What level of exercise do you recommend in patients with Parkinson's disease?

I recommend aerobic exercise for at least 30 minutes/day, 5 days a week. These recommendations are of course based on patient's physical ability. I usually advise using a stationary bicycle and if that is not possible, a recumbent bicycle for aerobic exercise. This way if there is bad weather or unavailability of means to go to a gym, the exercise schedule does not get affected. Treadmill is probably okay in the initial stage of the illness when patients have not developed postural instability. Later on, I do not recommend treadmill because of concerns for falls while using treadmill.

Whether a higher level of exercise leads to better brain health, was not addressed in the study. I am not sure if this has been addressed in another study.

In our study, we opted for a medium-intensity exercise intervention. Patients were instructed to cycle at 50-80% of target heart rate reserve 3 times per week for 6 months. Each session lasted for 30-45 minutes and included warm-up and cool-down periods. Injury prevention and safety was the top concern in setting up the intervention. We opted for cycling on a stationary home trainer given that patients can safely engage in it even if they suffer from balance issues or excessive slowness. We made sure to include warm-up and cool-down periods in each session to further decrease the risk of injury.

There are a number of considerations beyond safety to consider when recommending an appropriate exercise level. Previous research has shown that ben...

I have recommended a combination of moderate to severe aerobic conditioning along with stretches/ full body workouts, daily for at least 30-45 minutes, if not more- for the last 20 years and have seen improvement in motor function, balance, cognition ALWAYS.

When they are unsafe because of advanced disease or other comorbidities, I recommend exercise equipment like recumbent elliptical, stationary bikes, and chair exercises.

This helps at any stage of the disease.

Motivational video released by the NEJM group on Youtube - Cycling for freezing gait in Parkinsons' disease 4/1/2010.