May, 2022

Anthony Plettl, BSc Kin Student, Devon Portz, BSc Kin Student, Christian Ramos, BSc Kin Student, Brandon Reyes, BKin Student, and Caroline van Egteren, BKin Student

Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta

Take home message

  • Using endurance exercise guidelines as a minimal dose can lead to a reduction of motor function symptoms in individuals with Parkinson’s disease (PD) (Schenkman et al., 2018; van der Kolk et al., 2019)
  • The optimal dose for endurance exercise to attenuate motor function symptoms in individuals with PD remains inconclusive, however some progress has been made.
  • High intensity interval training has shown benefits for PD symptoms such as bradykinesia and impaired motor function for individuals with mild to moderate PD (Marusiak et al., 2019).

  • Treadmill and cycle training have both been reported as appropriate types of endurance exercise training modalities for individuals with PD (Schenkman et al., 2018; van der Kolk et al., 2019). More specifically, treadmill training applies to individuals with early stage PD while cycle training applies to individuals with mild to moderate PD who are on stable dopaminergic medication (Schenkman et al., 2018; van der Kolk et al., 2019).

  • For individuals with newly diagnosed PD, high intensity training is recommended over moderate intensity training.


  • A previous meta-analysis by Flach et al. (2017) investigated the effects of endurance exercise on motor function symptoms in individuals with PD. The results of this study showed a positive relationship between endurance exercise and improvements in the Unified Parkinson’s Disease Rating Scale (UPDRS) total and/or subsection III motor scores. Flach et. al (2017) suggest endurance exercise training, using the ACSM guidelines, should be included in the treatment of PD; however, an optimal dose of exercise prescription is lacking and warrants further investigation.

How the study was done

  • The authors replicated the search strategy of the meta-analysis performed by Flach et al. (2017) and updated the findings through qualitative synthesis based on research articles published between 2016-2020.
  • The authors searched 3 large databases using the search terms provided by Flach et al. (2017). These search terms were related to exercise and PD.
  • A total of 763 articles were screened based on the inclusion criteria from Flach et al. (2017). Each study had to: 1) include individuals with a diagnosis of PD; 2) be published in a peer-reviewed journal; 3) use a randomized controlled trial research design; 4) include a comparison group that was non-endurance in nature (i.e. strength training, yoga, tai chi, flexibility, etc.); 5) provide details of an endurance exercise intervention using ACSM criteria including type of exercise, duration (e.g., at least 20 min or more per session), frequency (e.g., at least 3 or more sessions per week), and intensity (e.g., “moderate” or “vigorous,” defined as ≥46% of maximal exercise oxygen uptake); 6) perform assessment using the UPDRS total or subsection III (motor signs of PD); and 7) be written in the English language. Similar to the Flach et al. (2017) meta-analysis, studies were excluded if the exercise intervention lasted less than 2 weeks, involved the prescription of endurance exercise training in both or all study groups, occurred less than three exercise sessions per week, or studied animals.
  • 3 randomized controlled trials met the inclusion criteria and were included in our review. The authors performed a qualitative synthesis of the data. A meta-analysis was not included.

What the researchers found

  • F.I.T.T. Progressions:
  • Frequency and Time Parameters – No progressions were found in the literature for people with PD in regards to these parameters. Therefore, they remain at the minimum ACSM recommendations.

  • Type Parameter – Cycle training and treadmill training are now recommended as beneficial modalities, but no optimal modality has been identified (Schenkman et al., 2018; van der Kolk et al., 2019). More specifically, treadmill training is recommended for individuals who are newly diagnosed with PD (Schenkman et al., 2018); cycle training is recommended for individuals with mild to moderate PD who are on medication (van der Kolk et al., 2019).

  • Intensity Parameter – High intensity exercise attenuates worsening of PD symptoms for individuals with early stage PD, while moderate intensity exercise does not. Optimal intensity recommendations for endurance exercise for other stages of PD remain inconclusive (Schenkman, 2018).


  • Research has found that moderate and high intensity endurance exercise using a treadmill or stationary cycle are safe modalities. For exercise professionals working with individuals with PD, the above information provides a safe and progressed dose of exercise to manage motor function symptoms for these individuals.


American College of Sports Medicine. (2020). Trending Topic: Physical Activity Guidelines.

Flach, A., Jaegers, L., Krieger, M., Bixler, E., Kelly, P., Weiss, E. P., & Ahmad, S. O. (2017).

Endurance exercise improves function in individuals with Parkinson’s disease: A meta-analysis. Neuroscience Letters, 659, 115-119.

Marusiak, J., Fisher, B., Jaskólska, A., Słotwiński, K., Budrewicz, S., Koszewicz, M.,

Kisiel-Sajewicz, K., Kamiński, B., & Jaskólski, A. (2019). Eight weeks of aerobic interval training improves psychomotor function in patients with Parkinson’s disease—randomized controlled trial. International Journal of Environmental Research and Public Health, 16(5), 880-896.

Schenkman, M., Moore, C. G., Kohrt, W. M., Hall, D. A., Delitto, A., Comella, C. L.,

Josbeno, D. A., Christiansen, C. L., Berman, B. D., Kluger, B. M., Melanson, E. L., Jain, S., Robichaud, J. A., Poon, C., & Corcos, D. M. (2018). Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo parkinson disease. JAMA Neurology, 75(2), 219-226.

van der Kolk, N. M., de Vries, N. M., Kessels, R. P. C., Joosten, H., Zwinderman, A. H., Post,

B., & Bloem, B. R. (2019). Effectiveness of home-based and remotely supervised aerobic exercise in parkinson’s disease: a double-blind, randomised controlled trial. The Lancet Neurology, 18(11), 998–1008.

This article is a summary of an article published in Applied Physiology, Nutrition & Metabolism. If you intend to cite any information in this article, please consult the original article and cite that source. This summary was written for the Canadian Society for Exercise Physiology and it has been reviewed by the CSEP Knowledge Translation Committee.