Any discussion of management of PD would not be complete without emphasizing the importance of physical therapy and improved conditioning of patients with PD. Regular exercise program, combined with appropriate medical management, has been shown to delay the onset of physical disability associated with PD. Many studies have shown that exercise improves stamina and prevents fatigability, constipation, depression, sleep, osteoporosis, and memory loss.
Exercise also decreases the risk of stroke and heart attacks by reducing body weight, blood pressure, and risk of diabetes, and increasing the HDL ("good") cholesterol. For these and many other reasons ongoing vigorous exercise and physical fitness, which should include stretching, range of motion, and conditioning exercises should be highly encouraged, particularly if there are no physical contraindications.
Many patients wrongly assume that the "exercise" they get during their daily routines at work or at home, such as housecleaning, climbing stairs, and even mowing the lawn are sufficient forms of exercise. While these activities are encouraged, regular exercise program, tailored to the needs of the individual patient, is critical for continued well being. The exercises should be designed to improve strength (e.g. using free weights, weight machines, and elastic bands) and overall fitness (e.g. walking, swimming). Water aerobics and dancing have been found particularly effective and safe.
Incorporation of external sensory cues in the rehabilitation protocol has been shown to extend short-term benefits of physical therapy. For example, a visual cue provided by an inverted L-shaped cane, horizontal beam on a walker, or by rhythmical sounds, such as listening to marching music, can significantly help overcome gait freezing.
Also, instructing the patient to take high steps or exaggerate their arm swing (e.g. simulating marching) may improve their gait and balance. Swimming or otherwise exercising in the water has the additional advantage in that there is very little stress on the joints and the resistance improves muscle strength. This low impact activity also increases endurance and balance. Some patients prefer stretching and muscle relaxing exercises such as Pilates, tai chi, and yoga and they are clearly useful additions but should not replace the various conditioning exercises.
Recent animal research has provided strong evidence that exercise can increase resistance to brain insult or injury and can improve learning, mental, and motor performance. Patients should always check with their physicians before launching into a new exercise program. All precautions should be taken to prevent injuries.