9 Things to Know About Exercise-induced Neuroplasticity in Human

Parkinson’s: Neuroplasticity, neuroprotection and neurorestoration are catchy words that

populate a lot of publications, blogs from many of us with Parkinson’s and from
professionals who study/work in the field of Parkinson’s. It is important for you to develop
your own opinion about exercise-induced neuroplasticity. My goal in this post is to provide
the basic elements, concepts and key reference material to help you with this opinion.
Here is a 1-page summary of “9 Things to Know About Exercise-induced Neuroplasticity in
Human Parkinson’s” (click here to download page).
(1) Parkinson’s Disease (PD): Parkinson’s is a neurodegenerative disorder. Parkinson’s
usually presents as a movement disorder, which is a slow progressive loss of motor
coordination, gait disturbance, slowness of movement, rigidity, and tremor. Parkinson’s
can also include cognitive/psychological impairments. ~170 people/day are diagnosed with
Parkinson’s in the USA; the average age of onset is ~60 years-old.
(2) Safety First: The benefit of an exercise routine/program will only work if you have (i)
talked about it with your Neurologist and have his/her consent; (ii) you have received
advice from a physical therapist/certified personal trainer about which exercises are ‘best’
for you; and (iii) you recognize that PD usually comes with gait and balance issues, and
you are ready to begin. Safety first, always stay safe!
(3) Exercise: Exercise is activity requiring physical effort, carried out especially to sustain
or improve health and fitness. Exercise is viewed by movement disorders clinicians,
physical therapists, and certified personal trainers as a key medicinal ingredient in both
treating and enabling patients at all stages of Parkinson’s.
(4) Brain Health: With or without Parkinson’s disease, taking care of your brain is all-
important to your overall well-being, life-attitude, and health. For a balanced-healthy brain,
strive for: proper nutrition and be cognitively fit; exercise; reduce stress; work and be
mentally alert; practice mindfulness/meditation; sleep; and stay positive.
(5) Neuroplasticity: Neuroplasticity describes how neurons in the brain compensate for
injury/disease and adjust their actions in response to environmental changes. “Forced-use
exercise” of the more affected limb/side can be effective in driving neural network
adaptation. Ultimately, this can lead to improved function of the limb/side.
(6) Synapses are junctions between two nerve cells whereby neurotransmitters diffuse
across small gaps to transmit and receive signals.
(7) Circuitry: A key result of neuroplasticity is the re-routing of neuronal pathways of the
brain along which electrical and chemical signals travel in the central nervous system
(CNS).
(8) Parkinson’s-specific Exercise Programs:
PWR!Moves
Rock Steady Boxing
LSVT BIG
Dance for PD
LIM Yoga
Tai Chi for PD
What types of exercise are best for people with Parkinson’s disease? Here is a nice
overview of the benefits of exercise for those of us with Parkinson’s (click here).
Regarding the PD-specific exercise programs, I am most familiar with PWR!Moves, Rock
Steady Boxing and LSVT BIG (I’m certified to teach PWR!Moves, I’m a graduate of LSVT
BIG, and I’ve participated in Rock Steady Boxing). A goal for you is to re-read ‘Safety First’
above and begin to decide which type of exercise you’d benefit from and would enjoy the
most.
(9) Brain/Behavior Changes: The collective results found increase in corticomotor
excitability, increase in brain grey matter volume, increase in serum BDNF levels, and
decrease in serum tumor necrosis factor-alpha (TNFα) levels. These results imply that
neuroplasticity from exercise may potentially either slow or halt progression of Parkinson’s.
What the terms mean: Corticomotor describes motor functions controlled by the cerebral
cortex (people with Parkinson’s show reduced corticomotor excitability). Brain grey matter
is a major component of the central nervous system consisting of neuronal cells,
myelinated and unmyelinated axons, microglial cells, synapses, and capillaries. BDNF is
brain-derived neurotrophic factor, which is a protein involved in brain plasticity and it is
important for survival of dopaminergic neurons. Tumor necrosis factor-alpha (TNFα) is an
inflammatory cytokine (protein) that is involved in systemic inflammation. Some studies of
exercise-induced neuroplasticity in human Parkinson’s found the above-mentioned
changes, which would imply a positive impact of exercise to promote neuroplastic
changes.
What can you do with all of the cited articles listed at the end? Compiled below are
some comprehensive and outstanding reviews about exercise-induced neuroplasticity in
Parkinson’s. Looking through these papers, you’ll see years of work, but this work has all
of the details to everything I’ve described.
“All life is an experiment. The more experiments you make the better.” Ralph Waldo
Emerson
What I believe about neuroplasticity and exercise in Parkinson’s: [Please remember I
am not a physician; definitely talk with your neurologist before beginning any exercise
program.] I think about exercising each day; I try to do it on a daily basis. As a scientist,
I’m impressed by the rodent Parkinson’s data and how exercise promotes neuroplasticity.
The human studies are also believable; sustained aerobic exercise induces neuroplasticity
to improve overall brain health. “Forced-use exercise” is an important concept; I try to work
my right-side (arm and leg), which are slightly weaker and stiffer from Parkinson’s. Initially,
I used my left arm more, now I ‘force’ myself on both sides with the hope my neural
network is stabilized or even improving. If you enjoy exercising as I do, I view it as both an
event and a reward; ultimately, I believe it can work and improve my response to
Parkinson’s. If you don’t enjoy exercising, this may be more of a task and duty; however,
the benefits over time can be better health. Exercise is good for you (heart and
brain). Begin slow, make progress, and see if you are living better with your
disorder. Remain hopeful and be both persistent and positive; try to enjoy your exercise.
“I am not afraid of storms for I am learning how to sail my ship.” Louisa May Alcott

References on neuroplasticity and exercise in Parkinson’s:

1. Farley, B. G. and G. F. Koshland (2005). “Training BIG to move faster: the application of the speed-amplitude
relation as a rehabilitation strategy for people with Parkinson’s disease.” Exp Brain Res 167(3): 462-467
2. Fisher, B. E., et al. (2008). “The effect of exercise training in improving motor performance and corticomotor
excitability in people with early Parkinson’s disease.” Arch Phys Med Rehabil 89(7): 1221-1229
3. Hirsch, M. A. and B. G. Farley (2009). “Exercise and neuroplasticity in persons living with Parkinson’s disease.”
Eur J Phys Rehabil Med 45(2): 215-229
4. Petzinger, G. M., et al. (2010). “Enhancing neuroplasticity in the basal ganglia: the role of exercise in Parkinson’s
disease.” Mov Disord 25 Suppl 1: S141-145
5. Bassuk, S. S., et al. (2013). “Why Exercise Works Magic.” Scientific American 309(2): 74-79.
6. Lima, L. O., et al. (2013). “Progressive resistance exercise improves strength and physical performance in people
with mild to moderate Parkinson’s disease: a systematic review.” Journal of Physiotherapy 59(1): 7-13
7. Petzinger, G. M., et al. (2013). “Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in
Parkinson’s disease.” Lancet Neurol 12(7): 716-726
8. Ebersbach, G., et al. (2015). “Amplitude-oriented exercise in Parkinson’s disease: a randomized study comparing
LSVT-BIG and a short training protocol.” J Neural Transm (Vienna) 122(2): 253-256
9. Petzinger, G. M., et al. (2015). “The Effects of Exercise on Dopamine Neurotransmission in Parkinson’s Disease:
Targeting Neuroplasticity to Modulate Basal Ganglia Circuitry.” Brain Plast 1(1): 29-39
10. Abbruzzese, G., et al. (2016). “Rehabilitation for Parkinson’s disease: Current outlook and future challenges.”
Parkinsonism Relat Disord 22 Suppl 1: S60-64
11. Hirsch, M. A., et al. (2016). “Exercise-induced neuroplasticity in human Parkinson’s disease: What is the evidence
telling us?” Parkinsonism & Related Disorders 22, Supplement 1: S78-S81
12. Tessitore, A., et al. (2016). “Structural connectivity in Parkinson’s disease.” Parkinsonism Relat Disord 22 Suppl 1:
S56-59
“If we could give every individual the right amount of nourishment and exercise, not too little and not
too much, we would have found the safest way to health.” Hippocrates
“Life is complex. Each one of us must make his own path through life. There are no self-help manuals,
no formulas, no easy answers. The right road for one is the wrong road for another…The journey of life
is not paved in blacktop; it is not brightly lit, and it has no road signs. It is a rocky path through the
wilderness.” M. Scott Peck