Lifestyle medicine for neuroprotection: evidence and implementation in Asian contexts

In Parkinson's disease (PD), the limitations in disease-modifying therapies have broadened the concept of neuroprotection beyond targeting specific pathogenic pathways to include the strengthening of motor reserve and resilience through modifiable lifestyle factors. This review synthesizes current evidence on lifestyle medicine for PD, focusing on its potential contribution to neuroprotection, symptom control, and implementation in Asian contexts. We first discuss physical activity and exercise, including community-based and technology-assisted approaches, as interventions that improve motor and non-motor outcomes and may have long-term disease-modifying potential. We then review nutrition from prevention-oriented, genetic, and disease-stage-specific perspectives, including dietary patterns, caffeine and tea exposure, and nutritional vulnerability in established PD. Sleep health and stress management are considered as interconnected determinants of daily function, quality of life (QoL), and resilience. We further discuss integrated lifestyle medicine as a multidomain care model that combines core lifestyle pillars with personalized, sustainable, and culturally responsive implementation. Future directions may include rigorous validation, practical implementation models, and digitally enabled monitoring tailored to diverse Asian healthcare systems. Although definitive disease-modifying effects remain unproven, integrated lifestyle medicine may offer a practical foundation for translating accumulating lifestyle evidence into more rigorous and scalable neuroprotective strategies for PD.