Exercise Intervention for REM Sleep Behavior Disorder in Parkinson's Disease: Mechanisms and Implications for...

REM sleep behavior disorder (RBD) is a prodromal non-motor symptom of Parkinson's disease (PD) and other α-synucleinopathies, affecting approximately 30%-60% of PD patients. It is closely associated with α-synuclein (α-syn) aggregation, with its primary pathophysiology involving the impairment of brainstem circuits, resulting in movement disorders and circadian rhythm dysfunction. Although exercise is recognized for improving motor symptoms and delaying neurodegenerative disease progression, a comprehensive framework of its underlying mechanisms for RBD symptoms has not yet been thoroughly analyzed.

This review examines current literature and evidence regarding the various mechanisms and neuroprotective effects of exercise interventions specifically targeting RBD and its associated symptoms.

Exercise exerts neuroprotective effects for RBD through multiple underlying mechanisms. The analysis highlights key pathways, including the enhancement of α-syn clearance, the regulation of neurocircuits and circadian rhythms, the modulation of oxidative stress and mitochondrial function, and the reduction of neuroinflammation.

Exercise demonstrates significant potential as a multi-targeted intervention. By addressing these underlying pathophysiological mechanisms, exercise provides supportive benefits that may positively influence the disease trajectory for patients with RBD and PD.