Fatigue, a major problem for Parkinson’s patients
Fatigue is a common complaint in Parkinson’s disease, affecting almost half of patients. People with PD describe fatigue as a feeling of being overwhelmed, exhausted and unmotivated for everyday activities, demonstrating that fatigue is a multidimensional non-motor symptom 1. Interestingly, fatigue seems to correlate with the severity of Parkinson’s disease 2: The more advanced the disease, the more tired patients feel.
No clear pathophysiology
Scientists have not yet found the cause of Parkinson’s fatigue. Some suspect that it is due to a dopamine deficiency, as patients treated with levodopa showed less physical fatigue, as measured by finger tapping and wrist contraction 3. Others suspect abnormal iron metabolism 4 or an altered immune system 5 as the underlying mechanism. Given the lack of understanding, treatment options are limited.
Physical exercise improves fatigue
A recent study examined randomised clinical trials investigating the effects of pharmacological and non-pharmacological treatments for fatigue in Parkinson’s patients 6. The use of levodopa, central nervous system stimulants, antidepressants or anti-dementia drugs was compared with physical exercise, psychotherapy, acupuncture and light therapy. While medication can have a positive effect on fatigue, physical exercise significantly improved symptoms. The measures analysed included running, muscle training, dancing and yoga. The fitness programme varied from study to study, but on average the exercises were performed for one hour, at least twice a week and for at least two months.
Fatigue in Parkinson’s: The following exercises are worth mentioning
- Exercises with the resistance band for the legs: Performing these exercises improved Parkinson’s patients’ fatigue and dynamic balance, i.e. ability to remain steady in motion, after 2 months of training.
- Nordic walking: Participation in a two-week, three-month Nordic walking programme – an outdoor exercise using walking poles – led to an improvement in blood pressure, leg strength and flexibility. Patients also reported feeling less depressed and tired.
- Exergaming (exercise + games): Playing virtual reality fitness games for half an hour twice a week reduced fatigue and improved patients’ balance after 3 months.
- Yoga: Participating in a two-month yoga programme reduced patients’ fatigue and improved their confidence in balance – the belief that they can perform an activity without falling or feeling unsteady – as well as their quality of life.
Unfortunately, this study is not without its limitations. The authors emphasise that only a few people took part in many of the clinical studies examined (10-15 people treatment vs. control), which means that the statistical significance is low. Larger studies are required to draw meaningful conclusions. A further limitation is that almost all clinical studies were conducted with Parkinson’s disease patients aged around 60 years: The effects on younger patients remain unknown.
Nevertheless, physical activity has a positive effect on general health and rarely has negative effects compared to medication – it could be an excellent way to combat fatigue.
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References
- Mantri S, Klawson E, Albert S, et al. Understanding the Lexicon of Fatigue in Parkinson’s Disease. J Parkinsons Dis. 2020;10(3):1185-1193. doi:10.3233/JPD-202029
- Zhou X, Xiang Y, Song T, et al. Characteristics of fatigue in Parkinson’s disease: A longitudinal cohort study. Front Aging Neurosci. 2023;15:1133705. Published 2023 Mar 10. doi:10.3389/fnagi.2023.1133705
- Lou JS, Kearns G, Benice T, Oken B, Sexton G, Nutt J. Levodopa improves physical fatigue in Parkinson’s disease: a double-blind, placebo-controlled, crossover study. Mov Disord. 2003;18(10):1108-1114. doi:10.1002/mds.10505
- Zuo LJ, Yu SY, Hu Y, et al. Serotonergic dysfunctions and abnormal iron metabolism: Relevant to mental fatigue of Parkinson disease. Sci Rep. 2016;6(1):19. Published 2016 Dec 21. doi:10.1038/s41598-016-0018-z
- Herlofson K, Heijnen CJ, Lange J, et al. Inflammation and fatigue in early, untreated Parkinson’s Disease. Acta Neurol Scand. 2018;138(5):394-399. doi:10.1111/ane.12977
- Folkerts AK, Nielsen J, Gollan R, et al. Physical Exercise as a Potential Treatment for Fatigue in Parkinson’s Disease? A Systematic Review and Meta-Analysis of Pharmacological and Non-Pharmacological Interventions. J Parkinsons Dis. 2023;13(5):659-679. doi:10.3233/JPD-225116