Evidence Summary
Any physical activity is better than inactivity and forced exercise better than self-paced voluntary activity. A review of studies showed that physical activity improved markers for cognition especially executive function [1]. They also showed various types of activity (aerobic, resistance, dance) can improve cognitive (executive) functions in Parkinson’s. The researchers commented; ‘any exercise should be encouraged as it may benefit numerous aspects of patients’ cognition and these effects could be transferrable to other tasks’.
There are fewer studies in older frailer patients but 1 showed a 3-month physical activity intervention improved physical abilities, executive functions, processing speed and working memory.
A further systematic review of 11 RCTs (n=508) in 68(+-4) year-olds demonstrated all activities are associated with improved cognitive function in individuals with Parkinson’s. Aerobic exercise showed best improvement for memory but clear effect of activity mode was not identified.
There was significant effect size for coordination exercise leading to improved executive function compared with non-exercising controls [2,3]. A further systematic review of 16 studies and metanalysis of 8 demonstrated global cognition and cognitive dual-tasking had greater improvement in the dance groups studied. Further research is needed to evaluate which modality provides the most benefit.
Physical activity has shown promising effects on cognitive function in healthy older adults and in treatment for patients with mild cognitive impairment (MCI) but this requires verification in people with Parkinson’s (PwP)[4].
Quality of Evidence
B – Moderate evidence that any form of activity may benefit cognition and forced exercise may increase that benefit across Hoehn-Yahr stages 1-4 reviewed. 1 small study in older frailer PwP over 3 months showed improvement across several domains. Further research is required to evaluate which modality provides best change.
Strength of Recommendation
1 – All studies reviewed demonstrated benefits of physical activity on brain function.
Conclusion
Physical activity can help with improving brain function in patients at any stage of Parkinson’s disease.
References
[1] Murray et al. The effects of exercise on cognition in Parkinson’s disease: a systematic review. Transl Neurodegener. 2014;3(1):5. doi:10.1186/2047-9158-3-5.
[2] Stuckenschneider et al. The Effect of Different Exercise Modes on Domain-Specific Cognitive Function in Patients Suffering from Parkinson’s Disease: A Systematic Review of Randomized Controlled Trials. Journal of Parkinson’s Disease, vol. 9, no. 1, pp. 73-95, 2019
[3] Uc et al. Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting, Neurology; Jul 2014; vol. 83 (no. 5); p. 413-25
[4] Kalyani HHN et al. Effects of Dance on Gait, Cognition, and Dual-Tasking in Parkinson’s Disease: A Systematic Review and Meta-Analysis. J Parkinsons Dis. 2019;9(2):335–49