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July 18, 2011

Does vigorous exercise have a neuroprotective effect in Parkinson disease?

July 19, 2011 issue
77 (3) 288-294


Parkinson disease (PD) is progressive, with dementia and medication-refractory motor problems common reasons for late-stage nursing-home placement. Increasing evidence suggests that ongoing vigorous exercise/physical fitness may favorably influence this progression. Parkinsonian animal models reveal exercise-related protection from dopaminergic neurotoxins, apparently mediated by brain neurotrophic factors and neuroplasticity (predicted from in vitro studies). Similarly, exercise consistently improves cognition in animals, also linked to enhanced neuroplasticity and increased neurotrophic factor expression. In these animal models, immobilization has the opposite effect. Brain-derived neurotrophic factor (BDNF) may mediate at least some of this exercise benefit. In humans, exercise increases serum BDNF, and this is known to cross the blood–brain barrier. PD risk in humans is significantly reduced by midlife exercise, documented in large prospective studies. No studies have addressed whether exercise influences dementia risk in PD, but exercised patients with PD improve cognitive scores. Among seniors in general, exercise or physical fitness has not only been associated with better cognitive scores, but midlife exercise significantly reduces the later risk of both dementia and mild cognitive impairment. Finally, numerous studies in seniors with and without dementia have reported increased cerebral gray matter volumes associated with physical fitness or exercise. These findings have several implications for PD clinicians. 1) Ongoing vigorous exercise and physical fitness should be highly encouraged. 2) PD physical therapy programs should include structured, graduated fitness instruction and guidance for deconditioned patients with PD. 3) Levodopa and other forms of dopamine replenishment therapy should be utilized to achieve the maximum capability and motivation for patients to maintain fitness.

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Information & Authors


Published In

Volume 77Number 3July 19, 2011
Pages: 288-294
PubMed: 21768599

Publication History

Received: December 19, 2010
Accepted: March 10, 2011
Published online: July 18, 2011
Published in print: July 19, 2011


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Dr. Ahlskog received the Fred Springer Award from the American Parkinson's Disease Association; serves on the editorial boards of Parkinsonism and Related Disorders and Clinical Neuropharmacology; receives royalties from the publication of The Parkinson's Disease Treatment Book (Oxford University Press, 2005), Parkinson's Disease Treatment Guide for Physicians (Oxford University Press, 2009), Parkinson's Disease and Movement Disorders (Humana Press, 2000), and Surgical Treatment of Parkinson's Disease and Other Movement Disorders (Humana Press, 2003); and receives research support from NIH/NINDS.


Affiliations & Disclosures

J. Eric Ahlskog, PhD, MD
From the Department of Neurology, Mayo Clinic, Rochester, MN.


Address correspondence and reprint requests to Dr. J. Eric Ahlskog, Department of Neurology, Mayo Clinic, Rochester, MN 55905 [email protected]

Author Contributions

Dr. Ahlskog: drafting/revising the manuscript, study concept or design, analysis or interpretation of data.

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