How can I lower my risk of developing Parkinson’s disease?

HEALTH

Kirk Gibson, right, who played Major League Baseball for 17 years, a career that included home runs that clinched a victory for the 1984 World Series Detroit Tigers and 1988 World Series Los Angeles Dodgers, talks about the foundation he created to help people like himself diagnosed with Parkinson’s disease. Listening to Gibson is Steve Annear, the foundation’s managing director. GINA JOSEPH — MEDIANEWS GROUP

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By Dr. Trisha Pasricha

Special to The Washington Post

Is there anything I can do to lower my risk of developing Parkinson’s disease?

Parkinson’s disease affects over 8.5 million people globally and is rising at an alarming rate: By 2030, the prevalence in many countries will have doubled from what it was in 2005.

There is still a lot we don’t know about how Parkinson’s disease develops. But as a physician-scientist who studies the disease’s origins, I regularly recommend one promising intervention to my patients: aerobic exercise. Even one hour per week of moderate to vigorous exercise — such as tennis, biking, swimming or jogging — has been shown to make a significant difference.

I know. “Exercise more” can feel like such clichéd advice coming from a doctor. But exercise is one of the best-studied interventions in Parkinson’s disease. It’s been shown to both lower the risk of developing Parkinson’s disease entirely, as well as to delay disease progression among people already diagnosed. That’s a huge deal: If you think about it, there are very few drugs that do both of those things for any disease.

Looking for where and how to begin a new exercise habit? The key is finding exercises you actually enjoy. Hate jogging on the treadmill? Try aqua-jogging or exploring an outdoor trail near you.

Exercise regimens that help improve balance, such as dancing or boxing, can be great for people at higher risk of falls. Speak with your physician about the most appropriate regimen for your needs.

Brain scans offer clues about the power of exercise

Many forms of exercise are beneficial to various aspects of our health, but to reduce Parkinson’s disease risk, studies have honed on some specifics. Light activity, such as walking or bowling, appear less protective. Most studies have found the greatest benefit with moderate to vigorous physical activity.

But studies have found it actually doesn’t have to be every day or even for very long. A 2010 study of over 200,000 people found that men and women in their 30s who engaged in one to three hours per week of moderate to vigorous exercise had a significantly lower risk of getting Parkinson’s disease later in life (for men, by 17% and for women, by 39%). That risk declined even further with more hours exercised each week. For seven or more hours, for example, men had a 30% reduced risk and women had a 53% reduced risk.

One reason exercise is so powerful is that it may be able to reverse the neurodegeneration seen in patients with Parkinson’s disease. For instance, a small study published earlier this year looking at brain scans of patients at an early stage of the disease found that six months of regular intense exercise (reaching 80% of a person’s age-appropriate maximum heart rate) appeared to improve the health and viability of the dopamine neurons in the brain.

The hallmark of Parkinson’s disease is a misfolded protein in the body, called alpha-synuclein, that is implicated in the loss of dopamine neurons in the brain. When those dopamine neurons are lost, people lose their ability to fully control their muscles, resulting in symptoms such as tremors and trouble walking.

The quiet signs of Parkinson’s disease

Doctors who treat patients with Parkinson’s disease know that by the time someone is diagnosed, the underlying molecular processes driving symptoms have already been brewing in their bodies for decades.

In other words, when we diagnose people with Parkinson’s, we’re already late. It is much harder to slow down the disease in someone who has few dopamine-producing neurons left in the brain than it would have been had we intervened earlier.

Those decades before classic symptoms of Parkinson’s show up — when we suspect the disease is quietly working its way through the body — are known as the “prodromal” period.

When I say quietly, sometimes it’s actually not so quiet — we just don’t always recognize it for what it is. People with prodromal Parkinson’s disease often do have symptoms, but not the “classic” ones we think of as associated with the disease.

These prodromal symptoms include loss of the ability to smell, constipation and excessive daytime sleepiness — and they can be present for years. Trouble swallowing, chronic nausea and irritable bowel syndrome also predict future development of Parkinson’s disease.

To be clear, any one of these signs isn’t a definite marker of disease (I mean, who here isn’t a little constipated from time to time?). But if your parent had Parkinson’s disease, you’ve lost your sense of smell, and you’ve had worsening constipation over the last few years — well, then you would have my attention.

If you’re concerned, speak with your health-care provider — and potentially a neurologist — to further assess your risk, which is based on many additional factors such as your genetics (10% to 15% of Parkinson’s cases have a genetic cause), environmental exposures and more.

What I want my patients to know

In some cases, researchers believe Parkinson’s disease may begin in the gut decades before it spreads to the brain. The data still isn’t quite at the stage where we can confidently say if reducing damage to the gut can lessen the likelihood of developing Parkinson’s disease. However, taking steps to improve your gut’s lining — like minimizing nonsteroidal anti-inflammatory drugs (NSAID) use, limiting alcohol and avoiding ultra-processed foods — will only boost your gut health and overall well-being.