Expert Exercises For Parkinsons Disease
By Melita Petrossian, M.D. Medical Director for Movement Disorders Center at Providence Saint Johns Health Center
In the past two decades, scientific studies have shown again, and again that exercise and physical activity can have dramatic impacts on the outcome and well-being in Parkinsons disease . The benefits of exercise are so widespread, as listed below, that exercise should be thought of as medicine, but with almost no side effects. I have many PD patients who are so dedicated to improving their neurological health with an exercise regimen that they become more physically fit than before they were diagnosed with PD. These patients often report, anecdotally, that they feel worse regarding their PD when they dont have the opportunity to exercise consistently.
Benefits of exercise include:
Direct effects of exercise include:
Dr Marina Clements Dpt
Exercise is the best medicine. We know this, but lets admit it sometimes it can be challenging to get motivated to exercise and even more difficult to establish consistency, which is key in making lasting improvements in your health and fitness. That is why I make it my personal mission to make exercise something you want to do. Exercise is a celebration of movement and what your body can do. It should be fun, make you feel good, and it should be something you look forward to doing.
Through my own health and fitness journey, I found that the only exercise regime I could stick to was attending group exercise classes. I fell in love with Zumba, kickboxing, strength, and cardio classes and have continued doing them ever since! There was a community of people who supported each other and held each other accountable for showing up to class each week. I would always leave happy that I showed up to class. Exercise suddenly became a scheduled priority on my calendar. Group exercise became one of my passions, and I knew that I wanted to lead and provide environments for others to improve their health and wellness by becoming an exercise class instructor.
I absolutely adore teaching, and it is my hope that everyone finds their mode of exercise that inspires them! Maybe group exercise will be your passion, too! Outside of teaching for the APDA, I enjoy swing dancing, attending live music events, spending time outside, thrifting, and trying new plant-based recipes.
Brian Grant Foundation Exercise Videos
Cost: Free
Cost: Free for 9 videos $29/month or $290/year for online streaming
The nine free classes include boxing fundamentals, HIIT , chair fit, tai chi, core, yoga, stretching/mobility. The free classes are 13 to 30 minutes. Classes are led by a physical therapist with Parkinsons specific certifications.
Paid classes incorporate PWR! Moves, cognitive dual task training, balance training, intensity training, and flexibility. For subscribers, new 20-25 minute videos are released weekly.
Cost: Free
Dance exercise class videos on YouTube. Each is fewer than 10 minutes long. Nearly 30 videos as of October 28, 2020.
Rachelle was featured at the Davis Phinney Foundation Victory Summit Albany in October, 2020. Watch an interview with Rachelle here, and Rachelle’s 25 minute Dance Beyond Parkinson’s Summit presentation here.
Cost: Free
Six seated dance exercise class videos on YouTube. Each is about one hour long. All are with the same instructor.
Cost: Free for 16 videos $50 for 100+ videos
Sixteen archived exercise classes are available for free viewing. Classes are designed to increase coordination, balance, flexibility, and strength through music and movement from a broad range of dance styles. 100+ archived classes and additional benefits are available for a $50 membership.
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What Type Of Exercise Should I Do If I Have Parkinson’s Disease
Exercise is a planned, structured, repetitive activity that is intended to improve physical fitness. There is no right exercise for people with Parkinsons. Everyones regimen will differ, depending on overall health, symptoms and previous level of activity. Any exercise helps, and a variety of exercise types may provide well-rounded benefits.
Aerobic exercise
Aerobic exercise involves activities that challenge your cardiorespiratory system such as walking, biking, running, and activities in the pool. Participating in aerobic exercise at least three days a week for 30-40 minutes may slow Parkinsons decline.
Strength training
Strength training involves using your body weight or other tools to build muscle mass and strength. Strength training two days per week, starting with low repetition and weight, may be beneficial in Parkinsons disease. A focus on extensor muscles, or muscles in the back of the body, can help with posture.
Flexibility training
Stretching two or more days per week can be beneficial to maintain range of motion and posture. Holding each stretch of major muscle groups for 30 to 60 seconds can improve muscle length.
Balance and agility training
This type of training often combines aerobic exercise, strength training, and flexibility training. Examples include:
- Dancing.
- Tai chi, yoga or Pilates.
Penile Modeling Following Ipp Implantation
IPP implantation involves a surgical procedure in which a prosthetic device is inserted inside the penis. This course of action is recommended for people in the chronic stages of PD who have ED as well.
This surgical intervention can correct penile curvature and sexual dysfunction. While it is possible for prosthetic implantation alone to resolve curvature issues, most people will need additional straightening procedures during the operation, such as penile modeling.
Once the IPP is implanted, the doctor will bend the penis in the opposite direction of the curvature. This maneuver can be repeated until they remedy the curvature.
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Exercise 3 Quadruped Hip Extension
STARTING POSITION: On hands and knees.
Repeat 15-20 times.Perform two rounds per leg.
What Are The Best Exercises For Parkinsons
An example of one of the best exercises for Parkinsons disease is the toe up, which gets the patient to raise his or her toes when taking a step. Stretches for the neck, arms and legs are also important, although some may be difficult for the patient to perform. Other exercises for Parkinsons include practicing being in small spaces, using small steps when turning and practicing any daily activity that is difficult.
The toe up exercise is one of the most important for people who suffer from Parkinsons disease. To perform the exercise, the person walks slowly while ensuring that the foot lands on the heel and rolls forward to the toe. Also, when performed slowly, the exercise can be used as a stretch for the lower leg muscles, which can help with leg cramps.
Practicing taking steps in the correct way is also important for someone with Parkinsons. In general, the person should use short steps only when turning, and long steps for regular walking. This can take some practice, but can reduce the chance of the patient falling over.
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How Hard Should I Exercise If I Have Parkinsons Disease
A rating of perceived exertion is a good way to measure intensity. On a scale from 0 to 10, 0 would be how you feel while sitting or lying down, while 10 would be the maximum effort you can give. Building up to an effort between 5 to 8 means you are exercising at a high intensity. A good gauge is, if you can have a conversation with someone while exercising, you should probably increase your intensity.
Pathophysiology Of Parkinsons Disease
The progressive death of dopaminergic neurons in the Substantia Nigra pars compacta located in the midbrain, more precisely in the Basal Ganglia , promotes a significant decrease in the levels of the neurotransmitter dopamine, and as a consequence the functional impairment of the neural circuits . The chronic reduction in dopamine levels gives rise to the manifestation of the motor symptoms that characterize this disease. However, the pathophysiology of PD is not limited to the dopaminergic system, that is, neuronal degeneration of other areas of the brain such as the brainstem and cortex competes and even precedes neuronal death in BG. Thus, other neurotransmitter systems are compromised, thus making PD a multisystemic pathology manifested by a series of motor and non-motor symptoms .
Examples of experimental tests showing a high and a low data dispersion.
The cardinal motor signs of PD are: resting tremor, plastic-type muscular rigidity, bradykinesia , and postural instability. This set of symptoms associated or not, forges characteristic clinical signs in patients with the disease such as gait and balance disorders, mask facies and dysarthria. In addition to these symptoms, a set of sensory autonomic and cognitive-behavioral symptoms may manifest during the course of the disease .
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Adverse Side Effects Of The Training
Two patients of the NW group and one patient of the walking group experienced exercise-induced hypotension after intense walking uphill in hot weather. Patients felt dizzy but did not lose consciousness and recovered after fluid intake within 10min.
During the supervised 6-month training period, four patients of the NW group fell due to obstacles. The falls did not lead to severe injuries. Five patients twisted their ankles during cross-country walking, but only one patient complained of pain and missed three training sessions. Two patients of the NW group developed shoulder pain which required medical treatment with nonsteroidal anti-inflammatory drugs. Both patients abstained from sports activities for one week.
Four patients of the walking group had falls during the supervised 6-month training period. Two patients tripped over roots and two patients slipped on wet ground while walking downhill. There was one fall in the flexibility and relaxation group during an attempt to stand up from the floor.
Muscle soreness was reported in all groups by 15% of the patients during the first three weeks of exercising.
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Identifying What Type Of Parkinsons You Have
Knowing what type of Parkinsons you have is also important in helping you to focus on the correct aspects of each exercise to make sure you get the most from them.
The three different types of Parkinsons that will define your exercise programme are:
Bradykinesia
Bradykinesia means that slow and small movements are the dominant feature of your Parkinsons and bother you the most in your daily activities. The reason why you experience bradykinesia is due to the loss of dopamine in your brain, specifically in the basal ganglia. As dopamine is an important neurotransmitter, the loss of it leads to poverty of movement where the regulation of normal movement size is varied down and smaller than required for efficient movement. It is important to focus on exaggerated and large movements in your exercise programme.
If you are bradykinesic your exercise programme needs to focus on exaggerated movements and power.
Part of your exercise programme needs to help you to re-adjust what normal movement should look and feel like. It will certainly feel strange when you first start to exaggerate your movements, but in time and with practice, you will find that the exaggeration really helps with daily tasks, walking, arm swing and other movements that might be impaired.
Tremor Dominant
This means that the tremor is the most dominant feature of your Parkinsons. The tremor can come on at rest or during prolonged or sustained postures.
Agility impaired
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Where Can I Find Support If I Have Parkinson’s Disease And Want To Exercise
You can find exercise support in your community. For example, many gyms and community centers offer seated exercise classes for people who struggle with balance. Ask your healthcare provider for ideas if you have Parkinsons disease and want to exercise.
A note from Cleveland Clinic
Exercise is an important part of managing Parkinsons disease. Talk to your healthcare provider about your exercise program and choose activities you enjoy so you stay motivated to get up and move every day.
Last reviewed by a Cleveland Clinic medical professional on 04/08/2021.
References
Assessment Of Technical Skills
The technique of the Nordic walking training appeared to be very challenging for the patients. Patients had difficulties in opening the hands during the push-off phase. Furthermore, patients tended to carry the pole without weight loading with the more affected hand. However, the group managed to learn the Nordic walking technique, but the level of performance differed between the patients. 17 of the patients mastered the NW technique very well, 10 patients showed a good technical performance and 3 patients performed poorly. Both the NW group and the walking group had difficulties in employing a diagonal sequence and an interlimb coordination. Patients did not notice the technical deficits and depended on the coaching of the instructors.
Seated Option: Calf Stretch with Strap
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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.
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.
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.
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.
Cost: Free
Recordings of nearly 30 exercise classes that include a warm up, low/medium/high intensity exercises, boxing, dance, and cool down. There are also recordings of choir for PD classes and communications classes.
Cost: Free
Cost: Free
Cost: $25.95
Try Seated Exercises If You Have Limited Mobility
Performing strength and flexibility exercises while sitting can help you stay fit and improve your range of motion all with minimal stress and wear and tear on your muscles and joints.
An example of a seated stretching routine recommended by the Parkinsons Foundation is the hamstring stretch. To do this stretch:
An example of a strength exercise you can perform while sitting down is the shoulder blade squeeze. To perform this exercise:
Your physical therapist can recommend additional seated exercises.
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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
Focused Exercise Videos For Parkinsons
According to Stanford Medicine, Exercise is an important part of a healthy lifestyle for everyone. When you have Parkinsons disease exercise is as important as taking your medications on time, every time. Exercise helps to maintain strength, flexibility, balance, and cognitive acuity so you can continue to do the things you have to do and the things you love to do. Building Your Abilities are specially designed exercise videos for Parkinsons.
Watch these videos to get your blood flowing and muscles moving. At times do you feel like you need to move after sitting too long? Or maybe, you would just like to warm up your body before your daily walk. Check out our new Building Your Abilities video series. Each video is around 10 minutes long and focuses on common challenge areas. Use one, two, or all 10 to fit your specific need.
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Strength Training Helps Build Muscle Mass
Strength training can involve lifting weights, using machines at the gym, using your own body weight for resistance, or even using common household items like a milk jug filled with sand, the Parkinsons Foundation notes. Your strength training should focus on the following muscle groups:
- Core muscles
- Arm muscles
- Hands and wrists
In general, strength training should be done two to three times per week, but scheduled so that youre not targeting the same muscles on consecutive days, as your muscles need to rest and recover, the foundation advises.
As with stretching exercises, strength training can be performed while standing, sitting, or while on the ground.
The Wisconsin Parkinson Association recommends several exercises to help strengthen your grip and improve your reach. Tasks such as handwriting and reaching for items on higher shelves can be a challenge for people with Parkinsons disease, and hand exercises can help minimize these issues.
In general, resistance training helps build and maintain muscle mass, Subramanian says. The stronger you are, the more independent youll be.