INTRODUCTION: Parkinson's disease (PD) is a progressive neurodegenerative condition and it is unclear if long-term nonpharmaceutical interventions can slow the progression of motor and nonmotor symptoms and lower drug dose. METHODS: In a randomized trial, after an initial 3-wk-long, 15-session supervised high-intensity sensorimotor agility exercise (E) program designed to improve postural instability, the exercise plus maintenance (E+M, n = 19) group continued to exercise three times per week for 2 yr, whereas E (n = 16), and the no exercise and no maintenance control (C, n = 20) continued habitual living. Eight outcomes were measured before and after the 3-wk initial exercise program and then at 3, 6, 9, 12, 18, and 24 months in all patients. RESULTS: The group-time interactions (all p < 0.005) revealed robust and favorable effects of the initial 3-wk agility program on all six nonmotor (eg, primary outcome Movement Disorder Society Unified Parkinson Disease Rating Scale, Motor Experiences of Daily Living, approximately 7 points; EuroQoL, approximately 9 points) and on each of the two motor outcomes (timed up and go test: approximately 6 s; posturography: up to 7 mm improvements in center of pressure path). E+M maintained but did not further improve the benefits produced by the initial 3-wk program. In E, the favorable effects of the 3-wk agility program lasted for 3 to 12 months. In C, patients declined steadily in all outcomes over 2 yr. By year 2, Leva-dopa equivalents increased by 99.4 mg/d (time main effect, p = 0.008). CONCLUSIONS: A high-intensity sensorimotor agility program with but not without a 2-yr maintenance program slowed the progression of parkinsonian symptoms.

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