Strength Training for Parkinson’s Disease: Benefits and Prescription Based on Research

Strength training involves working on increasing the strength and force that your muscles can produce. This can be through body weight exercises such as sit to stands, or can be performed with an external load such as dumbbells, resistance bands, weight machines etc. In this blog post, we will discuss the research surrounding strength training for individuals with Parkinson’s and provide a summary of the recommendations.

Evidence Supporting Strength Training for PD:

Most of the evidence on strength training in Parkinson’s Disease involves progressive resistance training. Progressive resistance training (PRT) means performing strengthening exercises that are gradually made more challenging as strength is improving. Below we will discuss what the evidence tells us regarding progressive resistance training for individuals with Parkinson’s Disease.

PRT Improves UPDRS Scores, Quality of Life, and Strength:

A study by Corcos et al in 2013 examined the effects of progressive resistance exercise for people with Parkinson’s Disease. Their study took place over the course of two years so there was a long term follow-up. In this study, individuals with Parkinson’s Disease were randomly assigned to the experimental group where they performed progressive resistance training, or the control group where they participated in the modified fitness counts program which includes stretching, balance, and strength training (but without progressive resistance). Individuals performed strength exercises two days per week for two years. They found that the individuals that performed the progressive resistance exercise had a better improvement on the motor portion of the Unified Parkinson’s Disease Rating Scale (UPDRS) while off medications compared to those that performed the balance, strengthening, and stretching program. Additionally, those that performed the progressive resistance training had higher scores on a subjective questionnaire of their quality of life (PDQ-39). The group that performed progressive resistance training also had a more significant improvement in their strength which was measured by calculating maximum muscle torque in certain muscle groups.

Graph A (on the left) shows how the UPDRS motor exam improves (a lower score is better on this exam) in individuals performing progressive resistance training in comparison tot he control group. Graph B (on the right) shows how those participating in progressive resistance training overall needed less medication to manage their Parkinson symptoms over the course of the two years when compared to the control group.

PRT Improves Walking:

People with Parkinson’s can have difficulty with gait initiation. This means that when someone with Parkinson’s attempts to begin walking from a stationary position, they may have some trouble. One study by Hass et al from 2012 examined the effects of progressive resistance training on gait (walking) initiation in individuals with Parkinson’s Disease. In this study, individuals with Parkinson’s Disease were assigned to either a twice weekly progressive resistance training program, or a control group for 10 weeks. They found that those participating in the progressive resistance training program had improvements in their posterior displacement of center of pressure as well as their initial stride length and velocity. This means, they were better able to shift their weight, could take larger steps, and could move faster than those that had not performed progressive resistance training.

PRT Improves Bradykinesia and Functional Performance:

Bradykinesia is the slowness of movement that can occur with Parkinson’s Disease due to the loss of dopamine. Vieira de Moraes Filho et al conducted a study in 2020 that examined how progressive resistance training can improve bradykinesia. They split individuals with PD into an experimental group where they performed 9 weeks of progressive resistance training and a control group where they attended educational seminars. After 9 weeks of progressive resistance training, they found improvements in bradykinesia on the UPDRS exam, improvements in knee extensor (quad) strength, and improved walking speed and functional mobility (measured via the Timed Up and Go test, 10m Walk Test, and 30sec Sit to Stand Test).

PRT to improve balance, strength and motor symptoms:

A systematic review means that researchers combined many randomized clinical trials in order to summarize the evidence. One systematic review conducted by Chung et al in 2014, examined the evidence for resistance training in individuals with Parkinson’s Disease. They included seven studies with a total of 401 participants with a range from early to advanced Parkinson’s disease. After examining all of the evidence, they concluded that resistance training performed 2-3 days per week over 8-10 weeks can significantly improve muscle strength, balance, and Parkinson’s motor symptoms in individuals with early to moderate Parkinson’s Disease.

Summary:

Let’s summarize the evidence. The research tells us that progressive resistance training performed 2-3 days per week can help improve:

• Balance

• Motor symptoms on the UPDRS exam

• Strength

• Quality of life

• Bradykinesia

• Walking

• Functional performance (sit to stands, walking speed etc)

What exactly should I be doing?

So now that we understand all of the benefits, let's discuss how progressive resistance training should be performed.

Progressive resistance training should be performed 2-3 days per week. In general, the goal is to perform 3 sets of 10 repetitions. How much weight should you use? Well, the literature on strength training uses a percentage of someone’s one repetition maximum (or 1-RM) to determine what weight should be used. For individuals with Parkinson’s, it is recommended to perform strengthening exercises at 60% of the individuals 1-RM. This means if you determine that the heaviest weight you can use to complete a bicep curl is 30lbs, then you should use 18lbs and complete 3 sets of 10 repetitions. But remember, as soon as this becomes easier, you should increase the resistance to make it harder! We can’t continue to improve if we do not continue to challenge ourselves.

Strength training should be performed for all major muscle groups. However, Because individuals with Parkinson’s Disease tend to have over-activation of the flexor muscles, it is generally recommended to focus on the extensor muscles. This means strengthening your postural muscles and the muscles that help you stand up tall.

If you have any questions, or are not sure where to start, please feel free to reach out to us! We also always recommend consulting with your physician or physical therapist prior to starting new exercise routine.

Sources:

Corcos et al, 2013. A two-year randomized controlled trial of progressive resistance exercise for Parkinson’s disease. Movements Disorders 28(9).

Hass et al, 2012. Progressive resistance training improves gait initiation in individuals with Parkinson’s disease. Gait and Posture 35: 669-673.

Vieira de Moraes Filho et al, 2020. Progressive resistance training improves bradykinesia, motor symptoms, and functional performance in patients with Parkinson’s disease. Clinical Interventions in Aging 15: 87-95.

Chung et al, 2016. Effectiveness of resistance training on muscle strength and physical function in people with Parkinson’s disease: A systematic review and meta-analysis. Clinical Rehabilitation 30(1): 11-23.