Key takeaways:

• Researchers say physical activity could affect disease progression.
• Benefits were strongest among those who got more than 4 hours of activity per week.
• Activity duration mattered more than intensity.

Higher levels of physical activity were associated with slower cognitive and motor decline in people with Parkinson’s disease, according to research published in Neurology.

Past research has shown how physical activity can improve motor symptoms in people with PD in the short term, but the new findings indicate that physical activity could have longer-term benefits when it comes to modifying disease trajectories and slowing cognitive decline, said Dong-Woo Ryu, MD, PhD, a neurologist with the University of Cincinnati.

Data derived from Ryu D, et al. Neurology. 2026: doi:10.1212/WNL.0000000000218682.

“Our study was observational, so we cannot establish causality,” Ryu told Healio. “However, based on its previously reported benefits and our findings, physical activity may be a modifiable factor influencing the course of Parkinson’s disease.”

As part of a longitudinal cohort study, researchers examined 294 individuals (mean age, 66.4 years; 33% female; 98.3% white) with mild to moderate PD enrolled in the Cincinnati Cohort Biomarker Program between January 2019 and February 2025. Those enrolled in the program had follow-ups annually for at least 10 years.

Ryu and colleagues took three different measurements of physical activity:

• Total physical activity time (TPT): calculated as the sum of moderate (eg brisk walking, light-effort bicycling, doubles tennis, household activities) and vigorous (eg jogging, fast bicycling, team sports, shoveling) activity time per week;
• total physical activity volume (TPV): calculated by assigning metabolic equivalent of task weights to moderate and vigorous activities, giving greater weight to more intense activities; and
• vigorous physical activity time (VPT): calculated as the sum of time spent on vigorous physical activity exclusively.

For each measurement, enrollees were separated into low (0 to 4 hours per week), medium (4 to 8 hours per week) and high (more than 8 hours per week) tertiles.

Researchers also tracked changes in scores on the Movement Disorder Society-Unified Parkinson’s Disease Rating Scale, part III (MDS-UPDRS-III) for up to 7 years, which measures decline in motor skills, and on the Montreal Cognitive Assessment (MoCA) for up to 5 years, which measures cognitive function.

Higher TPT, TPV and VPT were each associated with slower cognitive decline and motor progression, Ryu and colleagues wrote.

Individuals within the low tertile of TPT were predicted to see an average decline of 0.478 points on the MoCA after 7 years and an average increase of 0.143 points on the MDS-UPDRS-III after 5 years.

By comparison, those in the middle and high tertiles were predicted to see MoCA scores decline by 0.09 points and 0.007 points, respectively. Instead of increasing, scores on the MDS-UPDRS-III fell by 0.225 points and 0.783 points for those tertiles, respectively.

Researchers saw significant differences when comparing the lowest and highest TPT tertiles in predicted changes in MoCA scores (beta = 0.47; 95% CI, 0.203–0.737) as well as MDS-UPDRS-III scores (beta = 0.926; 95% CI; –1.835, –0.017).

There was no significant difference in MoCA scores between the high and middle tertiles.

For individuals in the lowest tertile, declines in MDS-UPDRS-III scores were significantly associated with declines in MoCA scores, which was not the case in the middle and high tertiles.

Ryu and colleagues said this suggests there could be a shared mechanism driving both motor and cognitive decline that physical activity helps attenuate independently.

When measuring the intensity of activities in isolation, researchers found intensity was not significantly associated with longitudinal changes in motor or cognitive scores. This suggests total activity duration is more important than intensity when it comes to disease progression, they wrote.

Ryu said the findings should provide encouragement for people with PD to stay physically active in addition to any standard disease treatment they are pursuing.

Additionally, he and his colleagues are following the ongoing SPARX3 trial, a multicenter, randomized, evaluator-blinded study examining the effects of aerobic exercise on PD.

That trial, expected to be completed in 2028, could shed additional light on determining whether physical activity can slow the progression of PD, he said.

Ongoing research, including work under way at the Cincinnati Cohort Biomarker Program, could also provide key information on the role biomarkers play in the process, Ryu told Healio.

“It is also important to understand the biological mechanisms through which physical activity may affect Parkinson’s disease,” he said. “Imaging and biological biomarkers may help us understand how physical activity affects disease-related processes.”

For more information:

Dong-Woo Ryu, MD, PhD, can be reached at neurology@healio.com.