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  • Daniel Rockman

Exercise for Parkinson's Disease

Parkinson's disease (PD) is a disorder of the central nervous system that affects movement. It is caused by a degeneration in the dopamine producing neurons in the brain and often results in tremors, slow movement, freezing, stiffness and loss of balance. PD can be treated with various medications, however it can't be cured.


People with PD often start with small tremors in their hands and gradually decline in function until it can be difficult to perform even simple daily tasks. However, exercise can play a vital role in the treatment of this disease. While it doesn't directly combat the cause of the condition (remember, not enough dopamine in the brain), it does directly maintain and even reduce the symptoms.


Exercise can improve:

  • Gait

  • Tremors

  • Flexibility

  • Balance

  • Falls risk

  • Strength

Coordination IN ADDITION to all the usual benefits of exercise


So how can you get started with exercise?


Guidelines

The guidelines for exercise for Parkinson's disease mainly follow the usual National Physical Activity guidelines for adults. It's important to note that these are just guidelines and do not take your specific circumstances into account. Use these as a general guide of what to aim for, not as a bible to follow religiously.


Exercise guidelines for adults with mild to moderate PD. Adapted from Kim et al 2020

Aerobic exercise

Resistance exercise

How often?

3-5 days per week

2-3 days per week

How much?

Gradually increase to 60 minutes per day

1-3 sets

8-12 repetitions

5-10 exercises

How hard?

Moderate intensity

6.5/10 RPE

Pick a resistance between 50-80% of your maximum

How to?

Continuous movements such as: walking, riding, swimming or cardio machines

Target large muscle groups using:

weight machines, free weights or elastic bands

Special considerations:

  • Overall progression should start with either duration or frequency, and finally progress intensity per tolerability of the person.

  • Rest your muscles 2–4 minutes duration in between sets and muscle groups.

  • Rest your muscles for at least one day between strength training sessions.

  • Aerobic and resistance training can be performed on the same day as aerobic exercise training, depending on tolerability.

  • The exercise training should be undertaken during medication cycles or in an “on” state.


In addition to the basic aerobic and resistance recommendations, it is also advised to perform balance-specific exercises and Parkinson's-specific exercises.


Balance-specific exercises could involve a progressively challenging 30 second hold (feet apart --> feet together --> tandem stance --> single leg stance), a movement based exercise such as step taps and a dual tasking exercise such as tandem walking while throwing a ball. This will challenge all aspects of balance.


Parkinson's-specific exercises target increasing the size of movements and the ability to multi-task. These large compound movements will strengthen the pathways that are most affected by PD, to help minimise the progression of the symptoms. There are many ways to perform Parkinson's-specific exercises. Check out PD warrior's channel on YouTube for ideas and support.



When designing your exercise program there are 3 core principles which your training should follow.


The three P's:

Personalised, purposeful, practice


The training must be meaningful to you, it must be specific to what you want to improve and you must perform it a lot.


There is nothing harder as an allied health professional than trying to motivate someone to do something they don't want to do. Making the training meaningful to you means not just lifting a weight for the sake of lifting a weight, it means taking what you want to do in your life and training for that reason. I could throw a lot of words at you here, but this wordless commercial does a far better job at describing what personalised training is.



Make your training meaningful.


Purposeful training means to make it specific to you. In other words, train what you want to get better at. If getting out of a chair has become a challenge for you, leg press can help build your muscle, but you need to practice getting out of a chair to get better at it. Why? You will build your specific motor patterns (switching on the right muscles at the right time), you will train all the assisting muscles (think about the core muscles stabilising) and, importantly, you will also build your confidence with that movement.


Finally, you need to practice. Not much more to say on this. You probably don't want to read a full paragraph on it, but you do need to read it... The more you practice, the easier things get. The body is really good at adapting to new things, but it needs to get the input to do so. With 24 hours in the day, how many of them will you spend practicing the right thing?



Falls risk


Due to the effects on gait, falls are a large concern for those with PD. Up to 68% of people with the condition fall each year.


Falls become a huge issue with PD due to the negative loop this can create towards immobilisation. Falls can lead to injuries, and a fear of falling which can decrease the amount of exercise and community participation which can, in turn increase the risk of a subsequent fall. Nasty stuff! The best way to stop this cycle is to prevent it in the first place.



When exercising, ensure there is something sturdy nearby you can hold onto and take rest breaks when you need to ensure you are minimising the risk of falls.



Cueing


One thing that can help if your gait is freezing is cueing. Cueing such as saying "lift your knee up high" or "take big steps" can have this reset effect on the brain that allows you to walk again temporarily. Find what cues work for you and let those close to you know what it is.


Another way to utilise cueing is by setting up a metronome to be in time with your given task. The constant beat of the metronome will provide the stimulation to start again after a freeze.


Dance, dance!

Dancing is incredibly helpful in Parkinson's disease as it involves large movements and provides continuous auditory cueing. There are stories of clients struggling to shuffle into the class and then completely changing into normal movements once the music starts! Watch the video below for an example of what a Parkinson's dance class looks like.





Parkinson's disease is a progressive, debilitating disease, but there is something you can do to slow it down and improve your function. Following the guidelines, completing balance-specific and Parkinson's-specific exercises, following the three P's, minimising falls risk and utilising cueing can help you to live your life to the best of your ability.



For help finding an exercise professional to assist with your Parkinson's journey, check out ESSA's find an AEP function.


Stay strong!

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