots. You need JavaScript enabled to view it
   • People with PD are rarely seen by a physical therapist until they begin to experience disability, usually due to loss of balance. In the US, the percentages of patients estimated to see a physical therapist anytime during the course of their disease are less (5-57%). Even when short-term therapy is available, the benefits of exercise quickly degrade unless adequate levels of continuous “normal use” are maintained post-rehabilitation. And yet, people with neurological disorders have few post-rehabilitation options for maintaining their physical activity levels sufficient to retain benefits from rehab or to promote long-term continuous recover
   • • It is not known why this is so – but there are most likely many barriers to early referral and access to community-based exercise and physiotherapy. We will be collecting data from surveys and questionnaires from the participants in our community to help identify these barriers and what is needed to overcome them. Also we will be educating the medical/health/fitness and lay community about the benefits of exercise in people with chronic illnesses, neurological disorders, and especially neurodegenerative diseases like PD.

(Reference: Hirsch MA, Farley BG. Exercise and Neuroplasticity in Persons Living with Parkinson’s Disease. Eur J Physical Med Rehabil 2009;45:215-229.