How Fitness Controls Symptoms And Which Activities Doctors Recommend You Try
by Cheryl Platzman Weinstock, AARP, April 23, 2021| 0
En español | You know that exercise is good for your heart and that it strengthens your bones. But it’s also one of the more important cornerstones of managing Parkinson’s disease , the second most prevalent progressive degenerative disease of the nervous system that affects movement.
Intensive research in the past several years has found that for Parkinson’s patients, exercise can increase coordination and balance, reduce falls and improve mood. Codrin Lungu, program director in the Division of Clinical Research at the National Institute of Neurological Disorders and Stroke, a part of the National Institutes of Health , says that preliminary evidence also shows that exercise slows the progression of the disease.
To understand how that might be so, research is building on earlier studies showing that exercise in older adults increases brain volume and improves neurological connections in areas that would otherwise undergo age-related decline. Research also has shown that intensive exercise appears to increase dopamine receptors that coordinate signals from the brain to muscles. Scientists believe a lack of dopamine causes PD.
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Pharmacological Treatment Of Parkinsons Disease
Pharmacological treatment of PD is based on the replacement of dopamine levels in the brain, which generally promotes the temporary improvement of physical disability and control of some of the symptoms. The medication considered gold standard in the treatment of PD motor symptoms is Levodopa , a metabolic precursor of dopamine that crosses the blood-brain barrier easily. Once in the Central Nervous System, L-Dopa is metabolized basally by DOPA decarboxylase, leading to dopamine. L-Dopa is marketed in association with a decarboxylase inhibitor drug , preventing the peripheral synthesis of dopamine and ensuring the drug’s arrival in the brain . Other drugs are available, in most cases in association with L-dopa, and are divided according to the mechanism of action in order to increase the concentration of dopamine levels such as Monoamine Oxidase-B , Catechol-O-Methyl Transferase inhibitors, or dopaminergic agonists such as Pramipexole . However, pharmacological treatment for PD has limitations ranging from possible drug interactions and side effects , to decrease in its efficacy with years of use and the appearance of secondary symptoms such as dyskinesias and fluctuations , due to the lack of effectiveness of the treatment of non-motor symptoms of the disease . The choice of drug or association that will be administered to the patient depends on factors such as age, stage of the disease, type of activity performed by the patient, and their mental state.
Neurochemical Effects Of Exercise In Animal Models Of Parkinsons Disease
Physical exercise has been extensively studied and implemented in rehabilitation and treatment programs in people with Parkinsons disease2222 Dashtipour K, Johnson E, Kani C, Kani K, Hadi E, Ghamsary M, Pezeshkian S, Chen JJ. Effect of exercise on motor and nonmotor symptoms of Parkinson’s disease. Parkinsons Dis 2015 586378: 1-5.), which acts by inhibiting complex 1 of the respiratory chain electron, but accomplishes this inhibition only half of its capacity in trained animals.
The neuroprotective role of physical exercise is mainly due to the increase in the neurotrophic factors BDNF and GDNF responsible for the regulation of neuronal survival, differentiation, and synaptic plasticity. Physical exercise raises the levels of proBDNF , which is cleaved and generates the mBDNF and mBDNF selectively activates a receptor also overexpressed by physical exercise, TrkB , triggering a signaling cascade intracellular, culminating in neuronal survival. It is suggested that cleavage of proBDNF is crucial in determining the regulation of brain neurotrophic actions.
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How Does Exercise Help
There is increasing evidence that exercise may have a neuroprotective effect, meaning that it can slow the progression of your condition. Researchers think that exercise can delay the onset of Parkinsons as well as slow progression if introduced early on.
There are also psychological benefits to exercise. It wont take Parkinsons away but it can give you a sense of control over it and make you feel better about living with the condition. This, together with a good medication regime, can really enhance quality of life and help you maintain independence. You can tailor your regime to suit your own individual abilities and requirements, whether you want to maintain the strength and fitness you already have or get yourself fitter and healthier. Remember, its never too late to start and the benefits can be enormous.
Some of the benefits of regular exercise include:
- improved balance and fewer falls
- improved posture and flexibility
- improved brain function and health
- fewer muscle and joint injuries
- preventing/reducing gait, sleep, speech and swallowing problems
- preventing/reducing bone wasting .
You should tell your physiotherapist or occupational therapist if you plan to use a Wii to exercise. Ask your doctor for advice if you have any concerns about using this tool.
Dance, for example Irish set dancing, tango, waltz and foxtrot, has also been shown to improve symptoms. For more information on dance and its benefits in Parkinson’s see Dance therapy.
Effect Of Exercise On Motor And Nonmotor Symptoms Of Parkinsons Disease
1Department of Neurology, School of Medicine, Loma Linda University, Loma Linda, CA 92354, USA
2Department of Physical Therapy, School of Allied Health Professions, Loma Linda University, Loma Linda, CA 92354, USA
3Department of Epidemiology and Biostatistics, School of Public Health, Loma Linda University, Loma Linda, CA 92354, USA
4Department of Pharmacy Practice, College of Pharmacy, Marshal B. Ketchum University, Fullerton, CA 92831, USA
LSVT BIG therapy incorporates large trunk and extremity functional motions and should only be administered by an LSVT BIG certified therapist. In contrast to other conventional training methods that use various techniques to facilitate movements, the LSVT BIG therapy uses amplitude as the main focus of the exercise and engages the patient in functional activities with the promise of sustainability after completion of the therapy .
2. Materials and Methods
2.2. Outcome Measures
2.3.1. General Exercise Protocol
2.3.2. LSVT BIG Therapy
The LSVT BIG therapy was delivered by an LSVT BIG certified physical therapist. The LSVT BIG therapy protocol has been previously described and patients were essentially encouraged to perform a variety of large amplitude functional movements with high concentration and effort over the course of 60 minutes with supervision .
2.4. Data Analyses
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Exercises To Prioritize When You Have Parkinson’s Disease
In this 16-minute YouTube video doctor of physical therapy, Sarah King, shares that at least two studies have demonstrated daily exercise slows the progression of Parkinson’s disease . Dr. King summarizes from those studies how often and how vigorously those with PD should exercise in order to benefit. Dr. King then describes how to prioritize the exercises you’ve been given by a physical therapist, those specific to PD, and those you just enjoy, depending on individual needs.
Obstacles To Exercise And Limitations In Current Literature
Although there have been a number of studies showing the benefits of various forms of exercise, most do not address long-term follow-up and adherence to exercise regimens. Reported reasons for failure to participate in training sessions include scheduling issues, commuting challenges, medical comorbidities, hospitalizations, motor vehicle accidents, musculoskeletal injury, and family demands.28 Depression, difficulty initiating movement, and decreased motivation are nonmotor symptoms of PD that also impede patients from initiating exercise.
The long-term effects of exercise in patients with PD are limited, as most prospective interventional studies are short, ranging from 1 to 6 months.26 Most studies lack adequate control groups and have small sample sizes and poor follow-up regarding long-term outcomes and adherence to the studied interventions. Most of the studied interventions utilized some form of supervision. Practically, the cost of physical therapy and personal trainers may prohibit patients from participating in supervised exercise. Adherence to and benefits from self-initiated independent exercise that is typically encouraged by clinicians remains unknown.
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Exercise And Parkinson’s Disease
Parkinson’s disease affects your ability to move, but exercise can help to keep muscles strong and improve flexibility and mobility. Exercise will not stop Parkinson’s disease from progressing but, it will improve your balance and it can prevent joint stiffening.
You should check with your doctor before beginning any exercise program. Your doctor may make recommendations about:
- The types of exercise best suited to you and those which you should avoid.
- The intensity of the workout .
- The duration of your workout and any physical limitations.
- Referrals to other professionals, such as a physical therapist who can help you create your own personal exercise program.
The type of exercise that works best for you depends on your symptoms, fitness level, and overall health. Generally, exercises that stretch the limbs through the full range of motion are encouraged.
Here are some tips to keep in mind when exercising.
Davis Phinney And Kelsey Phinney Practice Vocal Exercises For Parkinson’s
In this 23-minute episode of The Parkinson’s Podcast, Davis Phinney and his daughter and podcast host, Kelsey Phinney, practice and explain some vocal warmup exercises before Davis sings a few pop songs. Davis’s voice gets louder and clearer over the course of the session and is a good demonstration of the benefit of speech therapy and daily practice of speech exercises, including singing, for those with Parkinson’s.
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Connect With Other People And Share Tips On How To Manage Parkinsons Disease In Our Forums
These conflicting results may be linked with the different types of exercises, but also suggest that the benefits of exercise may be function-specific linked with attention, processing speed, executive function, memory, or working memory.
Researchers at the Institute of Movement and Neurosciences, German Sport University, Cologne, Germany and colleagues at the School of Health and Sport Sciences, University of the Sunshine Coast, Queensland, Australia, performed a comprehensive literature review of randomized clinical trials that evaluated the effects of various types of exercise coordination, resistance, and aerobic on specific cognitive function in people with Parkinsons.
Physical exercise is generally associated with increased cognitive function in older adults, but the effects in individuals suffering from PD are not known, Stuckenschneider said.
Eleven studies comprising 508 patients were included . Patients disease severity ranged from mild to severe .
The studys main outcome was overall cognitive function, which was subcategorized in specific domains, including attention, executive function , speed of processing , and memory. The Unified Parkinsons Disease Rating Scale , commonly used to assess both motor and non-motor symptoms, was included as a secondary outcome.
Global cognitive function also showed a tendency to improve after aerobic, resistance, and combined resistance and coordination exercises, but not after coordination exercises.
Effects Of Exercise On Mobility In People With Parkinson’s Disease
Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
Department of Neurology, Oregon Health & Science University, Portland, Oregon, USA
Relevant conflicts of interest/financial disclosures:: Nothing to report.
Full financial disclosures and author roles may be found in the online version of this article.
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Urinary Dysfunction And Exercise
Bladder dysfunction, including nocturia and increased urgency and frequency of micturition, is one of the most commonly reported symptoms of AutD in PD, affecting up to 93% of patients. These symptoms can inhibit social activity, disrupt sleep, and impair quality of life. To our knowledge, no studies to date have investigated the influence of traditional exercise on bladder dysfunction in PD. However, bladder training exercises have been investigated and shown to reduce urinary incontinence in PD. Therefore more studies are required to establish any role of exercise in treating urinary dysfunction in PD patients.
How Does Exercise Affect The Brain
Researchers have studied the brains of mice that exercised under conditions similar to a human being on a treadmill. Exercise did not increase the number of neurons or amount of dopamine in mices brains. But it did prompt their brains to use dopamine more efficiently.
Dopamine is a neurotransmitter that helps regulate movement and emotional response. Lack of it is associated with neurodegenerative diseases like Parkinsons.
Some studies have indicated that exercise reduces the chance that dopamine neurons will become damaged.
Note: Parkinsons News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website.
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Major Sources Of Risk Of Bias For Clinical Studies
Most of the studies had a selection bias from not adequately standardizing control subjects. More specifically, the subjects physical fitness levels and their concomitant medications before and during the study period were not documented and may have impacted their ability to exercise and the ability to compare their potential benefits on cognition. Additionally, information bias resulted from variability with the timing and intensity of the exercise intervention between subjects. Individuals may have received different amounts and types of exercise which could have affected the impact of exercise on cognition.
Of the five randomized controlled clinical trials, four studies included control groups that received the same social interaction as the exercise intervention group. One study included a control group receiving usual care, which did not control for the potential benefits to the subjects mood and cognition from increased social interaction through participation in the exercise intervention. Overall, both the pre-clinical and clinical studies showed a trend of selective reporting for only significant outcomes. A risk of bias across studies includes a publication bias, as studies with insignificant or negative findings are less likely to be published. The risk of bias for each clinical study is summarized in Table .
Eligibility Criteria For Study Characteristics
The participants included healthy human subjects, subjects with PD and animals with experimental PD. Studies were included if their primary intervention was exercise and their primary or secondary outcomes were to assess either behavioral or neurobiological markers of cognitive function. All articles were included where the authors treated the outcome measure as a test of cognition. In some cases, the measure was a surrogate , was a sub-score of cognition from a larger scale, or was influenced by motor capacity. An exercise intervention was defined as any purposeful increase in the subjects physical activity through a single bout of exercise or prolonged exercise over the course of a structured or unstructured program. Cohort and experimental study designs were included, whereas case series, casecontrol, cross-sectional and descriptive studies were excluded. Original research articles were included from 1966 through October 2013. Studies were considered if they were written in the English language and either published or in press.
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Physical Exercise For Parkinsons Disease: Clinical And Experimental Evidence
1Institute of Psichiatry, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
2Castelo Branco University, Rio de Janeiro, Brazil
1Institute of Psichiatry, Federal University of Rio de Janeiro , Rio de Janeiro, Brazil
3Physical Activity Neuroscience, Physical Activity Sciences Postgraduate Program – Salgado de Oliveira University, Niterói, Brazil
4Physical Education Department, Faculty of Unidas de Campinas , Goiânia, GO, Brazil
5Politechnique Institute of Porto, Healthy School, Porto, Portugal
8Intercontinental Neuroscience Research Group, Yucatán, Mexico
Autonomic Dysfunction In Pd
Autonomic dysfunction is common in PD, with reported prevalence ranging from 14 to 80%. It may include dysregulation of cardiovascular, gastrointestinal, urinary, pupillary, and thermoregulatory systems. AutD can occur at any stage of the disease, with gastrointestinal, urinary, and orthostatic symptoms increasing over time but notable in early and even premotor stages. As the disease progresses, AutD significantly impairs quality of life in PD patients.
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Be Active & Beyond: A Guide To Exercise And Wellness For People With Parkinson’s Disease
This 34-page booklet outlines the importance of exercising for those with PD, discusses barriers to exercise and how to overcome them, distills exercise guidelines from several organizations into a quick reference chart for those with PD, provides information on exercise basics and how to get started along with specific exercises to increase endurance, strength, flexibility, and balance.
How Can It Help In Parkinson’s
Nordic walking can improve fitness in the same way that running does, but it is much kinder to the ankles, knees and hips as it has a much lower impact on the joints. This can be particularly attractive if you experience joint pain.
Perhaps the most important advantage of Nordic walking if you have Parkinsons is that is allows you to maintain and develop your ability to walk well by:
- enhancing balance and coordination
- reducing slowness of movement
- reducing freezingand gait problems
- improving mobility and creating more fluid movements
- correcting posture, particularly the stooped position associated with Parkinsons
- reinforcing the alternating movements of the arms and legs which can be lost in Parkinsons and so improving stability
- boosting independence and quality of life.
Various studies 1,2 have shown that people with Parkinsons who participate in Nordic walking programmes have improved functional independence and quality of life. It seems that mood also improves.
Once the basic steps have been learnt you can tailor your programme to suit how you feel at any particular time. Walking in a group also has social and psychological benefits.
Carers and family members who walk with you may find that they too feel fitter and have fewer aches and pains.
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