Targeting exercise intensity and aerobic training to improve outcomes in Parkinson’s disease

Aerobic training is popular for people with Parkinson’s disease (PD) given its potential to improve aerobic capacity, relieve symptoms, and to stabilise disease progression. Although current evidence supports some of the assertions surrounding this view, the effect of exercise intensity on PD is currently unclear. Reasons for this include inconsistent reporting of exercise intensity, training regimes based on general guidelines rather than individualised physiological markers, poor correspondence between intended exercise intensities and training zones, and lack of awareness of autonomic disturbance in PD and its impact on training regimes and outcome. We also consider the selective effect of exercise intensity on motor symptoms, function and disease progression. We review aerobic training protocols and recent guidelines for people with PD, highlighting their limitations. Considering this, we make suggestions for a more selective and discerning approach to aerobic training programming.