Can The Brain Change
We know that in PD, neurons that produce the chemical transmitter dopamine are damaged and lost. There is a period of time between when the loss of neurons begins and when PD movement symptoms start to show. By the time most people are diagnosed, nearly 80 percent of their dopamine neurons are already gone.
During this period, the brain changes, compensating for the loss of dopamine neurons which occurs during the process of neurodegeneration. Scientists call this ability to change and compensate exercise-dependent neuroplasticity . This same process occurs throughout life in response to experience. As children learn motor skills, for example, their brain cells make new connections. This process continues through adulthood.
Exercise may affect the brain by driving this compensation, or plasticity. People with PD who exercise regularly can move more normally than those who do not. We believe that exercise may be contributing to neuroplasticity helping the brain maintain old connections, form new ones and restore lost ones. This may outweigh the effects of neurodegeneration.
Spotlight On Parkinsons Disease: Staying Healthy Keeping Fit
In this 45-minute webinar Terry Ellis, PhD, PT, shares which Parkinsons symptoms are reduced by what types of exercise, the intensity of exercise required to have an impact on PD symptoms, how to overcome resistance to exercising, and tips for implementing an effective exercise routine. In the last 15 minutes of the webinar Dr. Ellis answers listener questions.
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Re+active Pt Videos For Home Exercising
Publisher: re+active PT
Cost: Free
re+active has posted to its YouTube channel a few exercise videos, including a seated re+move class , Parkinsons exercise class , and pole walking .
Publisher: Rock Steady Boxing Indianapolis Headquarters
Cost: Free
This is a series of 66 short videos. There are stretches, warm ups, workouts, fitness challenges, tai chi, and tips & tricks videos. The idea is by the time youve followed along with one video in each category, youve done a whole body workout.
Publisher: APDA Greater St. Louis Chapter
Cost: Free
Three short videos include quick chair exercises, exercises for stronger legs and glutes, and exercises for better balance.
Publisher: Patrick LoSasso
Cost: $14.95/month or $135/year after a free one week trial
A growing library of workouts for those with Parkinsons, including: 5-minute workouts, Undefeated Boxing, Rise & Shine morning blast, exercise ball, Brain & Body Bar, and Parkinsons workout with towel and ball.
Publisher: U-Turn Parkinsons
Cost: Free
This collection of pre-recorded exercise videos includes three 20-minute warm up/stretching videos, four 20-minute seated workouts, one 20-minute upper body boxing video, a 9 minute boxing basics video, two one-hour Rock Steady Boxing Winnipeg workouts, two advanced RSBW workouts, and two yoga Parkinsons workouts.
Publisher: Neuro Challenge Foundation For Parkinsons
Cost: Free
Publisher: Yoga for Parkinsons
Cost: $40
Cost: Free
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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.
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.
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Meaningful Physical Activity For Those Impacted By Parkinsons Disease
On the Day 2 video of the Upper Midwest Parkinsons Symposium, at timestamp 1:31, you will find a one-hour talk by Dr. Kristin Pickett, PhD. She explains the difference between occupational therapy and physical therapy . She believes those diagnosed with Parkinsons disease should have PT, OT and speech therapy as part of their care team early on. Especially if you hate exercise, you can incorporate physical activity/movement into your everyday tasks. This is what she means by meaningful physical activity.
Spotlight On Parkinsons Disease: Getting Ready To Move
In this 1-hour webinar Terry Ellis, PhD, PT, shares the US HHS exercise guidelines. She briefly explains the benefit of exercise on the quality of life for those with Parkinsons, why people are resistant to exercise, and what motivates people to exercise, before sharing tips and tricks for successfully integrating exercise into daily life. The last 20 minutes are spent answering listener questions.
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A Deeper Look At Possible Benefits
The findings spurred SPARX3, a much larger study with greater geographical reach. This time, patients will be randomly assigned to two groups for 30 minutes of treadmill exercise, four days a week. The exercise heart rates for the groups will again be 65% and 85% of the maximum. The aims: further test the effectiveness of exercise in blunting the advance of the disease and which, if either, approach is more effective in doing so.
Were not suggesting that exercise will eliminate Parkinsons disease, said Dr. Cory Christiansen, assistant professor of Physical Medicine and Rehabilitation with the CU School of Medicine, but the results of SPARX2 signaled that exercise can slow the rate of disease progression.
Christiansen is principal investigator for SPARX3 at CU and part of a diverse investigative team . He co-authored the JAMA Neurology article on the SPARX2 trial and counts Dr. Schenkman, who is now retired, as a mentor.
The much larger and farther-reaching SPARX3 trial will help to show if the studys exercise approach is generalizable to a broad population with regional differences, Christiansen added.
We might discover factors that differ between groups, he said. For example, people in Colorado are generally very active compared to other states, he noted.
Epidemiological Studies Have Demonstrated The Benefits Of Exercise As It Relates To Pd Risk And Pd Severity
These findings are summarized in this paper and include:
- Those in midlife who routinely engage in moderate to vigorous exercise have a lower risk of developing PD than those who dont
- Cardiovascular fitness is associated with better cognitive and motor scores in those who have PD
- Longevity in PD is associated with increased physical activity
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Creating An Exercise Plan With A Physical Therapist
Before beginning a new workout regimen, the American Parkinson Disease Association recommends consulting with a physical therapist who has experience treating your condition, such as a board-certified neurologic specialist .
A physical therapist can help you select the right routines and exercises to increase mobility, strength, and balance. They can also tailor a plan to your specific symptoms and lifestyle needs.
For example, to improve your performance on a routine skill, like walking, your physical therapist may have you work on whats called dual-task practice, during which they ask you to practice walking while bouncing a ball or counting backward. The idea is to get your mind used to focusing on two tasks simultaneously.
Similarly, if youre having problems getting up from a seated position, your therapist may have you target muscle strength in your legs and ask you to practice sitting and standing with seats at different heights, while counting or answering questions.
There are physical therapists who specialize in neurological conditions, including Parkinsons disease, Dr. Subramanian notes. Having access to someone who knows about the disease helps. In fact, research has shown that working with a physical therapist trained in the needs of people with Parkinsons disease can reduce the number of therapy visits needed and, therefore, patient costs. Given how expensive care for Parkinsons disease can be, thats important.
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Strategies For Parkinsons Gait
A person with Parkinsons disease can improve the way they walk with targeted effort. Training that challenges motor and cognitive skills may have a positive effect on coordination.
What works for one individual may not work for another, so some trial and error may be necessary. A few strategies include:
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Activity And A Positive Outlook
For Robert, exercise not only allows him to remain physically strong, but it bolsters his emotional and mental fortitude to fight the disease, which is normally diagnosed at about the age of 71.
“Trying to maintain doing the things that make you happy is a good approach to maintaining a positive outlook,” Robert says. “Besides the medication, I think you’ve got to keep moving. That’s what I do. I find there’s some peace in that, and I think it’s a healthy thing to do.”
In fact, research studies show exercise may actually curb the effects of Parkinson’s disease.
Parkinsons Training For Fitness Health And Wellness Professionals
Online training program specifically designed to teach fitness professionals how to best meet the unique needs of PD patients
The importance of exercise and physical activity for people diagnosed with Parkinsons disease has been well documented. Exercise produces many benefits including increased physical functioning , improved gait and balance, cardiovascular fitness, and overall better quality of life. As such, great strides are being made to make exercise a part of the standard treatment of PD.
Take the training online
This on-line training program has been developed to assist fitness and health and wellness professionals so they may safely and effectively work with people with PD to develop exercise regimens that will support treatment of their symptoms and substantially improve their quality of life. It will also teach professionals about the signs and symptoms of PD and the important ways in which exercise can improve those symptoms, as well as how to describe common PD symptoms and clearly explain the benefits of exercise to those with PD.
APDA has partnered with the Oice of Continuing Professional Education at Rutgers University in New Jersey to create this user-friendly program .
The APDA Parkinsons Disease Training for Fitness Professionals is a 1-2 hour course with instructional videos. All of those who complete the training course will receive a certificate of completion.
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Moving For Better Balance
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.
Cost: Free
This 30-minute video is a personal account by Michael Weiss, a person with Parkinson’s. 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.
Can This Injury Or Condition Be Prevented
To date, there is no known way to prevent PD. Studies have shown improved walking, balance, strength, flexibility, and fitness in people with PD, who participate in a regular exercise program. However, these studies also indicate that people with PD gradually lose the gains they make when their supervised exercise program ends. Its important to work with your physical therapist to help develop good long-term exercise habits.
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Should I Talk To My Healthcare Provider Before I Start Exercising If I Have Parksinson’s Disease
Talk to your neurologist and your primary care provider before starting a new exercise regimen. They can:
- Counsel you on how intense your exercises can be.
- Recommend exercises appropriate for your individual health.
- Refer you to a physical therapist to create a personal exercise program.
- Warn about exercises to avoid based on your particular challenges or limitations.
What Parkinsons Symptoms Can Improve From Exercise
Research has shown that exercise can improve gait, balance, tremor, flexibility, grip strength and motor coordination. Exercise such as treadmill training and biking have all been shown to benefit, along with Tai Chi and yoga.
Studies have shown that:
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Should I Talk To My Healthcare Provider Before I Start Exercising If I Have Parksinsons Disease
Talk to your neurologist and your primary care provider before starting a new exercise regimen. They can:
- Counsel you on how intense your exercises can be.
- Recommend exercises appropriate for your individual health.
- Refer you to a physical therapist to create a personal exercise program.
- Warn about exercises to avoid based on your particular challenges or limitations.
The Basic Elements Of Exercising With Parkinsons
There are four core elements of exercise that are important for people with PD:
Including all four of these elements in your exercise regimen is ideal .
Aerobic activity or high-intensity exercise may be particularly important for Parkinsons and general health
High-intensity exercise has been formally studied in PD with impressive results. The Study in Parkinson Disease of Exercise Phase 2 enrolled 128 people with early PD, who were not yet on dopaminergic medication into three groups:
- a high-intensity treadmill exercise group, in which people exercised at 80-85% of their maximum heart rate
- a moderate-intensity treadmill exercise group, in which people exercised at 60-65% of their maximum heart rate
- a wait-list control group
After six months, the high-intensity group had essentially no change in their motor scores, whereas the control group had a three-point worsening of their motor scores.
Currently, the SPARX3 trial is enrolling participants and underway. This trial is similar to SPARX2, but with a goal of studying many more participants.
Forced exercise
Cognitive challenges in exercise
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Alliance Of Independent Regional Parkinson Organizations
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How To Stay Motivated
Make exercise a regular part of your day
Set a consistent time to exercise every day. Keep it the same time so that you know how it works in around your medication and is timed when you are typically feeling at your best.
If you are really busy, you might find breaking your programme down into several manageable 10minute chunks suits you better. There is good evidence to show that this is still effective to receive a cardiovascular and strength training. For amplitude and motor output training this is sufficient as well. Perhaps you might schedule a few exercises for when you wake up in the morning, another round at midmorning, lunch, midafternoon, and then evening. See what works best for you with your lifestyle and medication schedule, but make sure you plan it, do it and record it.
If you are particularly short of time, avoid the temptation to throw in the towel completely. Do what you have time to do. Something is better than nothing at all. Even five minutes of targeted exercises done well may yield results when done consistently.
Stay Motivated with Goal Setting
Start Recording and Charting in Your Diary
Record each of your sessions in the back of this booklet. Even if it is only a 10-minute session. It is important that you can add up the total number of minutes spent exercising at the end of each week.
Workout with a buddy
Building a Strong Foundation
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More Questions To Contemplate
Christiansen emphasized that exercise is not a replacement for medications that effectively manage Parkinsons disease, notably carbidopa-levodopa and dopamine agonists, which are a group of drugs that fire parts of the brain that are normally charged by dopamine. However, he added, exercise could help people safely avoid the side effects of these medications, at least temporarily.
It would be impactful if we could possibly delay the onset of symptoms, and/or decrease the dose of medications, Christiansen said.
He added that SPARX3 will also examine a host of potential secondary outcomes of regular exercise, including improvements in quality of life, cognition, walking, fitness, and quality of movement. Researchers will also scrutinize blood biomarkers that are indicators of inflammation and changes in the nervous system.
In fact, the SPARX3 trial launch only begins to answer many questions about the promising but emerging benefits of exercise for Parkinsons disease patients, Christiansen said.
Were hopeful that both groups will show the benefits of exercise, but we dont know if it will be one or the other or equal, he said. He noted, for example, that its not a good thing if patients spend so much energy on their exercise regimen that they have little left over for activities in the community.
We dont know if more intense exercise is better, he concluded.
For more information on the SPARX3 trial, contact study coordinator Katherine Balfany at or 303.724.9101.