Am Fam Physician. 2009 Jun 15;79(12):1043.
to the editor: We read with great interest the article by Dr. Rao and colleagues on Parkinson disease, especially the section on nonpharmacologic interventions such as exercise. Historically, physicians did not think that exercise had an effect on Parkinson disease. Rao and colleagues cite a 2001 Cochrane meta-analysis on physical therapy and exercise for Parkinson disease1 that is consistent with this view and conclude that “non-pharmacological interventions do not improve the cardinal symptoms of Parkinson's disease.”2 More recent studies suggest that exercise improves some of the cardinal features of this disease that often resist pharmacologic intervention, including gait, posture, and dysarthria.3–5 Animal studies on aerobic exercise for Parkinson disease suggest that exercise does provide a protective effect on the Parkinson disease brain.6 These animal studies have been replicated and a large National Institutes of Health human trial on exercise and Parkinson disease is forthcoming.
Family physicians are often the first to diagnose and treat patients with Parkinson disease. Given the current evidence supporting exercise as a treatment for this disease and its impact on other associated conditions, including heart disease and depression, we strongly suggest that physicians encourage exercise in all patients with Parkinson disease.
Anecdotally, we saw a patient who was diagnosed with idiopathic Parkinson disease in 2001 at 49 years of age who lost his insurance when he became unemployed in 2006. As a result, he decided to wean himself off his medications while continuing an intense exercise program. His main symptoms were stiffness and tremor in his left leg and hand. He was an avid athlete, participating in activities such as weight lifting, biking, running on a treadmill, water aerobics, stretching and flexibility, and jumping rope throughout his life for at least two hours per day, six times a week. At baseline, he was receiving amantadine (Symmetrel) 100 mg, and ropinirole (Requip) three times daily. He went to taking one dose of ropinirole at night for six months and then stopped all medications for more than two months. His symptoms remained stable, but he reported increased lower extremity rigidity within 24 hours if he did not exercise.
We believe that exercise should be considered in the treatment regimen for all patients with Parkinson disease who do not have specific contraindications.
Author disclosure: Nothing to disclose.
1. Deane KH, et al. Physiotherapy for patients with Parkinson's disease: a comparison of techniques. Cochrane Database Syst Rev. 2001;(3):CD002817.
2. Rao SS, et al. Parkinson's disease: diagnosis and treatment. Am Fam Physician. 2006;74(12):2046–2054.
3. Jöbges EM, et al. Clinical relevance of rehabilitation programs for patients with idiopathic Parkinson syndrome. II: Symptom-specific therapeutic approaches. Parkinsonism Relat Disord. 2007;13(4):203–213.
4. Suchowersky O, et al., for the Quality Standards Subcommittee of the American Academy of Neurology. Practice parameter: neuroprotective strategies and alternative therapies for Parkinson disease (an evidence-based review) [published correction appears in Neurology. 2006;67(2):299]. Neurology. 2006;66(7):976–982.
5. Goodwin VA, et al. The effectiveness of exercise interventions for people with Parkinson's disease: a systematic review and meta-analysis. Mov Disord. 2008;23(5):631–640.
6. Tillerson JL, et al. Exercise induces behavioral recovery and attenuates neurochemical deficits in rodent models of Parkinson's disease. Neuroscience. 2003;119(3):899–911.
editor's note: This letter was sent to the authors of “Parkinson's Disease: Diagnosis and Treatment,” who declined to reply.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2009 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions