Guidelines on exercise testing and prescription for patients at different stages of Parkinson's disease

Background Exercise is highly recommended in patients with Parkinson's disease (PD). Exercise-induced amelioration of motor, non-motor, and drug-induced symptoms are widely known. However, specific guidelines on exercise testing and prescription in PD are lacking. Objective This study reviews the literature on exercise-based approaches to the management of symptoms at each stage of the disease and evaluate: (1) the most suitable clinical exercise testing; (2) training programs based on testing outcomes and PD stage; (3) the effects of exercise on antiparkinsonian drugs and to suggest the most effective exercise-medication combination. Methods A systematic search was conducted using the databases MEDLINE, Google Scholar and, Cochrane Library using Parkinson's Disease AND Physical therapy, Training AND Parkinson, Exercise, Exercise AND Drug as key words. In addition, references list from the included articles were searched and cross-checked to identify any further potentially eligible studies. Results Of a total of 115 records retrieved, 50 (43%) were included. From these, 23 were included under the rubric exercise testing; 20 focused on the effectiveness of different types of exercise in PD motor-functional symptoms and neuroprotective effects, throughout disease progression, were included under the rubric training protocol prescription; and 7 concern the rubric interaction between exercise and medication, although none reported consistent results. Conclusions Despite the lack of standardized parameters for exercise testing and prescription, all studies agree that PD patients should be encouraged to regularly train according to their severity-related limitations and their personalized treatment plan. In this manuscript, specific guidelines for tailored clinical testing and prescription are provided for each stage of PD.

Automated summary

Exercise is highly recommended for patients with Parkinson's disease, with known benefits for both motor and non-motor symptoms. This study reviewed the literature on exercise-based approaches to managing symptoms at each stage of the disease and evaluated testing, training programs, and the effects of exercise on medication. Despite a lack of standardized parameters, tailored exercise testing and prescription guidelines were provided for each stage of PD.