Parkinsons Disease: Background Info
Parkinsons disease usually occurs spontaneously and is of unknown origin. About one million Americans live with Parkinsons disease. Worldwide there are 10 million people living with Parkinsons disease. The average age of diagnosis of those with Parkinsons disease is 60 years, and the disease gradually progresses during the next 10 to 25 years after diagnosis.
In the brain, nerve cells use dopamine to control muscle movements. In people with Parkinsons disease, the brain cells making dopamine gradually die. Over time, it becomes harder for people with Parkinsons disease to move their muscles.
The following are some symptoms of Parkinsons disease:
- Pill-rolling tremor of the hands at rest
- Sleep disturbances
- Restlessness
The diagnosis of Parkinsons disease is based on history and physical examination findings. Importantly, neuroimaging, EEG, and spinal fluid studies are usually within normal limits for age in those with Parkinsons disease.
Unfortunately, there is no cure for Parkinsons disease. Certain drugs such as carbidopa-levodopa and MAO-B inhibitors can be used to substitute or increase dopamine levels in the brain. These dopaminergic drugs, however, lose efficacy over time and have negative side effects.
Parkinsons disease is also treated symptomatically with drugs that help with mood disturbances, pain complaints, and sleep problems.
Benefits Of Exercise And Medication In Parkinson’s
In the last few years, the importance of exercise has become even more significant for people with Parkinsons. Research is showing that a tailored Parkinsons specific exercise programme is important for your health. This means that alongside medication, the right kind of exercise may improve your overall physical ability, your symptoms and the quality of your life. Exercise helps to slow symptom progression as well as to maintain general health and ward off concurrent cardiovascular risk factors, metabolic conditions, frailty and falls.
Exercise can provide the vehicle to teach you how to achieve that functional and efficient movement again, even if you have to work harder through the movement to achieve it. Parkinsons medication, among other things primarily is used to enhance, replace or simulate the missing dopamine in your system. This can have very good effects on your movement, and to some extent your mood, overall. It is important that your medication is optimised for your needs as well. This often requires regular updates with your doctor to ensure you are functioning at your best.
The best approach to managing your Parkinsons with exercise is to target your symptoms appropriately and to be optimally medicated.
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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Types Of Exercise Suitable For Parkinsons Disease Patients
If you have Parkinsons disease, there are a lot of health benefits that come along with exercise. Staying active can help you sleep, strengthen your muscles and joints, reduce stress and depression, and improve posture, balance, and gait.
But what sort of exercise should you do? The types of exercise you choose will depend, to some degree, on the severity of your Parkinsons disease and your overall health. According to the Parkinsons Disease Clinic and Research Center at the University of California, the exercises should be varied and incorporate changing directions through unplanned movement, cardiovascular exercise, balance, strength training and rhythmical exercises.
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Unplanned and Random MovementThe exercises listed require the person to change tempo and direction regularly. These will challenge a person mentally as well as physically as they require concentration to perform.
- Walking, hiking or jogging
- Racket sports such as badminton, table tennis, squash
- Yoga or Tai Chi
- Swimming in different strokes
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.
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Parkinsons Home Exercise Program
You dont need to join a gym or purchase expensive fitness equipment to stay active with Parkinsons disease. On the contrary, there are many great exercises that you can do from the comfort of your home, regardless of which stage of the disease you are in. Take a look at some great examples in the sections below.
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
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Parkinsons Specific Exercise Guidelines
Exercise : Side Leg Raise
STARTING POSITION: Lying on your side. The leg closest to the floor is bent, and the top leg is straight. Cradle your head with your arm, or use a pillow for neck support.
Repeat 20 times per leg.Rest and perform a second set before switching to the other side.
Bad Form Alert!
Its very easy to do this exercise incorrectly. When done correctly, you should feel muscles in the back of your hip working. You should NOT feel it in the front of your hip. If you do, youre using your hip flexor or TFL muscles.
DONT:
- Let your hips fall backward. Keep them stacked by actively leaning forward.
- Let your leg kick in front of you. Raise it straight up as if youre sliding your heel along an invisible wall behind you.
- Let your toes point up. Keep your foot parallel to the floor, or even point the toes slightly down to the floor if possible.
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Exercise For People In Early
Dr Schenkman, Dr Schwartz, and Dr Kohrt provided concept/idea/research design. Dr Schenkman, Dr Barón, Dr Schwartz, and Dr Kohrt provided writing. Dr Hall, Dr Schwartz, Ms Mettler, and Dr Kohrt provided data collection. Dr Schenkman, Dr Barón, Dr Schwartz, Ms Mettler, and Dr Kohrt provided data analysis. Dr Schenkman and Ms Mettler provided project management. Dr Schenkman provided fund procurement. Dr Schwartz and Dr Kohrt provided facilities/equipment. Ms Mettler provided clerical support. Dr Hall provided consultation . The authors gratefully acknowledge members of the research team who made this study possible and the participants with Parkinson disease, without whom there would have been no study.
Physical Therapy
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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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.
Why Is It Important To Exercise
Current research shows that exercise is important for individuals with neurological conditions as it not only improves cardiorespiratory fitness, but also muscle strength. This in turn has shown to have positive effects on managing symptoms associated with Parkinsons disease.
Remember that better mobility may improve quality of life and prolong independent living. Exercise may also have positive effects on mood and improve brain function and make drug therapy more effective.
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Morning Bradykinesia Common Device
Trunk rigidity is a common symptom of Parkinsons disease. Instead of turning the body in a top-down approach with the head moving first, then the shoulders and the hips patients tend to move all these body parts together, or en bloc.
Such rigidity in movement can affect turning and balance to increase the risk of falling, the researchers noted. While Parkinsons treatments like levodopa therapy and deep brain stimulation aim to address such difficulties, they best do so when paired with exercise training, the team added.
How task-specific movement exercises might improve en bloc turning in Parkinsons, however, has not been reported.
Researchers based at the Mahidol University in Thailand evaluated a monthlong and task-specific movement exercise program on turning motion and clinical disease outcomes in a small patient group.
They enrolled 22 early- to mid-stage Parkinsons patients matched by age and disease severity. Half were randomly assigned to an exercise group, and the other half continued with routine medication as a control group. Turning movements and clinical outcomes, determined by measures that included the Unified Parkinsons Disease Rating Scale or UPDRS, were assessed before and after the exercise program.
While turning the half-circle, the step size, total step, step duration, and turning speed all significantly improved in exercise group patients relative to the control group.
Dance For Pd Instructional Dvds/streaming
Cost: vol. 1 DVD $29.99, vol. 2 DVD $59.98, vol. 3 $29.99 DVD, vol. 4 $24.99 stream or download , vol. 1, 2 or 3 streaming $23.99 each, full media bundle $120 .
Each volume is a complete class with movements that draw from ballet, modern dance, tap, jazz and improvisation to create accessible, stimulating dances for all.
Volumes 1 and 3 feature seated and standing dances, and a teacher is always on screen to demonstrate both seated and standing versions. Volume 2 is designed to be done seated. Volume 4 is the first all standing class, but can be equally enjoyed from a chair.
Cost: Free
In early 2019, trained and licensed Dance for PD affiliate, Pamela Lappen, posted a series of twelve 30-minute videos on YouTube using the Dance for PD exercise model. Between March and September 2020, she posted five more exercise videos .
Cost: $39.95 for book/DVD set
This exercise program includes categories such as wake up call, walking and balance, cardiovascular, strength, facial and vocal, and night-time stretching. Suitable for any disease stage, with many levels of difficulty. Designed by certified trainer and orthopedic surgeon with PD.
Cost: $39.95 for book/DVD set
Fifteen chapters are organized by activity of daily living, including getting off the floor, getting out of a car, getting out of bed, freezing, moving about in big crowds, and getting dressed.
Cost: Free
Cost: Free
Cost: $50/month
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How To Develop A Parkinsons Exercise Program
The Parkinsons Foundation recommends intense exercise as often as possible for those who have been diagnosed with PD and to people who are concerned about developing PD due to their family medical history. However, every patient is different and each experience with Parkinsons is unique. When developing a fitness plan for Parkinsons, its important to consider a seniors abilities, limitations, PD symptoms, overall health, resources and energy level.
Baseline Testing And Outcome Measures
All testing took place at the University of Colorado and was performed by study personnel who were blinded to group allocation. The first test session took place at a time of day when participants had their best response to PD medications subsequent sessions were conducted as close to that time as possible.
In one session, energy expenditure was measured at 4 walking speeds in 0.5-mph increments . The maximum speed was based on the participant’s fastest tolerable speed during the graded exercise test. A heart rate monitor was worn throughout the test. First, a resting measurement was obtained with the participant sitting in a chair for 5 minutes. Then the participant walked for 5 minutes at each of 4 different speeds, beginning with the slowest speed. Oxygen uptake was measured during the last 2 minutes of each stage using an automated indirect calorimeter system .
Performance on the FRT, a test of balance in older adults, was measured as described previously. The FRT is predictive of falls and can be used reliably with individuals who have PD. Participants performed 2 practice trials and 3 test trials.
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History Of The Role Of Exercise In Parkinsons
The benefits of exercise in PD have not always been well characterized. Despite the American Academy of Neurology encouraging the use of exercise as an adjunctive therapy for Parkinsons patients in the 1990s , systemic reviews from the Cochrane collaboration released in 2001 found insufficient evidence to support or refute the efficacy of physiotherapy in PD . Although most of the individual trials analyzed in these reviews appeared to find a beneficial effect of physiotherapy, it was determined that many of the studies had methodological flaws and biases that prevented any firm conclusions of the validity of physiotherapy . Interestingly, this led to a situation in which physicians were instructed to encourage regular exercise, despite little evidence of its efficacy in slowing disease progression or improving activities of daily living .
Balance Exercisescan Improve Your Mobility
Balance is an important aspect of mobility, and people with Parkinsons commonly experience balance problems when standing or moving around, the APDA notes. Dance and tai chi are two activities that can help you improve balance, and the APDA recommends performing balance-related activities two to three days a week for 20 to 30 minutes each time.
Balance training can help you prevent falls, Subramanian notes.
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What The Research Tells Us
A recent systematic review looked at whether home-based exerciseprescribed by a physiotherapist or other health care providerimproves balance-related activities and quality of life in adults with mild to severe Parkinsons disease, but without cognitive impairment. Home-based exercise was compared to usual care and centre-based exercise . Exercises included balance, walking, range of motion, and strength activities.
The review found that home-based exercise programs can improve walking speed and the ability to perform balance-related activities by a small amount immediately after the end of the program. However, these improvements appear relatively short-lived, making the case that exercise may need to be continued to see lasting benefits. Home-based exercise can also improve quality of life by a small amount. Interestingly, this benefit was not seen right away, but instead appeared at six to 46 weeks after the exercise program was completed.
Whats more, a few small studies within the review demonstrated that comparable home vs. centre-based exercise programs produced similar effects on balance and quality of life immediately after program completion .
If you or a loved one have Parkinsons disease, consider speaking to a physiotherapist or health care provider about whether home-based exercise programs are a good fit for you. They can work with you to create an exercise plan thats easily accessible, tailored, affordable, and most importantly safe.