Pharmacological Treatment Of Parkinsons Disease
Pharmacological treatment of PD is based on the replacement of dopamine levels in the brain, which generally promotes the temporary improvement of physical disability and control of some of the symptoms. The medication considered gold standard in the treatment of PD motor symptoms is Levodopa , a metabolic precursor of dopamine that crosses the blood-brain barrier easily. Once in the Central Nervous System, L-Dopa is metabolized basally by DOPA decarboxylase, leading to dopamine. L-Dopa is marketed in association with a decarboxylase inhibitor drug , preventing the peripheral synthesis of dopamine and ensuring the drug’s arrival in the brain . Other drugs are available, in most cases in association with L-dopa, and are divided according to the mechanism of action in order to increase the concentration of dopamine levels such as Monoamine Oxidase-B , Catechol-O-Methyl Transferase inhibitors, or dopaminergic agonists such as Pramipexole . However, pharmacological treatment for PD has limitations ranging from possible drug interactions and side effects , to decrease in its efficacy with years of use and the appearance of secondary symptoms such as dyskinesias and fluctuations , due to the lack of effectiveness of the treatment of non-motor symptoms of the disease . The choice of drug or association that will be administered to the patient depends on factors such as age, stage of the disease, type of activity performed by the patient, and their mental state.
Best Physical And Occupational Therapy Exercises
Physical therapy exercises target your areas of concern. They can help develop your strength, balance, and coordination. Youll also enhance your functional mobility by improving concentration, flexibility, and range of motion.
Occupational therapy exercises are intended to help you perform daily activities related to work, school, or home with greater ease.
What Is The Parkinson’s Exercise Framework
Even though the message from research and the experience of people with Parkinson’s is that exercise is good for you, not all professionals have been able to keep up to date about what people with Parkinson’s should be doing and when. A worrying trend is that some professionals can even be a barrier to a person’s progress.
The Parkinson’s exercise framework was developed to help answer questions about what the right type of exercise is for people with Parkinson’s at different stages of the condition.
A group of expert physiotherapists came together to develop the framework based on research and speaking to people with Parkinson’s and professionals. The aim is to provide information on how people with Parkinson’s should be engaging in exercise safely and effectively.
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What Types Of Exercise Can Help Manage Parkinsons Disease
There are several types of exercises you can do to manage Parkinsons disease. You can create a varied routine based on your specific concerns, fitness level, and overall health.
Aim to do at least a few minutes of movement each day. Include exercises that improve cardiovascular health, flexibility, and strength. If you change up your exercises every week. your body can learn new ways to move.
There are a few different types of exercise that may be especially helpful to those with Parkinsons, including:
- physical and occupational therapy
How Does Exercise Change The Brain
What happens in the brain to produce these visible benefits? Researchers at the University of Southern California looked at the brains of mice that had exercised under conditions parallel to a human treadmill and discovered that:
- Exercising did not affect the amount of dopamine in the brain, but the mice that exercised the brain cells were using dopamine more efficiently.
- Exercise improves efficiency by modifying the areas of the brain where dopamine signals are received the substantia nigra and basal ganglia.
Scientists at University of Pittsburgh found that in animal models, exercise induces and increases the beneficial neurotrophic factors, particularly GDNF , which reduces the vulnerability of dopamine neurons to damage.
At the molecular level, at least two things happen to make dopamine use more efficient:
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What Is The Best Type Of Exercise For Parkinson’s
As Parkinson’s affects everyone differently, there is no ideal solution or exercise for everyone. So the exercise framework suggests a blend of styles and intensity that will help people with Parkinson’s do what they can at different times over the course of their condition.
Some people should be participating in more vigorous exercise at the gym, or out cycling and running with friends. Others are best doing chair-based exercises at home.
Exercise might be done individually or in a class, and can be targeted to specific symptoms, like balance, or at improving general health and wellbeing, like walking.
So, to answer this question, we say that the best type of exercise should help people with Parkinson’s to feel and remain as fit and well as possible to manage everyday life.
The Potential Neuroprotective Effect Of Exercise
Arguably the most important benefit of exercise if you have Parkinsons disease is its neuroprotective effects. The Parkinsons Foundation defines neuroprotection as defenses against the damage, degeneration, and/or death of neurons, or the cells in your nervous system.
This is important, given that Parkinsons interferes with the neurons in your brain that control body movement.
In fact, the Parkinsons Foundation says that interventions that provide neuroprotective benefits, including exercise, can change the course of Parkinsons disease in other words, slow the progression of symptoms.
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All Kinds Of Exercise May Be Good For Parkinson’s
Nov. 6, 2012 — Exercise helps put people with Parkinson’s disease on a path to better health, a new study shows.
All Parkinsonâs patients reach a point in their disease where they begin to have trouble walking. Typically, a person starts to lean forward as they walk, their arms move stiffly with their strides, and they start to take shorter, shuffling steps.
This so-called gait impairment isnât just disabling, itâs also disheartening since it is often the first time the disease becomes visible to the outside world.
Drugs and surgery may help for a time, but eventually they fail to make normal movement possible. So doctors have been testing whether exercise might help people walk and move more easily.
âThereâs increasing evidence that people with Parkinson’s disease who exercise do better than those who donât, and that people who stop exercising do worse than those who continue to exercise,â says Ray Dorsey, MD, MBA, director of the Parkinson’s Disease and Movement Disorders Center at Johns Hopkins University in Baltimore. Dorsey wrote an editorial on the study but was not involved in the research.
Davis Phinney And Kelsey Phinney Practice Vocal Exercises For Parkinson’s
In this 23-minute episode of The Parkinson’s Podcast, Davis Phinney and his daughter and podcast host, Kelsey Phinney, practice and explain some vocal warmup exercises before Davis sings a few pop songs. Davis’s voice gets louder and clearer over the course of the session and is a good demonstration of the benefit of speech therapy and daily practice of speech exercises, including singing, for those with Parkinson’s.
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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
Impact Of Exercise On The Brain
Exercise not only helps the physical aspects of PD but the mental ones as well. It has been shown to help relieve symptoms of fatigue, mood, sleep problems, and mental health.
Dopamine is a neurotransmitter that controls the brains reward and pleasure centers, as well as regulating movement and emotional responses. In PD, there is a dopamine deficiency.
While exercise has not been shown to increase the amount of dopamine in the brain, research does show that it helps it to be used more efficiently.
The exercises that someone with PD should undertake will depend on how limiting their symptoms are. In all cases, the exercise should focus on three areas:
- flexibility and stretching
- aerobic, also known as cardio
- resistance or using the muscles against opposing force
There are many different types of exercise that involve all three of these areas. These exercises include:
- tai chi
- Pilates
- dancing
The exercise type known as random practice has been shown to benefit people with PD particularly. This is an aerobic exercise that challenges the individual to change speed, activity, or direction.
It is also essential for someone with PD to vary activities. This is because people with the condition may have trouble changing activity and doing two activities at the same time. As a result, random practice and variation will help to challenge those symptoms.
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When It Comes To Exercise How Can I Support Someone With Parkinson’s
Exercise can be as important as medication and should be ‘prescribed’ in a similar way. Because of this you can use the exercise framework to promote exercise as an important part of everyday life for people with Parkinson’s.
You can direct professionals to the UK Parkinson’s Excellence Network resources and learning hub, and we also want you to share the Parkinson’s exercise framework with your networks.
Any professional working in neurology or with older people should be conveying the message that exercise is important for everyone, as it helps keep the body as fit and well as possible, both physically and mentally.
Essentially, promoting and providing education on exercise should be central to the role of health and exercise professionals.
Keep On Moving Exercises To Do At Home
Publisher: Keep It On
Four short videos designed to be challenging and engaging, including physical amplitude, arms and legs working and thinking together, brain exercise, daily-life moves / dance-like exercise. Repeat them as often as you need to improve your individual outcomes.
Coming soon – breath and voice exercise.
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Parkinson’s On The Move
Publisher: Parkinson’s On The Move
Cost: Free
Thirty-one archived workouts for those with Parkinson’s. Videos are sortable by level of difficulty, area of the body to focus on, and preferred position . Other pages on this website offer free recipes and articles about nutrition and PD.
Also available is the Parkinson’s On The Move Exercise Library. This collection of 58 short videos each focus on stretching or strengthening a specific part of the body.
Publisher: JCC Tampa Bay on the Cohn Campus
Cost: Free
Suzanne Chen leads 43-minutes of stretch and strengthening exercises for those with Parkinson’s. Equipment to follow along include an elastic band, light weights , a 8-9 inch soft ball , and a stable chair with no arms.
Publisher: JCC Greater Boston
Cost: Free
Eight YouTube exercise videos for those with Parkinson’s, including four focused on neuromuscular integration, two total body conditioning and one seated strength. Most videos are about 30 to 45 minutes.
Publisher: PD Warrior PTY LTD, Australia
Cost: Free
Similar to Rock Steady Boxing in the US, this Australian app is available from Google play or the App Store is designed for early stage Parkinson’s disease. It includes 10 PD Warrior core exercises for free with upgrades and additional bundles available via in app purchases to customize your workout. Each exercise is demonstrated by a physiotherapist.
Publisher Parkinson’s Foundation of the National Capital Area
Cost: Free
Publisher: Power For Parkinson’s
Cost: Free
Effects Of Physical Exercise On The Treatment Of Parkinsons Disease
Other therapeutic strategies have been evaluated clinically and scientifically in recent years in the search for an action to reduce clinical problems of PD, such as, non-pharmacological interventions like physiotherapy and physical exercise . Rehabilitation through physical therapy has a variety of goals and methods that generally promote benefits in parkinsonian mobility, posture, and balance. However, some limitations have been observed in a consensual way by some researchers in two topics: in relation to the benefits that seem to be more immediate , and the variety and low methodological quality of the studies . Other nonpharmacological approaches to rehabilitation in Parkinson’s disease are the practice of different modalities of physical exercises such as walking, running, strength training, whole body vibration and functional exercises, which are related to the reduction in the risk of falls, decreased motor symptoms, motor performance improvements, balance and gait improvements, positive repercussions in quality of life and executive functions .
Kurtais et al. investigated the effects of six weeks of supervised treadmill walking, three times a week for 40 minutes in patients with mild to moderate PD, and observed significant improvements in lower limb functional parameters such as walking, balance, and agility, and in related parameters, the adaptations promoted by aerobic exercise as increase of peak VO2 and caloric expenditure in METs .
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Are There Any Risks Of Exercising With Parkinsons Disease
Some symptoms, like Parkinsons tremors, may seem worse during exercise. But exercise generally improves tremors and other symptoms in the long run.
Reduce challenges by stretching before and after exercise. Use good form to prevent injury. And avoid slippery floors, poor lighting and tripping hazards. If you have pain, stop and rest.
Pushing yourself too hard during exercise can lead to injury. Start slowly and increase intensity and duration over time. Keep a log to track your exercise choices and how you feel. Eventually, youll learn what works best for you.
Why Is Exercise Good For People With Parkinsons
Exercise is good for everyone, and is especially important for people with Parkinsons as movement becomes slower and smaller if your muscles and joints get stiff and rigid.
We know that people with Parkinsons are generally less active than the rest of the population, but many do not realise this difference is present early on, even at the point of diagnosis.
Whether you have Parkinsons or not, a regular exercise routine can help you maintain, if not build, the strength and power in your muscles, the flexibility in your joints, keeping you generally fit and mobile. And its not just good for your body exercise can also help keep your mind healthy, improve your mood and help you sleep so that you can cope better with the challenges living with Parkinsons may bring.
In the news recently, researchers shared results showing aerobic exercise such as cycling or walking to work may improve cognitive abilities, such as thinking, reading, learning and reasoning, in the over-50s. They also highlighted that muscle training for example, using weights had a significant effect on memory and the brains ability to plan and organise.
We have previously written about some of the research evidence on the benefits of an active lifestyle and regular exercise for people with Parkinsons.
We know that exercise can:
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Exercise And Parkinson’s Disease
Parkinson’s disease affects your ability to move, but exercise can help to keep muscles strong and improve flexibility and mobility. Exercise will not stop Parkinson’s disease from progressing but, it will improve your balance and it can prevent joint stiffening.
You should check with your doctor before beginning any exercise program. Your doctor may make recommendations about:
- The types of exercise best suited to you and those which you should avoid.
- The intensity of the workout .
- The duration of your workout and any physical limitations.
- Referrals to other professionals, such as a physical therapist who can help you create your own personal exercise program.
The type of exercise that works best for you depends on your symptoms, fitness level, and overall health. Generally, exercises that stretch the limbs through the full range of motion are encouraged.
Here are some tips to keep in mind when exercising.
New Types Of Exercise For Parkinsons
Researchers are continually studying different types of exercise for PD and APDA works to keep you informed about these new findings.
- Karate People who participated in a study involving a 10-week karate class program noticed improvements in gait, quality of life and self-reported impression of change. We highlighted this research study at the 2019 American Academy of Neurology Annual Meeting.
- Golf A preliminary study was done to determine if golf is a beneficial mode of exercise for people with PD We highlighted this research at the 2021 American Academy of Neurology Annual Meeting.
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