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Parkinson's Disease Clinic & Research Center
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Exercise and physical therapy for Parkinson's disease Should I exercise? Research has shown that regular exercise benefits people with Parkinson’s disease. Exercise reduces stiffness and improves mobility, posture, balance and gait. Aerobic exercise increases oxygen delivery and neurotransmitters to keep our heart, lungs, and nervous system healthy. General exercise may also reduce depression. Learning-based exercises can also help keep our memory sharp. What types of exercise are best for people with Parkinson’s disease? There is increasing evidence that aerobic and learning-based exercises could be neuroprotective in aging individuals and those with neurodegenerative disease. Facilitating exercise programs that challenge our heart and our lungs as well as promote good biomechanics, good posture, trunk rotation and normal rhythmic, symmetric movements are the best. Dancing to music may be particularly good for decreasing stiffness. Although research on this subject is ongoing, it does appear that beyond aerobic activities performed with healthy movement patterns, exercises challenging the individual to change tempo, activity, or direction (what is referred to as “random practice” exercise) benefits people with Parkinson’s disease. It is also important to keep variety in exercise activities, because individuals with Parkinson’s disease often have difficulty in shifting from one activity to another or in performing two activities at the same time. Exercises that require balance and preparatory adjustment of the body are also important. Finally, exercises that promote attention and learning are beneficial. What types of exercises do this? Walking outside or in a mall, dancing, yoga classes, Tai Chi classes, stepping over obstacles, marching to music with big arm swings as well as participating in sports (ping pong, golf, tennis, volleyball) and aerobic or jazzercise classes promote motor learning. What types of exercises promote cardiopulmonary fitness? Paced walking, treadmill walking with a harness at different speeds and different inclines, hiking using walking sticks and swimming with different strokes with the eyes open and closed not only challenge motor learning but also increase heart rate and provide good cardiopulmonary conditioning. What types of exercise do not challenge motor planning? Riding a stationary bicycle without doing other activities, weight lifting, treadmill walking at a slow speed and lap swimming can be very habitual and also automatic. These exercises for cardiovascular, endurance and strengthening could be enriched by performing simultaneous activities such as reading, writing, problem solving, singing or throwing and catching balls. Exercises that demand attention, repetition, progression of difficulty with spaced practice over time are the best exercise routines to promote learning. You can purchase learning programs from PositScience, Wii, Nintendo and there are several learning-based programs on the web (e.g. Luminosity). Is there any value in strength training? Weight lifting per se is not the best choice of an exercise program for the person with Parkinson’s disease, particularly if it is the only exercise activity. Individuals need to be careful how they perform strengthening exercises to minimize increasing stiffness and rigidity. When performed properly, strengthening exercises do have some value. As one ages, more exercise must be performed to maintain muscle mass. Muscle mass and strength allow an individual to complete daily chores and to maintain balance. Additionally, strengthening postural muscles may help to maintain a more upright posture. Integrative, functional exercises other than weight-training may strengthen muscles in ways that are more beneficial to individuals with Parkinson’s disease. For example, legs can be strengthened by activities in a standing position, such as pushing up to rise on the toes or modified squats. Helpful arm exercises include arms push-ups or wall push-ups. Light weights are just as effective as heavy weights in maintaining muscle tone and do not increase stiffness as much. Walking with ankle and wrist weights can help strengthen while encourage increased awareness of arm swinging and high stepping. Moderation is the best word for strength training without other forms of exercise. However, integrating strengthening and flexibility exercises into aerobic, rhythmic and learning-based exercise routines that are fun, engaging, progressing in difficulty and rewarding are the best. What about swimming? Swimming provides good cardiopulmonary training and maintains muscle strength. However, lap swimming does not challenge balance or stimulate variety of movements. Therefore, lap swimming is a second-choice activity. However, since the arms, legs and head may be doing different things, it may increase coordination. The resistance of the water increases stiffness in some people and decreases it in others. Adding resistance with paddles and trunk support provides more opportunity for reciprocal movements and circling movements of the arms and the legs. Rolling and summersaults in the pool are good for those who are particularly comfortable in the water. For individuals with Parkinson’s disease who have difficulty in breathing, swimming may not be a comfortable aerobic activity. Thus, swimming may be an appropriate choice of exercise for individuals who have enjoyed it in the past and are comfortable with the techniques and those with musculoskeletal conditions particularly of the knee and back. Swimming using certain strokes can also help increase shoulder range of motion. Will exercise make my muscles less stiff? Exercises that require large, rhythmical movements through a full range of motion have been shown to decrease rigidity. In addition, rotating the trunk can decrease stiffness and enable more variability of movement. Vibration, rocking and swinging can also decrease stiffness. In a program of aerobic exercise using music, there was a reduction in rigidity in 9 out of 10 participants immediately after the exercise program. Avoiding tremors (e.g. touching the limb that is shaking to quiet the movement) can also decrease tension. Decreasing stress in ones life, having fun, thinking positively about planning and carrying out challenging, socially engaging and learning-based activities can also decrease stiffness. Sometimes cooling and at other times warming the tense extremity can be helpful. When should I exercise in relation to medication? The best time to exercise is when mobility is best. For individuals who take medications for Parkinson’s disease, the best level of function often occurs about 1 hour after a dose of medications. The answer to this question varies by individual. The individual reaction to the medication is also important. How often should I exercise? The guidelines for people with Parkinson’s disease are no different from those without the disease (i.e. 3-4 times a week for at least 30-40 minutes). This assumes that your heart is beating at 70 to 80% of maximum (220 – your age times 70 or 80%). Make the exercise time fun and where possible engage in group exercise, movement or dancing classes. For many, participating in activities with other people, can be more stimulating and increase compliance. It is also helpful to think about staying active throughout the day. For example, walk whenever possible instead of driving. Climb the stairs instead of taking the elevator. Integrate exercise into your usual day, such as: taking regular 5 minute breaks every 30 minutes, lifting the arms up over your head, performing wall glides, breathing diaphragmatically, getting up to get a glass of water, or putting theraband on chairs to work on some strengthening. Long periods of time watching TV and or using a computer should be avoided. Is there anything else I should know? A “cool-down period” is important. After exercise, allow yourself a longer time for a cool-down than others would need (Individuals who exercised before developing Parkinson’s disease typically double their cool-down time). A cool-down period accomplishes two goals— (1) it promotes a slow decrease in heart rate and (2) it allows the muscles time to cool down gradually so they do not become stiff. A cool-down period consists of the same exercise activity but at a progressively slower pace. During the cool-down, all muscles need to go through a slow, full range of motion. If you feel exhausted and want to fall asleep immediately after exercise, then you are not cooling down slowly enough. Stay active. Learn something new every day. Challenge your memory and problem solving skills every day. If you listen to the news, talk to someone about it. Listen to educational programs and discuss what you learned. Do crossword puzzles or participate in memory training programs on the web or from a CD. It is also important to remember to practice writing. Learn to hold your pen lightly and write with big cursive type movements. Write by moving the whole arm, not just the fingers. Practice writing to music and even say the words out loud as you write. Also remember to exercise your voice. Talk slowly, clearly and loudly with a lot of expression of your eyes and your face. Have everyone speak loudly and slowly. If you find you continue to talk softly and quickly and people are having difficulty understanding you, then ask a friend to read and record some passages from a book. Then you put the head set on and hear your friends voice as you read the same passages. This may strengthen the learning. When should I request a referral for Physical Therapy? When first diagnosed, all patients should have a consultation with a physical therapist to define the appropriate exercise program tailored to “you”. This will also establish a baseline of your current physical status. Ideally, all patients with PD should have a good fitness program as well as specific exercises to maintain good posture and balance as well as improve symmetry in flexibility and strength. Then, one may benefit from a consultation with a physical therapist when signs and symptoms increase the risk for falling or limit comfortable community mobility and confidence. The therapist will also work on improving gait with practice using visual and auditory cues, as well as without those cues. As the disease progresses, periodic re-evaluations are helpful to assure your exercise program is having the maximum benefit. A program of individualized exercises addressing posture, balance and gait has been shown to be beneficial in decreasing the risk of falling. In some cases, where balance or musculoskeletal problems develop, supervised outpatient treatments a few times per week may be helpful for a few weeks. Safe mobility may be enhanced by using a bodyweight supported treadmill to minimize discomfort, assure stability, decrease the fear of falling and facilitate normal movement. In every case, a regular home program of exercise is critical. In addition to physical exercise, it is important for everyone to maintain a high level of learning-based exercise activities to improve the ability to do multiple tasks simultaneously and safely without falling. The combination of learning-based memory training, aerobic exercise, over ground gait practice and integrative, engaging activities in the community are essential to positive health and well being despite aging or neurodegenerative disease. Are there techniques to help me walk? Often individuals with Parkinson’s disease have problems with abruptly halting or “freezing,” when walking. Reciprocal arm swinging, high long steps, scanning the environment and using visual fixation on an object in the distance or auditory cues (listening to music, singing to yourself, counting) can help decrease freezing. If you think about making big steps to clear obstacles on the floor or marching (high steps), it is possible to break these freezing behaviors. Also, walking hand in hand, swinging the arms with a friend or family member can help minimize these episodes. Having someone place their foot in front of you as a cue to step high and over can also be worthwhile. One person found that throwing pennies and stepping over them was helpful (“But,” he added, “don’t bend down to pick them up.”). Loud rhythmical clapping can also be useful. When walking for exercise, some people find it helpful to do paced walking with high stepping. Using walking sticks can also be helpful…. using them for sensory feedback and sense of stability may be more important than using a cane. Of course, using a cane or a walker can be helpful if there is a lot of weakness and stiffness. However, pushing one’s self to stay active should be the goal. Are there hints to help me get out of bed? For some people with Parkinson’s disease, getting out of bed may become difficult. When trying to come to sitting from lying in bed, try rolling over on your side. Push on your elbow and let your feet come over the edge of the bed and then sit up at the edge. Sit there for a minute to adjust and then rise to stand and then walk. This technique is not only easier but better for your back. Another technique to make it easier to move around in bed is to wear satin pajamas or use satin sheets (but not both). You can also improve your transitional movement skills by practicing standing up and sitting down quickly from a chair without using your hands. Also, practice getting up quickly from a chair and taking a few big steps and then turn around and go sit back down. You should also practice safe skills by climbing and descending stairs. If you are seeing a physical therapist, these are some of the activities that should be practiced.
What is PD? | Members of the team | Ongoing clinical research | Support groups | Links and other resources | Link to National Parkinson's Foundation | Information for people with Parkinson's disease | Information for Health Professionals | Introduccion a la Enfermedad Parkinson | Chinese | Contact Information If you experience any difficulty with this site, Copyright © 2009, The Regents of the University of California.
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