The effect of habitual exercise using resistance training or nordic walking on the rate of progression of Parkinson’s disease : a PICO study

Abstract

Introduction: "Exercise is medicine" is a commonly used phrase in rehabilitation. This PICO study aims to understand the impact of physical activity on Parkinson's Disease (PD) patients. Nearly one million Americans and seven million people worldwide are living with Parkinson's. In Malta, 600 new PD cases may be diagnosed annually (Fiorini 2022). By 2040, the number of people with Parkinson's Disease is projected to exceed 12 million worldwide (Dorsey and Bloem 2018). “The Parkinson pandemic is fuelled by ageing populations, increasing longevity, declining smoking rates, and the by-products of industrialization. The incidence of Parkinson disease increases with age and rises sharply at around age 65” (Van Den Eeden, Tanner et al. 2008). It is important to keep in mind that patients under 50 years of age may still develop early-onset PD. Although to date, there is no cure for Parkinson's, research shows that exercise can help delay some of the mobility problems associated with disease progression (Mischley, Lau et al. 2017). Studies have demonstrated that PD patients benefited from exercising, no matter at which stage they started exercising (Farley 2020). This research aims to enrich the discussion around the importance of having an effective habitual exercise routine and the difference it makes in the progression rate of Parkinson's Disease with particular reference to two specific types of exercise interventions, that is, resistance training and Nordic walking. Method: The search string used was Parkinson* AND ("nordic walking" OR "resistance training") AND (randomized OR randomised). Databases used include EBSCO, AgeLine, CINAHL Complete, Cochrane Central Registry of Controlled Trials, Cochrane Database of Systematic Reviews, MEDLINE Complete, ProQuest, and Scopus. Study Findings: PD patients need whole-body training to address fine motor, respiration, gait, speech, and postural control, which impacts overall brain health and protection (disease progression). Specific skill training reinforces the dopamine circuits, leading to brain repair and adaptation. Based on the literature reviews, resistance training, and Nordic walking positively affect the PD progression rate. However, the long-term effects have not been studied for more than 3 or 6 months from the initial training starting point. Further, multicenter longitudinal studies with larger sample sizes need to be conducted to understand better the long-term impacts. Conclusion: This study suggests that it is time for a new paradigm in PD treatment. Studies have shown that prescribing exercise immediately after diagnosis slows motor deterioration and disease progression, and prevents end-stage PD. Not all exercises demonstrate the same effect on PD. Timing matters – evidence shows that the sooner someone starts exercising, the better for disease modification. Similarly exercise intensity matters. Evidence reviewed in this study shows that exercise complexity should include task switching, problem solving, inhibition, dual tasks and focused attention. Exercises should be reward-based, use music, encourage social interaction, and be relevant. Exercises also need to be continuously repeated to reach sustained health benefits. Lastly, specificity also matters; when the same exercise is practised multiple times, the PD movement patterns improve.