Evidence Summary: Systematic reviews have reviewed across different stages of Parkinson’s. As long as physical activity is tailored to the individual it can be beneficial across the different stages of Parkinson’s and is safe. [1,2]
A combination of different aspects of physical activity (strength, flexibility, endurance, aerobics) improves disability and outcomes both motor and non-motor symptoms. Higher intensity activity leads to better outcomes  and is safe . There is evidence of benefit in newly diagnosed patients as well as patients who have had a Parkinson’s diagnosis for a long time .
Multiple systematic reviews confirm improvement in quality of life [1 – 10] through improved functionality across a number of parameters including muscle strength, walking distance and speed, balance and confidence in balance, motor symptoms, flexibility and handgrip strength that contribute to better coping with daily activities. This includes feeling that they are ‘taking back control’ . Systematic review of multiple dance studies strongly supports dance’s ability to manage motor symptom severity and improve balance and functional mobility. Low resistance training can help older People with Parkinson’s improve their functionality such as flexibility, aerobic resistance, gait speed, balance and handgrip strength that helps with daily activities and thereby improving quality of life .
Another recent review suggests that activity interventions, especially aerobic exercise, dance, and Tai chi significantly improve overall QoL of Parkinson’s patients. This benefit was significant when the period of intervention was at least 12 weeks. Further research is needed to investigate the impact of exercise on different QoL domains, as well as the impact of longer durations of intervention 
Additional benefits of activity on quality of life in Parkinson’s include improved mood, sleep, cognition, reduced fatigue and potential delay of disease progression reduced need for medication – see separate evidence reviews.
Quality of Evidence
B – Moderate quality due to studies included having mixed criteria, variable activities studied and outcome parameters. Most studies relate to mild to moderate disease although 1 RCT showed benefit for low resistance activities in older patients, there is less information for advanced disease
Strength of Recommendation
1 – Clear benefits for physical activity preferably tailored to the individual.
Physical activity in Parkinson’s is safe, best tailored to the individual by an experienced practitioner in Parkinson’s and by improving functionality can improve quality of life. It has good effect when commenced early after diagnosis but can benefit all stages of Parkinson’s
 Ellis T et al. Mobilizing Parkinson’s Disease: The Future of Exercise. Journal of Parkinson’s Disease 8 (2018) S95–S100
 Mullligan H et al. Engagement in exercise for people with Parkinson’s: What is meaningful? New Zealand Journal of Physiotherapy; 2018; vol. 46 (no. 1); p. 19-28
 Schenkman et al. Effect of High-Intensity Treadmill Exercise on Motor Symptoms in Patients With DeNovo Parkinson Disease A Phase 2 Randomized Clinical Trial. JAMA Neurol. 2018 Feb 1;75(2):219-226.
 Wu et al. Effectiveness of physical activity on patients with depression and Parkinson’s disease: A systematic review. PLoS One. 2017 Jul 27;12(7):e0181515.
 Ramazzina I et al. Systematic review on strength training in Parkinson’s disease: an unsolved question. Clin Interv Aging. 2017 Mar 31;12:619-628 doi:10.2147/CIA.S131903.
 Tschentscher et al. Health benefits of Nordic walking: A Systematic Review. Am J Prev Med. 2013 Jan; 44(1):76-84.
 Rodriguez et al. Vigorous Aerobic Exercise in the Management of Parkinson’s Disease: A Systematic Review. PM R xx (2020) 1–11
 Sumec et al. Psychological Benefits of Nonpharmacological Methods Aimed for Improving Balance in Parkinson’s Disease: A Systematic Review. Behavioural Neurology
Volume 2015, Article ID 620674, 16 pages
 Uc E 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
 Tambosco et al. Effort training in Parkinson’s disease: A systematic review. Ann Phys Rehabil Med. 2014 Mar;57(2):79-104.
 Leon CP et al. Low-volume resistance training improves the functional capacity of older individuals with Parkinson’s disease. Geriatr Gerontol Int. 2019 Jul;19(7):635-640.
 Chen K et al. Effect of Exercise on Quality of Life in Parkinson’s Disease: A Systematic Review and Meta-Analysis. Parkinson’s Disease Volume 2020, Article ID 3257623, 10 pages