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Randomized Clinical Trial of 3 Types of Physical Exercise for Patients With Parkinson Disease
Open accessAbstract
OBJECTIVE: To compare the efficacy of treadmill exercises and stretching and resistance exercises in improving gait speed, strength, and fitness for patients with Parkinson disease. DESIGN: A comparative, prospective, randomized, single-blinded clinical trial of 3 types of physical exercise. SETTING: The Parkinson's Disease and Movement Disorders Center at the University of Maryland and the Baltimore Veterans Affairs Medical Center, Geriatric Research Education and Clinical Center. PATIENTS: A total of 67 patients with Parkinson disease who had gait impairment were randomly assigned to 1 of 3 arms of the trial. INTERVENTIONS; (1) A higher-intensity treadmill exercise (30 minutes at 70%-80% of heart rate reserve), (2) a lower-intensity treadmill exercise (50 minutes at 40%-50% of heart rate reserve), and (3) stretching and resistance exercises (2 sets of 10 repetitions on each leg on 3 resistance machines [leg press, leg extension, and curl]). These exercises were performed 3 times a week for 3 months. MAIN OUTCOME MEASURES: The primary outcome measures were gait speed (6-minute walk), cardiovascular fitness (peak oxygen consumption per unit time [$$ VO2], and muscle strength (1-repetition maximum strength). RESULTS: All 3 types of physical exercise improved distance on the 6-minute walk: lower-intensity treadmill exercise (12% increase; P=.001), stretching and resistance exercises (9% increase; P<.02), and higher-intensity treadmill exercise (6% increase; P=.07), with no between-group differences. Both treadmill exercises improved peak $$ VO2 (7%-8% increase; P<.05) more than did the stretching and resistance exercises. Only stretching and resistance improved muscle strength (16% increase; P<.001). CONCLUSIONS: The effects of exercise were seen across all 3 exercise groups. The lower-intensity treadmill exercise resulted in the greatest improvement in gait speed. Both the higher- and lower-intensity treadmill exercises improved cardiovascular fitness. Only the stretching and resistance exercises improved muscle strength. Therefore, exercise can improve gait speed, muscle strength, and fitness for patients with Parkinson disease. The combination of treadmill and resistance exercises may result in greater benefit and requires further investigation.
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“Studies have reported similar improvements in gait speed and stride length (Pohl et al., 2003) and aerobic capacity (Ridgel et al., 2009; Shulman et al., 2013) for high-intensity (80% of maximum capacity) and low-intensity (50% of maximum capacity) training programs.”
From Perception of Physical Demand, Mental Demand, and Performance: A Comparison of Two Voice Interventions for Parkinson's Disease (2022) · cites this paper as Shulman et al., 2013
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Self-Reported Exercise Trends in Parkinson’s Disease Patients
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“Treadmill training for 12 weeks showed an improvement in walking distance [26].”
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MethodVoluntary exercise increases striatal dopamine release and improves motor performance in aging mice
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“Given its repeatability and modifiability, the VO2 peak has been used as a primary endpoint for non-invasively assessing the response to the treatment of physical exercise in several randomized clinical trials (Shulman et al., 2013; Wallace et al., 2019).”
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“Many trials examining the effects of treadmill training or exercise in PD exclude people with cognitive impairment based on MMSE or MoCA scores [39,40].”
BackgroundMyelin Basic Protein and Cardiac Sympathetic Neurodegeneration in Nonhuman Primates
Metzger, J. M., Matsoff, H. N., Vu, D., Zinnen, A. D., Jones, K. M., Bondarenko, V., Simmons, H. A., Moore, C. F., & Emborg, M. E. (2021) · Neurology Research International · doi:10.1155/2021/4776610 · Cited by 3
Correction to: Current Perspectives on Aerobic Exercise in People with Parkinson's Disease
Schootemeijer, S., van der Kolk, N. M., Bloem, B. R., & de Vries, N. M. (2022) · Neurotherapeutics · doi:10.1007/s13311-022-01219-6 · Cited by 4
“[3] and calculated the adjusted mean, standard deviation and sample sizes according to Higgins et al.”
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Santos, L., Burtscher, J., & Taboada, L. H. D. (2025) · Journal of Neural Transmission · doi:10.1007/s00702-025-03050-7 · Cited by 3
“Shul-man et al. (Shulman et al. 2013), for example, assessed the effect of three different exercise programs on the gait and fitness of a group of seventy-seven PD´s patients, in thirty-six sessions of training distributed in three weekly sessions for three months; lower-intensity walking treadmill…”
InfluentialEffects of boxing exercise in people with Parkinson’s disease: a systematic review
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“Notably, compared to moderate-intensity exercise, high-intensity exercise has a greater impact on regulating BDNF, resulting in increased post-training BDNF levels (Shulman et al., 2013).”
Park, J.-H., Prochnow, T. M., Smith, M. L., Lee, J. M., & Amo, C. (2025) · Healthcare · doi:10.3390/healthcare13172212 · Cited by 3
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“In another exercise study, Shulman et al. (2013) recruited 67 PD patients to perform three types of interventions (high- and low-intensity treadmill, stretching, and resistance exercise) for three times a week for 3 months.”
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Effect of resistance exercises on gait of middle-aged and older adults with Parkinson’s disease
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“Consequently, this may result in decreasing execution speed of sequential, two-handed and, primarily, asymmetrical tasks which demand increased motor complexity [13,15,21,30,55-59].”
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“[50] Hirsch MA, Farley BG (2009) Exercise and neuroplasticity in persons living with Parkinson’s disease.”
BackgroundInfluentialClinical and genetic analysis of Costa Rican patients with Parkinson’s diseasePreprint
Acosta, G. T., Yu, E., Lobo-Prada, T., Ruiz‐Martínez, J., Pagola, A. G., Gan‐Or, Z., Carazo-Céspedes, K., & Trías, J. F. (2020) · medRxiv · doi:10.1101/2020.09.29.20202432 · Cited by 2
Well-Being and Work–Life Balance
Bolton, M. A., Lobben, I., Pruzinsky, T., & Stern, T. A. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108650182.046 · Cited by 1
Forgiveness, Gratitude, and Spirituality
Idicula, S. A., Thrower, N., & Lomax, J. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108650182.029 · Cited by 1
Bokarius, V., & Bokarius, A. V. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108650182.037 · Cited by 2
Wellness Interventions in Patients Living with Chronic Medical Conditions
Steiner, A. J., Aguilar-Hernandez, L., Pizano, D. R., Dascal, J., & IsHak, W. W. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108650182.014 · Cited by 1
Liu, B., Yu, J., Fan, Q., Hao, F., Wu, J., Xiao, W., Yu, F., & Ren, Z. (2023) · Frontiers in Neurology · doi:10.3389/fneur.2022.1074521 · Cited by 1
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Lee, M.-H., Kim, J.-H., Han, J.-S., & Kim, M.-K. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm15010166
“…brain regions by generating depolarization and subsequent action potentials. rTMS protocols are often differentiated by frequency (e.g., high frequency > 5 Hz for excitation, low frequency ≤ 1 Hz for inhibition) to induce and sustain excitability changes even after the stimulation ends [18].”
Thwaites, C. K., Harris, D. M., Callisaya, M. L., Mouer, R., Clifford, A. M., Blazé, R., & Morris, M. E. (2026) · Disability and Rehabilitation · doi:10.1080/09638288.2025.2606644 · Cited by 1
“Registered physiotherapists frequently implement movement rehabilitation programs for older people with PD in hospitals or rehabilitation units [28,29].”
Matsushita, W., Nagaki, K., Takashi, N., Ohtera, S., Ohara, C., & Takahashi, M. (2026) · Journal of Parkinson s Disease · doi:10.1177/1877718x261418989 · Cited by 1
“…light-to-moderate intensity, guided by clinical judgment and individual tolerance 24 ; (3) resistance training using body weight or light elastic bands, primarily targeting the lower limbs and trunk 23 ; and (4) static and dynamic balance training focused on postural stability and fall prevention.”
Sugiyama, K., Kataoka, M., Iwata, A., Higuchi, Y., Saga, R., Ikebuchi, M., Takahashi, S., & Nakamura, H. (2026) · Disability and Rehabilitation Assistive Technology · doi:10.1080/17483107.2026.2626848 · Cited by 1
Bosch‐Barceló, P., Tersa-Miralles, C., Martínez-Navarro, O., Masbernat, M. A., Pakarinen, A., & Fernández‐Lago, H. (2026) · Neurological Sciences · doi:10.1007/s10072-026-09136-8 · Cited by 1
Zhang, Z., & Zhou, Y. (2026) · Frontiers in Aging Neuroscience · doi:10.3389/fnagi.2026.1831208 · Cited by 1
Potenzialanalyse zur physiotherapeutischen Laufbandtherapie bei Morbus Parkinson
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“Studies on early- and mid-stage PD subjects suggest exercise-induced neuroplasticity in dopaminergic signaling may be an effective method to improve motor function [11, 12, 13].”
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Aging with Parkinson’s Disease
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“Many researches showed that exercise led to the improvement of functional recovery in patients with Parkinson [12] or Alzheimer [13]; such improvement is a result of exercise on brain function, local neurogenesis and long-term potentiation (LTP) in the hippocampus [14, 15].”
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Dieppe, P. A., Goldingay, S., & Warber, S. L. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108650182.042 · Cited by 3
Emotional Intelligence and Its Role in Sustaining Fulfillment in Life
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Family Relations, Friendships, and Love
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Molecular mechanisms of glial cells in brain disorders following physical exercise
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“In addition, exercisebased therapies have the potential to counteract depression and anxiety related symptoms [19,38-40].”
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Metadata
- Authors
- Shulman, L. M., Katzel, L. I., Ivey, F. M., Sorkin, J. D., Favors, K., Anderson, K. E., Smith, B. A., Reich, S. G., Weiner, W. J., & Macko, R. F.
- Affiliations
- University of Maryland, Baltimore (US)
- Corresponding author
- Shulman, Lisa M.
- ORCID
- Venue
- JAMA Neurology
- Publisher
- American Medical Association (AMA)
- Published
- 2013-02-01
- Volume
- 70
- Issue
- 2
- Pages
- 183
- ISSN
- 2168-6149 (ISSN-L)
- PMC
- PMC4574905
- OpenAlex
- W2124808208
- Cited by
- 410
- References
- 40
- Citations by year
- 2026: 16 · 2025: 25 · 2024: 33 · 2023: 19 · 2022: 32 · 2021: 36 · 2020: 78 · 2019: 34 · 2018: 27 · 2017: 25 · 2016: 21 · 2015: 24 · 2014: 21 · 2013: 16
- FWCI
- 50.17
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- JAMA Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Aging (T32AG000219, R01AG034161, P30AG028747)
- National Heart, Lung, and Blood Institute (R01HL095136, K30HL004518)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK090401)
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01AR057967)
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Clinical Neurology › Parkinson's Disease Mechanisms and Treatments
- Keywords
- Parkinson's disease, physical activity, treadmill exercise, resistance training, stretching, walking speed, cardiorespiratory fitness, peak oxygen uptake, muscle strength, exercise intensity, 6-minute walk test
- MeSH terms
- Adult, Aged, Electrocardiography, Exercise Test, Female, Gait, Humans, Male, Middle Aged, Parkinson Disease, Prospective Studies, Exercise, Single-Blind Method, Muscle Stretching Exercises, Resistance Training
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