Why after 200 years there is nothing to help stop or reverse Parkinson disease?

The research on rehabilitation and exercise was severely lacking until 2000. It has only recently been valued as an integral evidenced-based part of “the healthcare team” for a person with Parkinson (PWP).  But we have only just begun! The next step is in developing new healthcare models for the implementation of exercise and rehabilitation as standard of care - one that begins at diagnosis and is sustained for life.  Here’s why.

The dogma of YESTERDAY (1813 – 2000)

Ever since 1813, when Parkinson disease (PD) was first characterized by Dr. James Parkinson, then more completely described in medical textbooks in the 1870’s by the founding fathers of Neurology, Drs. Jean-Martin Charcot and William Gowers, the “prescription” of choice was: rest, reduce stress, spa treatments and a carefree lifestyle. This prescription persisted until 2000!

The Exercise Revolution (2000 – Today)

The Exercise Revolution was sparked in 2000, when the research on exercise in animal models of PD began in full force.  Believe it or not, before the year 2000, there were no community PD-specific exercise programs or PD-specialized therapists and exercise instructors or PWR!Gyms or much of anything for PWP to do!  Publications and clinical trials before 2000 were rare (see Table below).  In 2001, the first systematic review of the literature for exercise and physical therapy concluded “insufficient evidence for the effect of physiotherapy vs. no physiotherapy.”  Fortunately, those poor reviews, along with the release of compelling publications on exercise in animal models of PD sparked a research SURGE in the number of high-quality exercise and physiotherapy trials in humans.

As the evidence for the positive effects of physical therapy and exercise in humans accumulated, multiple systematic reviews and meta-analyses were completed.  This led to the first international clinical practice guidelines for PT’s, OT’s, SLP’s in 2001 that are now updated every few years with new research evidence.  In 2006, the medical management guidelines for PD were updated to recommend physiotherapy and exercise as an adjunctive therapy that “may be helpful to improve motor symptoms, function or disability”.  

Today, the dogma about exercise/rehabilitation has reversed, instead the prescription reads: Challenge PWP to work harder than they self-select, physically and cognitively. Start early and maintain higher levels of physical activity for life.  The research on exercise is now being integrated into specialized educational programs for entry level, advanced, and multidisciplinary training for healthcare professionals.  In addition, Parkinson non-profits across the globe are informing PWP, families, and caregivers of the value of exercise and how to get started with PD-specialized instructors, personal trainers and rehabilitation providers.  

In 2021, the Parkinson Foundation (PF) working with the American College of Sports Medicine, developed the 1^st exercise guidelines for PD and defined the competencies (knowledge and skills) required for exercise professionals to implement classes and personal training programs that are consistent and effective (publication pending) for PWP.  The research, and now the exercise guidelines and competencies provide the potential to elevate exercise as a clinical standard of care for PWP.  To implement clinical exercise, community networks of vetted PD-specialized exercise professionals are needed that are willing to work in collaboration with allied health professionals.  This will allow exercise to be integrated and updated with the rehabilitation plan of care - for life.  The plan of care, proactive management and a bidirectional referral process allows for personalized exercise prescriptions to: begin at diagnosis and keep people better, exploit the disease-modifying potential of exercise and be eligible for healthcare subsidy in the future.

To work towards that integrated standard of care model, our PWR!Moves Instructor workshop curriculum uses those guidelines and competency requirements to  train and certify exercise professionals to design and lead PD-specific functional exercise for PWP that is effective and safe and collaborative with rehabilitation.  Our PWR!Moves Therapist workshop curriculum advocates for this integrated model and challenges rehabilitation professionals to build their local bi-directional exercise referral networks!