Bradykinesia and Exercise in PD
By Natara Ng
One of the most common early signs of Parkinson’s disease (PD) is bradykinesia. Exhibited in up to 98% of persons with Parkinson’s, bradykinesia refers to the slowness of voluntary bodily movement, and this can be observed as difficulty initiating movements and slowness with physical actions. Bradykinesia reduces quality of life because it increases physical dependency on others and also increases the probability of falling.
Bradykinesia can manifest in several different ways, and it is linked to other Parkinson’s symptoms such as akinesia and hypokinesia. Akinesia refers to the loss of movement, for example, loss of facial expression. Hypokinesia is characterized as reduced scale of movement, and one common example of this is reduced size of handwriting.
The onset of bradykinesia is highly unpredictable and oftentimes it is seen as a sign of PD rather than a symptom. Physiologically, it is speculated that bradykinesia arises from dopaminergic denervation of the basal ganglia as well as striatal cortical circuit dysfunction.
While there are several medications available for the management of bradykinesia, there are several types of exercise interventions that are effective in decreasing bradykinesia symptoms and improving quality of life for persons with PD.
There is evidence that eccentric resistance training can reduce bradykinesia in PD patients. Eccentric training differs from regular resistance training in that it emphasizes load during the lengthening phase rather than the contraction phase of muscle activation. A preliminary study by Dribble et al. (2009) looked at the effects of high intensity eccentric resistance training on bradykinesia in PD patients. Over a 12-week period, groups performed standard exercises such as walking on a treadmill and resistance training on both lower and upper extremities; the experimental group substituted high intensity eccentric training for resistance training in the lower extremities. They found that muscle force, bradykinesia, and quality of life were improved in participants who performed high intensity eccentric resistance training compared to the control group.
Cardiovascular training is also known to reduce bradykinesia in persons with PD. Ridgel et al. (2012) conducted an intervention study where PD patients participated in forty-minute active-assisted cycling sessions. The results showed that a single session of cardiovascular exercise at high intensity resulted in immediate reductions in bradykinesia in most participants.
Another form of exercise that addresses bradykinesia in PD is dance. Tango is a discipline that is particularly useful for managing bradykinesia because it entails many directional changes, stops and starts, and different speeds and rhythms (Borrione et al., 2014). Not only does dance improve symptoms of bradykinesia, but its enjoyable nature also helps with patient compliance.
Overall, exercise-based management of bradykinesia has proven to be effective across many disciplines, training types, and intensities. It will be important to provide diverse options of exercise programs to persons with PD such that they can choose the best program that fits their needs in managing this symptom.
Borrione, P. (2014). Effects of physical activity in Parkinson’s disease: A new tool for rehabilitation. World Journal of Methodology, 4(3), 133. https://doi.org/10.5662/wjm.v4.i3.133
Dibble, L. E., Hale, T. F., Marcus, R. L., Gerber, J. P., & LaStayo, P. C. (2009). High intensity eccentric resistance training decreases bradykinesia and improves quality of life in persons with Parkinson’s disease: A preliminary study. Parkinsonism and Related Disorders, 15(10), 752–757. https://doi.org/10.1016/j.parkreldis.2009.04.009
Ridgel, A. L., Peacock, C. A., Fickes, E. J., & Kim, C. H. (2012). Active-assisted cycling improves tremor and bradykinesia in Parkinson’s disease. Archives of Physical Medicine and Rehabilitation, 93(11), 2049–2054. https://doi.org/10.1016/j.apmr.2012.05.015