Exercise and Parkinson’s: more evidence of its long term benefits

We all know that exercise is important for people with Parkinson’s. But as new evidence emerges, it is worth repeating why. If exercise could be sold in pills, people would probably be popping them like sweets. The more important question is whether staying active can do more than improve fitness and help manage symptoms. Could it also be associated with slower long term deterioration? A new study published in Neurology on 7 October 2026 investigated this question, examining the relationship between physical activity and changes in both movement and cognitive function over several years. $1 The researchers analysed data from 294 people with mild to moderate Parkinson’s enrolled in the Cincinnati Cohort Biomarker Program between January 2019 and February 2025. Participants had an average age of 66.4 years, and one third were women. Physical activity was assessed through structured interviews. The researchers examined three measures: total time spent being physically active, overall physical activity volume, and time spent doing vigorous physical activity. They then compared these measures with changes in two established clinical assessments. Movement was measured using part III of the Movement Disorder Society’s Unified Parkinson’s Disease Rating Scale, known as MDS-UPDRS, where higher scores indicate worse motor symptoms. Cognitive function was assessed using the Montreal Cognitive Assessment, or MoCA, a screening test in which higher scores generally indicate better cognitive performance. Participants were followed for up to seven years for motor outcomes and up to five years for cognitive outcomes. The researchers used statistical models to account for demographic and disease related factors that could influence the results. $1 The results showed a clear association between greater physical activity and slower deterioration in both areas. For cognition, participants were divided into three groups according to how much time they spent being active. In the group with the lowest activity levels, MoCA scores declined by an average of 0.478 points per year. In the middle group, the annual decline was 0.090 points. In the most active group, scores declined by just 0.007 points per year, on average. These figures suggest that cognitive scores remained much more stable among participants who were more physically active. However, the study does not establish that their underlying brain changes were prevented, and the results describe group averages rather than predicting what will happen to any individual. The differences in motor scores were also notable. The least active group experienced an average annual increase of 0.143 points on the motor assessment, indicating slight worsening. The middle group had an annual change of minus 0.225 points, while the most active group had a change of minus 0.783 points. Because higher motor scores indicate worse symptoms, these negative changes represent an improvement in the measured scores rather than deterioration. They do not necessarily mean that participants experienced a lasting improvement in every aspect of their Parkinson’s. When the researchers directly compared the most active group with the least active group, the association with slower cognitive decline was statistically strong. The association with slower motor progression was also statistically significant, although the evidence was less robust. $1 One of the study’s most interesting findings concerned the relationship between the duration and intensity of physical activity. Although greater amounts of vigorous activity were associated with better outcomes in the initial analyses, this relationship was no longer evident after the researchers accounted for total physical activity time. This suggests that spending more time being active may be an important factor, rather than vigorous exercise necessarily providing additional benefits beyond overall activity. The researchers also examined recent activity in relation to physical activity during the previous ten years. Recent activity remained associated with changes in both motor and cognitive scores after accounting for earlier activity levels. This supports the importance of maintaining activity rather than assuming that being physically active earlier in life will be enough. However, the findings do not establish a precise minimum number of minutes or hours that people with Parkinson’s should aim for. $1 There is an important limitation: this was an observational study, not a clinical trial in which participants were randomly assigned to different exercise programmes. Physical activity was self reported, and people with less severe symptoms or better general health may find it easier to remain active. Statistical adjustments cannot eliminate every possible influence. The study therefore cannot prove that exercise itself slowed the progression of Parkinson’s. Nor can it establish that increasing exercise will produce the same results in every person. Nevertheless, following participants over several years and examining both motor and cognitive outcomes provides useful evidence. The results strengthen the case for treating physical activity as an important part of long term Parkinson’s care, rather than focusing exclusively on exercise as a way to improve fitness or manage individual symptoms. We already know that exercise matters. What this study adds is evidence that people who remain more active tend to experience more favourable changes in movement and cognitive scores over time. The next challenge is to establish through controlled trials whether exercise directly changes the course of the disease, and which approaches offer the greatest benefit. If exercise were a pill, these findings would certainly attract attention. For now, they provide another reason to take physical activity seriously, while recognising that it is not a proven substitute for treatments that target Parkinson’s itself.