Parkinsons Patients Take Big Steps
The Messenger Fall 2010 Issue. Comments by Brian Cooper, OTR, Residential Home Health, Member, MPF Professional Advisory Board.
Preliminary studies show that patients with Parkinsons disease who regularly do certain exaggerated movement exercises are seeing reductions in their symptoms. In an article published in MedPage Today, www.medpagetoday.com/MeetingCoverage/AAN/19593, the senior editor reported on a study of 20 patients who underwent a supervised program called LSVT BIG for eight weeks and then worked with the Nintendo Wii video gaming system in the final four weeks.
The patients participated in a supervised open-floor series of exercises, which stresses large extensions and movements of the arms and legs. The Wii activities encouraged patients to swing their arms and move vigorously. At the end of the study, all patients showed measurable improvements.
Locally, Brian Cooper, an occupational therapist with Residential Home Health, explained that BIG is based on a successful speech therapy program for PD patients, called LSVT . That therapy helps participants enhance sound and articulation by speaking at an exaggerated volume.
LSVT BIG teaches patients how to move better, focusing on high amplitude movements to overcome perceptual deficits, said Cooper. It shows patients, through modeling, how to make bigger movements, then reinforces through practice how to perform high intensity, high amplitude exercises.
Forced Exercise In Parkinsons
An important study in 2009 by researchers at the Cleveland Clinic compared two types of exercise groups: forced exercise and voluntary exercise. Forced exercise is different than voluntary exercise in that forced exercise involves a slower, more consistent pace for a longer duration whereas voluntary exercise involves a rapid pace and shorter duration. The study showed that forced exercise elicits improvements in motor function in Parkinsons disease patients. Forced exercise can be done on a tandem bike, using an able-bodied person as a pace-setter, pedaling at 80-90 revolutions per minute . Using forced exercise, patients can work up to 30% harder than they would work on their own.
The forced exercise groups showed a 35% improvement in motor function scores, including improvements in upper-extremity dexterity after 8 weeks of training. This effect was not noted in the group that participated in the voluntary exercise. Both groups had improvements in their aerobic fitness, as both worked at 60-80% of their heart rate max. Both groups also showed similar or improved levels of rigidity and bradykinesia after exercise. These positive changes lasted for about four weeks.
Establish A Regular Exercise Routine
Outside of seeking physician approval, its important to understand that the best exercise for Parkinsons disease is the kind that patients enjoy and will stick with. Forming a new habit can be daunting, but long-lasting physical fitness regimens are the most effective against PD symptoms regardless of their intensity. Activities that raise your heart rate and promote deep breathing are ideal, but every little bit helps. If an activity isnt clicking after giving it a fair try, then move on to something else that might be more promising.
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Aerobic Exercises Like Cycling Provide Benefits
If its been a while since you got your bike out, its time to dust off the spokes and grease up the chain. For people with Parkinsons, cycling is an excellent way to exercise, thanks largely to the fact that it delivers a comprehensive aerobic workout. Aerobic exercise is particularly important for individuals with Parkinsons disease to do, not only because it keeps your cardiovascular system and function healthy and improves flexibility , but it also appears to have potent effects on brain function.
A study published in the Annals of Neurology examined the effects of aerobic exercise on the brain, using participants with Parkinsons who took part in stationary bike training three times a week over six months. At the end of the study period, the results looked pretty good. Participants had notably lower brain atrophy, stronger neural connections that led to better motor skills, and better cognitive control when compared to individuals who did different types of exercise for the same period. Not bad, right? And if that wasnt enough, cycling regularly may also improve the gait of people with Parkinsons, according to a further review published in npj Parkinsons Disease, with the reviews authors concluding that cycling provided an overall better quality of life.
Pd Clinical Progression And Exercise
The study led by Dr. Kazuto Tsukita found that overall regular physical activity had a significant effect on the balance and stability of the participants. Patients with early-stage PD who took 4 hours of moderate-to-vigorous exercise each week had a slower decline in balancing and walking compared to those who took less exercise.
Speaking to Medical News Today, Dr. Tsukita explained: One very important message from our research is that the domains that are most improved by exercise are those that cannot be improved by drugs .
He went on to say, I believe that exercise should be used in conjunction with, not in place of, drug therapy.
Dr. Rebecca Gilbert, Chief Scientific Officer of the American Parkinson Disease Association , who was not involved in the study, echoed these comments. Dr. Gilbert told MNT:
The vast majority of people with PD, even those who exercise the most rigorously, eventually need medication for PD. The goal of exercise should not be to replace drug therapy, but rather to work with drug therapy to maximize quality of life.
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Important Things To Focus On In Your Parkinsons Exercise
Patients with Parkinsons disease usually find it difficult to be independent in daily activities of living. However, self-exercise is one of the best ways they can improve and train their body to reach a good level of independence in their daily life. Here are 10 wonderful exercises for individuals with Parkinsons disease that target range of activities.
1. Maintaining your balance
To maintain balance, patients of Parkinsons disease can practice swinging both arms while walking. This will lessen fatigue and loosen the arms and shoulders. Furthermore, walking while changing the speed of your gait from fast to slow from one destination to another is a good technique for improving your balance. Using a chair as a support, you can also do leg lifts to the front and side, making sure that your back stays straight and your spine remains in a neutral position.
2. Walking
The best exercise to improve your walking in Parkinsons disease is toes up! The rule is to stride forward, striking the heel and rolling the foot as you transfer weight forward to the toe. This is a good way to avoid commonly occurring calf cramps or freezing, making the lower leg active. In addition, always practice walking briskly, with both arms helping to elevate the strides. To aid balance, legs should always be further apart while walking.
3. Sitting and standing
4. Posture and tight muscles
5. Fine motor skill: Working the hands and fingers for everyday tasks
6. Facial exercises
Parkinson’s Disease And Movement Disorders Center
Our center provides compassionate and timely treatment to patients with movement disorders, such as dystonia, ataxia, essential tremor and similar conditions. But our mission goes beyond patient care excellence. By offering educational events and support groups, we empower patients and caregivers to become better partners in their health.
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Add Medication For A Winning Combo
Diet and exercise are important for managing PD, but dont forget about medications. Take them regularly and exactly as your doctor prescribes.
If you tend to forget your medication, set an alarm to remind you. You can also use a pillbox thats labeled with days and times of day. Take your meds on a set schedule, dont skip doses and dont double dose, says Dr. Gostkowski. When youre diligent about taking your medications and following a healthy lifestyle, youll feel your best.
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The Benefits Of Exercise For Parkinsons Disease
Your family and friends are constantly encouraging you to exercise. Your doctors tell you that exercise is a vital component of Parkinsons disease treatment. APDA programming includes exercise programs as a way for people with PD to gain control over their disease. But is exercise worth all the fuss? What does exercise actually do for someone with PD? Is there evidence that shows exercise really helps? And if it does help, are there specific types of exercise that help more than others?
I will address these fundamental questions about exercise and Parkinsons in two parts. In todays post, I will address why it is so important for a person with PD to exercise. My next post will address what types of exercise to consider for PD.
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Careful Patient Selection And Execution
Nationally, Northwestern University leads SPARX3, with a target enrollment of 370 at CU the goal is 24 patients, Christiansen said. Study coordinator Katherine Balfany said that to be included, patients must be:
- Between 40 and 80 years old
- Within the first three years of their diagnosis
- Not currently on Parkinsons disease medications or slated to be within the next six months
- Not enrolled in a structured exercise program, but healthy enough to meet the activity requirements of the study for 18 months.
The trial also requires a brain-imaging test called a DaT scan to confirm a diagnosis of Parkinsons disease. The test involves injecting a radioactive tracer that attaches to a protein that transmits dopamine. Dopamine is the neurotransmitter, or chemical messenger, that plays an important role in movement. An imaging scan then reveals how much, or little, of the tracer laid down roots in the brain. A small amount of tracer is consistent with low dopamine levels, an indicator of Parkinsons disease.
Balfany said those enrolled in the study will be fitted for heart monitors with a chest strap. During exercise, they will connect via Bluetooth to their smartphone, which will display their heart rate as they churn through their routine and draw their attention to the percentage they should be targeting, Balfany said.
Benefits Of Exercise For People With Parkinsons Disease
Exercise has been shown to have several significant benefits for people with Parkinsons disease. These helpful effects seem to stem from two specific neurological changes that occur when you work out:
- The release of a chemical called dopamine: This positively impacts your movement, mood, and sensation of pain.
- Growth and change in the cortical striatum:This is an area of the brain that controls your voluntary movements.
These two exercise-related changes can result in many concrete advantages for people with Parkinsons, including:
- Improved balance
- Reduced sleep disruptions
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Pain From Parkinsons Can Be Improved With Tai Chi
On the surface of things, tai chi can seem like a pretty easygoing exercise, but it has some profound benefits. The exercise practice can strengthen your muscles and your immune system, calm your mind, and encourage better flexibility, all in one go . And for folks with Parkinsons, all of these things could be incredibly helpful for managing your disease. Tai chi could also be useful to manage pain associated with Parkinsons, and may improve your walking function, says Parkinsons UK.
Given that tai chi often incorporates a constant flow of movement into its practice, its useful to think about how this may impact you if you have Parkinsons, especially if you have any conditions that run alongside it. People who have osteoporosis as well as Parkinsons may find tai chi challenging and should consult with a doctor and an instructor about whether its the right form of exercise for them .
Fitness Tips To Manage Pd Symptoms
- Choose an exercise program that you will actually do! Dont design a great, Parkinsons-specific program and then skip it because its too hard or not fun.
- Follow a varied routine. Perform simple stretches and posture exercises daily, and make sure to include aerobic and strengthening exercises several times per week.
- Keep intensity at a level that feels somewhat hard for you.
- Consider joining an exercise class or group. Classes are good motivation and also provide an opportunity to socialize. Trained instructors give clear guidelines and offer modifications.
- Try exercise videos or home exercise equipment if it is difficult to get out.
- Music can enhance performance by providing rhythm to coordinate movement.
- Be creative with your fitness. Challenge yourself and have fun!
- Consider attending Moving Day, a Walk for Parkinsons, in your area to keep moving and strengthen your PD fitness community.
Sponsored by Kyowa Kirin. Content created independently by the Parkinson’s Foundation.
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Is Physical Therapy Helpful For Parkinsons
Physical Therapy can be immensely beneficial for Parkinsons patients. A physical therapist is a skilled practitioner that can help advise you on which movements and exercises that can benefit YOUR specific case. Each person is unique in their needs and should have guidance to develop an exercise plan that is tailored to their needs.
A physical therapist can help you with exercises that can help maintain muscle strength, good balance, and good posture. Seeing a physical therapist at the onset of diagnosis can help create a plan to maintain essential physical functions so that physical function stays stronger for longer. Once any physical symptoms like stiffness or balance issues arise, seeing a physical therapist can help improve those symptoms.
This article is not intended to diagnose or treat any individual with Parkinsons Disease or any individual who experiences hallucinations. This article was created for educational purposes only and is not a substitute for medical, psychological or any other sort of professional care. Please always contact your medical provider with any questions or concerns involved treatment for hallucinations and Parkinsons Disease.
If you have any questions about The Parkinsons Plan or on how we help our patients, please give us a call at 603-605-1477
Other Strengthening And Flexibility Activities
There are many more activities that help to build strength and flexibility that may be of use to people with Parkinsons, but many have not been researched to find out about their specific benefits in the condition. You can visit our forum to read experiences of exercise programmes people have tried, and join in the conversation.
Publisher: Jamestown New York YMCA, May 1, 2013
Cost: Free
These two instructional videos part I is 10 minutes and part II is 5 minutes are taught by a Jamestown New York YMCA staff member using the Moving for Better Balance approach, an evidence-based fall prevention program.
Publisher: Michael Weiss
Cost: Free
This 30-minute video is a personal account by Michael Weiss, a person with Parkinsons. In it he shares stretches, breathing, and physical exercises he has compiled for himself. Exercise demonstration begins 8-minutes into the video and include toe lifts, leg swing, leg lift, knee circles, hip circles, squats, arm stretches, arm twists, shoulder stretches, chair push-ups, bicycle legs, toe touches, chopping wood, conducting, dancing, and facial exercises.
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Working With A Physical Therapist To Create An Exercise Plan
Physical therapists are experts in getting people moving. While most people think physical therapy is just for rehabbing after an injury, its an important part of preventive care and treatment for patients with chronic conditions like Parkinsons disease.
Your experience with Parkinsons disease is unique. A physical therapist can help with Parkinsons by designing a personalized program for you. Theyll teach you specific exercises to manage your unique symptoms and keep you engaged in activity.
How often should you meet with a physical therapist? Checking in at least once or twice a year can help you develop an exercise plan that fits with your current level of mobility and the season.
How Can It Help In Parkinson’s
Nordic walking can improve fitness in the same way that running does, but it is much kinder to the ankles, knees and hips as it has a much lower impact on the joints. This can be particularly attractive if you experience joint pain.
Perhaps the most important advantage of Nordic walking if you have Parkinsons is that is allows you to maintain and develop your ability to walk well by:
- enhancing balance and coordination
- reducing slowness of movement
- reducing freezingand gait problems
- improving mobility and creating more fluid movements
- correcting posture, particularly the stooped position associated with Parkinsons
- reinforcing the alternating movements of the arms and legs which can be lost in Parkinsons and so improving stability
- boosting independence and quality of life.
Various studies 1,2 have shown that people with Parkinsons who participate in Nordic walking programmes have improved functional independence and quality of life. It seems that mood also improves.
Once the basic steps have been learnt you can tailor your programme to suit how you feel at any particular time. Walking in a group also has social and psychological benefits.
Carers and family members who walk with you may find that they too feel fitter and have fewer aches and pains.
References
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Pd And Rls: An Overview
PD is a progressive neurodegenerative disorder characterised by pathologic intraneuronal alpha-synuclein-positive Lewy bodies and neuronal cell loss. In particular, involvement of dopaminergic cells in the substantia nigra pars compacta is associated with development of the motor features of the disease. The cardinal clinical symptoms and signs of PD are bradykinesia, rigidity, tremor, postural instability and freezing attacks . The prevalence of PD increases with age, affecting 1-2% of the population over the age of 65 years, and 3% of those over 85 years . Several monogenic forms of PD and numerous genetic susceptibility factors have been identified . Sleep disturbances have been widely reported in PD, although an increased incidence of periodic leg movements of sleep is debatable, with polysomnography studies revealing mixed findings .
RLS can be associated with medical conditions such as renal failure, iron deficiency, neuropathy, and pregnancy . Family history, with an autosomal dominant mode of inheritance may be present in more than half of the cases. Five genetic loci for RLS have been reported in different pedigrees, of which 4 are autosomal dominant and one autosomal recessive . The detection of PLMS during overnight polysomnography is the the most frequent objective abnormality and can be demonstrated in the majority of RLS patients . However, the absence of PLMS does not exclude RLS .
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