Rehabilitation and Parkinson's disease: exercise is as important as medication

LEARNING OBJECTIVES: 1. Discuss the latest evidence regarding the effectiveness of exercise in the management of Parkinson disease. 2. Identify various evidence-based exercise approaches for individuals with Parkinson disease. 3. Explain to patients, caregivers, and other professionals the importance of exercise and physical activity for people with Parkinson disease. DESCRIPTION: Mounting evidence suggests that exercise and physical activity are critical components in the management of Parkinson disease (PD), as current pharmacological and surgical treatment approaches do not fully address many aspects of the disease. This growing body of research supports the use of various exercise approaches in a variety of settings. We will present the most recent evidence regarding the role of exercise and physical activity in PD rehabilitation. We will open with a discussion gait, balance and falls in PD, with an emphasis on identification of those at risk for falls who are in need of treatment and recent clinical trials designed to reduce falls. This will be followed by a discussion of traditional, clinic-based exercise programs, highlighting key evidence-based elements, such as resistance training, that these programs should include. We will then discuss how approaches to gait rehabilitation have changed in recent years, focusing on shifting views of the role of cognition and recent evidence regarding training in dual task conditions and cueing. The importance of motivation and barriers to exercise will then be addressed, emphasizing the importance of self-efficacy and emerging research on the use of behavioral interventions using virtual exercise coaches to facilitate physical activity in the community. Finally, we will discuss results of recent clinical trials that utilize community-based group exercise approaches such as dance to promote physical activity. In summary, we will discuss the future of rehabilitation in PD and propose an ideal model of care where physiotherapists play a key role and exercise is viewed as evidence-based medicine. IMPLICATIONS/CONCLUSIONS: Exercise and physical activity are key tools in the management of Parkinson disease. There are multiple appropriate, evidence-based exercise approaches for individuals with PD in a variety of settings ranging from the clinic to the community. Physiotherapists are poised to be on the front lines of PD management, with growing evidence to support the idea of exercise as medicine. Armed with this evidence, therapists can and should educate others and advocate for early and ongoing involvement in the care of individuals with PD