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There is general agreement that the first line of therapy for mild symptoms in early Parkinson's disease is not drug therapy but rather lifestyle modifications. This approach alone, however, is usually not sufficient once the symptoms begin to interfere with activities of daily living.

With the initial diagnosis of Parkinson's disease, the patient and doctor must determine the level of discomfort or inconvenience of the symptoms in daily life and, based on these findings, the initial decisions for therapy are established. In early Parkinson's disease, several nonpharmacologic options may be helpful. These include:

• Education
• Exercise
• Nutrition

Education

The patient and family are encouraged to learn as much about Parkinson's disease as possible. Aspects of education include:

• Knowledge about the disease
• Variation in the rate of progression of disease among patients
• Support services available in the community
• Emotional needs of patients and caregivers
• Coping strategies
• Help at home
• Respite care

Exercise

This is considered the most important adjunct therapy at all stages of Parkinson's disease. Though it does not affect the progression of Parkinson's disease, it has a very positive effect on mobility and mood of the patient. It also helps the patient retain as much function as possible given the stage of disease. It is important for the patient with Parkinson's disease to learn techniques to prevent falling since they are at a higher risk for falling and subsequent injury. Exercise should be carried out under the guidance of a physical therapist who can respond to the changing needs of the Parkinson's disease patient as the disease progresses.

The types of exercises that are most important are:

• Aerobics
• Strengthening exercises
• Stretching exercises
• Balance training

Activities such as walking, swimming, or gardening are beneficial. Some researchers believe that weight-bearing exercises (such as walking) are especially helpful. Since energy levels fluctuate, it is important for Parkinson's disease patients to pace themselves when performing these activities.

Exercise needs to be done consistently. Physical therapists suggest 20 minutes, three times a week dependent upon flexibility and fatigue level and the emphasis should be on extensor muscles to counteract the flexors, which become rigid. With the progressing severity of Parkinson's symptoms, physical therapy plays an increasingly important role for maintaining limb mobility and range of movement.

Nutrition

It is important for the Parkinson's disease patient to eat a healthy diet with adequate fruits, vegetables, and whole grains to optimize health at every stage. Also, Parkinson's disease patients are at increased risk for weight loss and loss of muscle mass, which is another reason to be vigilant about eating habits. Good dietary habits are also helpful in preventing or alleviating some symptoms of Parkinson's disease such as constipation.

Protein acts as a competitor with dopamine when it comes to being metabolized by the body. As a result, doctors recommend that patients not eat any protein for 30-45 minutes before and after taking levodopa-related medications.

The conclusions drawn from large studies supported by the National Institute of Neurological Disorders and Stroke indicate that there is no therapeutic or neuroprotective benefit to tocopherol (Vitamin E) or other antioxidants. However, there is ongoing investigation of the neuroprotective properties of Coenzyme Q10. It is not regulated or approved by the FDA and is still considered a dietary supplement. Currently there is insufficient available information regarding this supplement and more studies are required.