EVIDENCE
4D Life is an evidenc
e-based health and fitness programme for people with Idiopathic Parkinson’s, in the early or mid stages of the condition. This means that for any of the topics that we cover, we have based the information on the strongest available research specific to Parkinson’s. For topics where there is no specific Parkinson’s research yet available, we have used the combined experience of qualified professionals to give the best advice.
In this section of the website we highlight and link to examples of some of the evidence that underpins the programme. There is now a substantial weight of evidence proving that the right exercise, diet and lifestyle choices can have a significant effect on motor and cognitive symptoms, quality of life and progression in Parkinson’s.
When looking at research it is important to remember that it is rare for any one study to provide definitive answers. Sample size is important, meaning results from a study involving hundreds of people are more reliable than a study involving tens. But the key is to look at the evidence in the whole, taking account of peer review, consensus, rigorous practice and also sample size.
To read entire research documents usually involves a small fee to buy access, but we have provided a brief summary, and the links that then take you to the page where the full text can be purchased.
We provide a much broader range of the evidence available in the Research Library inside the programme.
Exercise and Nutrition Combined Study
https://cureparkinsons.org.uk/2022/08/diet-exercise-and-parkinsons
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2795409
General Exercise Studies
The Role of Exercise in Treating Parkinson’s Disease
This article describes how exercise can lead to well-established health benefits such as improved cerebrovascular health and psychological well-being, reduction of osteoporosis/fracture risk, age-related muscle loss and risk of malignancy. People with Parkinson’s can also benefit from specific improvements, such as in motor symptoms and cognition and reducing the risk of falling. It supports the notion that as many people as possible with Parkisnon’s should be encouraged to exercise.
It references to The Office of Disease Prevention and Health Promotion Scientific Report, which recommends that older individuals including those with PD should participate in moderate-intensity activities for 150 to 300 minutes per week. It mentions that PWP’s may also benefit from additional supervision, especially when they are just beginning to exercise after having been relatively sedentary.
https://practicalneurology.com/articles/2018-may/the-role-of-exercise-in-treating-parkinsons-disease
Exercise alleviates Parkinsonism; Clinical and laboratory evidence.
This article describes how there is a tendency for PWP’s to present with either normal or reduced exercise capacity due to factors including fatigue, quality of life and severity of symptoms. It then looks into the effects of exercise on quality of life and uses animal laboratory models to examine dopamine loss and the effects that exercise can have on L-Dopa (which converts to Dopamine). The article concludes thatDopaminergic nerve cells respond well to exercise and therefore the principal of ‘use it or lose it’ may be particularly applicable to Parkinson’s.
https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0404.2010.01360.x
The Role of Resistance Training
Progressive Resistance Training Improves Bradykinesia, Motor Symptoms and Functional Performance in Patients with Parkinson’s Disease
This article describes how common symptoms of bradykinesia and muscle weaknesses are associated with reduced functional performance, increased falls risk, and reduced quality of life. It aims to improve the understanding of how resistance training (RT) can help control and reduce these symptoms and thus aims to increasing possibilities to treat the disease. It reviewed forty patients diagnosed with PD from stage 1 to 3 on the Hoen and Yahr scale and divided them into two groups; a training group that performed a 9 week RT programme and another group that attended disease lectures instead. The results concluded that RT can help to reduced bradykinesia and improve functional performance and balance in those with mild to moderate PD.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986410/
Effects of Moderate-Volume, High-Load Lower-Body Resistance Training on Strength and Function in Persons with Parkinson’s Disease: A Pilot Study
Resistance training research has demonstrated positive effects for PWP’s but it remains difficult to specify what is the optimal resistance training programme. The purpose of this study was to explore the effects of an 8-week resistance training intervention on strength and function in PWP’s. Eighteen participants were divided into two groups; a training group who performed a set strength work out twice a week, and another group who received standard care. Results demonstrated that moderate, high-load resistance training can increase lower body strength in PWP’s. Other studies have shown that increased leg strength reduces falls in PWP’s.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957327/
A two-year randomised controlled trial of progressive resistance exercise for Parkinson’s disease.
The aim of this trail was to compare outcomes of two groups of PWP’s at 6,12,18 and 24 months. One group received progressive resistance exercise training with weights, the other group received a stretching, balance, and strengthening exercise programme. Both performed these exercises 2 x week. The results demonstrated a statistically and clinically significant reduction in the pwp perception of their motor and non motor symptoms in the group who performed the resistance training. The conclusion of this trial is that resistance training can be a useful way to improve Parkinsonian motor signs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3701730/
Exercise and Neuroplasticity / Neuroprotection
Enhancing neuroplasticity in the basal ganglia: the role of exercise in Parkinson’s disease
Research trials have suggested that exercise is beneficial for PWP’s, but how exercise specifically drives these improvements remains unknown. This review presents findings from both patient and animal models. The data indicates that exercise may help to reduce the effects of the hyper excitability found in the basal ganglia in Parkinson’s. This knowledge has the potential to help identify new treatment approaches that could reverse or delay the progression of PD.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4111643/
Does vigorous exercise have a neuroprotective effect in Parkinson disease?
More and more evidence suggests that vigorous exercise and physical fitness may have a positive effect on motor symptoms of Parkinson’s. Parkinsonian animal models have shown that exercise can lead to related protection from neurotoxins that negatively affect dopamine and can encourage neuroplasticity, helping cognitive function.
Research in humans has shown that exercise can reduce the risk of Parkinson’s and can improve cognitive scores of PWP’s. The article surmises that ongoing vigorous exercise and physical fitness should be highly encouraged and that fitness programmes should be structured and graduated.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3136051/
Exercise and neuroplasticity in persons living with Parkinson’s disease.
A strong body of research supports non-pharmacological approaches, such as exercise and physiotherapy for the treatment of Parkinson’s, alongside medication. More recent studies using animal models of PD have begun to explore how exercise induces changes in the course of the disease.
There is a growing body of evidence to suggest that continuous, targeted, intensive training may also be linked to neuroprotection, thus having the potential to slow, stop or reverse the progression of the condition.
The evidence also suggests that exercise may promote neurorestoration. Much work remains to further explore and understand these findings in bigger human trials but the preliminary results are encouraging.
https://pubmed.ncbi.nlm.nih.gov/19532109/
High Intensity Exercise
The impact of high intensity physical training on motor and non-motor symptoms in patients with Parkinson’s disease (PIP): a preliminary study
The aim of this study was to explore the effects of a complex, high intensity physical training programme, with a long duration, on motor and non-motor symptoms in PWP’s. 24 patients with PD Hoehn and Yahr stage 1-3 were allocated into 2 groups; the intervention group whose participants underwent 32 weeks of high intensity personalized physical training twice a week, and the control group who received general recommendations regarding physical activity. The results of this study suggest that a personal high intensity exercise programme may positively influences both motor and non-motor symptoms in patients with mild to moderate PD.
https://pubmed.ncbi.nlm.nih.gov/24990028/
Intensive rehabilitation increases BDNF serum levels in parkinsonian patients: a randomized study.
This study examined whether intensive rehabilitation reduces motor disability in patients in the early stages of PD and if it increases growth factors (that stimulate cell growth, survival, and tissue repair.)
Thirty participants in the early stages of PD treated with rasagiline were divided into two groups; group one who received 3 hours of rehabilitation including aerobic exercise for 28 days and group two who did not receive rehabilitation. Results showed that intensive rehabilitation treatment increases growth factor levels and improves PD signs in patients in the early stages of the disease. These results are in line with studies on animal models of PD and healthy subjects.
Dairy and Parkinson’s
Consumption of Dairy Products and Risk of Parkinson’s Disease
Diet may play an important role in the etiology of Parkinson’s disease, either by altering the oxidative balance in the brain or by serving as a vehicle for environmental neurotoxins. Few epidemiological studies have been able to examine potential associations between diet and Parkinson’s disease because of its relatively low incidence.
The authors prospectively investigated the association between intake of dairy products and risk of Parkinson’s disease among 57,689 men and 73,175 women from the American Cancer Society’s Cancer Prevention Study II Nutrition Cohort.
https://academic.oup.com/aje/article/165/9/998/90221
Vitamin D and Parkinson’s
Prevalence of Vitamin D Insufficiency in Patients With Parkinson Disease and Alzheimer Disease
This report of 25(OH)D concentrations demonstrates a significantly higher prevalence of hypovitaminosis in PD vs both healthy controls and patients with AD. These data support a possible role of vitamin D insufficiency in PD. Further studies are needed to determine the factors contributing to these differences and elucidate the potential role of vitamin D in pathogenesis and clinical course of PD.
https://jamanetwork.com/journals/jamaneurology/fullarticle/796288
Omega 3 and Parkinson’s
FATTY ACIDS: EFFECTS ON BRAIN DOPAMINE SYSTEMS AND POTENTIAL ROLE IN THE ETIOLOGY AND TREATMENT OF NEUROPSYCHIATRIC DISORDERS
A number of neuropsychiatric disorders, including Parkinson’s disease …involve dysregulation of the brain dopamine systems. The etiology of these diseases is multifactorial, involving genetic and environmental factors. Evidence suggests that inadequate levels of n-3 (omega-3) polyunsaturated fatty acids (PUFA) in the brain may represent a risk factor for these disorders. These fatty acids, which are derived from the diet, are a major component of neuronal membranes and are of particular importance in brain development and function.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6563911/
Probiotics, Gut Microbiota and Parkinson’s
Probiotics for Parkinson’s Disease
A link between alterations in gut microbiota and Parkinson’s has also opened a new line of research. Evidence exists of a bidirectional pathway between the gastrointestinal tract and the central nervous system. Probiotics, prebiotics and synbiotics are being examined that might influence gut-brain axis by altering gut microbiota composition, enteric nervous system, and CNS. This review provides status on use of probiotics for Parkinson’s. Limitations and future directions will also be addressed to promote further research considering use of probiotics for the condition.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6747430/
Parkinson’s Disease: The Emerging Role of Gut Dysbiosis, Antibiotics, Probiotics, and Fecal Microbiota Transplantation
The role of the microbiome in health and human disease has emerged at the forefront of medicine in the 21st century. Over the last 2 decades evidence has emerged to suggest that inflammation-derived oxidative damage and cytokine induced toxicity may play a significant role in the neuronal damage associated with Parkinson’s.
The restoration of the gut microbiome in patients with Parkinson’s may alter the clinical progression of the condition and this alteration can be accomplished by carefully designed studies using customized probiotics and fecal microbiota transplantation.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657920/
Other great sources of information and research on exercise and nutrition for People with Parkisnon’s include:
The Michael J Fox Foundation
https://www.michaeljfox.org/news/exercise-and-parkinsons-frequently-asked-questions
Professor Bas Bloem’s research
