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Physical Activity is safe (Parkinson’s evidence)

Evidence Summary
PHYSICAL ACTIVITY SHOULD BE INCLUDED REGULARLY IN PARKINSON’S AT ALL STAGES OF DISEASE AND STARTED EARLY AFTER DIAGNOSIS

Physical Activity of various forms helps improve many different aspects of motor symptoms in Parkinson’s.
Evidence summary: A growing body of evidence from randomised controlled trials, systematic reviews and meta-analysis in Parkinson’s with mild to moderate symptoms has revealed that regular physical activity helps improve different elements of motor function such as improving walking quality, balance and muscle strength. There is also evidence to show that physical activity can reduce adverse motor symptoms of Parkinson’s disease such as tremor. Cardiovascular fitness has been demonstrated to be improved with physical activity. There have been relatively few adverse events reported and seem related to increasing activity rather than Parkinson’s issues. A meta-analysis which analysed four trials in eighty four patients with mild Parkinson’s, has shown that large amplitude orientated intensive therapy has a greater overall benefit in motor function compared to general physical activity or Nordic walking. This was done with a specialist trained in delivering large amplitude exercise. However, it is important to stress that PwP can safely carry out a general cardiovascular or strength training in the community and evidence is strong that physical activity is safe. Overall, any physical activity helps and more is better.
The need for adapting activity around potential for postural hypotension in later stages of Parkinson’s was advised by an expert focus group and in some cases medication may be needed to reduce this issue.
It is recommended that physical activity should be individualised (by a Parkinson’s specialist professional) where possible. The minimum amount of activity is recommended in the CMO guidelines for different stages of life. There is evidence to suggest that physical activity at an early stage of disease can help slow down disease progression. Although most of the activities in the studies have recommended physical activity with physiotherapists or in a group setting, home exercises could be considered particularly with telecommunication support.

Quality of Evidence
A- A number of systematic reviews, meta- analysis, randomised controlled trials and guidelines have supported the above recommendation.

Strength of Recommendation
1 – On the basis of existing evidence of safety, there is strong evidence that physical activity should be encouraged in all People with Parkinson’s.

Conclusion
Physical activity is safe in Parkinson’s and should be encouraged at all stages of Parkinson’s and started early after diagnosis. Further medical advice re adapting activity or treatment may be needed if postural hypotension symptoms are significant.

References:
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[26] UK Chief Medical Officer Physical Activity Guidelines
ttps://assets.publishing.service.gov.uk/government/uploads/system/uploads/attach ment_data/file/832868/uk-chief-medical-officers-physical-activity-guidelines.pdf
[27] NICE Guidelines: Parkinson’s Disease.
https://www.nice.org.uk/guidance/ng71
[28] Canadian Guideline for Parkinson’s Disease. https://www.cmaj.ca/content/191/36/E989
[29] World Health Organisation: Physical Activity.
https://www.who.int/news-room/fact-sheets/detail/physical-activity

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