Friday, March 24, 2023

Exercise For Freezing In Parkinson’s

Important Things To Focus On In Your Parkinsons Exercise

Exercises for Freezing: Session 2

Patients with Parkinsons disease usually find it difficult to be independent in daily activities of living. However, self-exercise is one of the best ways they can improve and train their body to reach a good level of independence in their daily life. Here are 10 wonderful exercises for individuals with Parkinsons disease that target range of activities.

1. Maintaining your balance

To maintain balance, patients of Parkinsons disease can practice swinging both arms while walking. This will lessen fatigue and loosen the arms and shoulders. Furthermore, walking while changing the speed of your gait from fast to slow from one destination to another is a good technique for improving your balance. Using a chair as a support, you can also do leg lifts to the front and side, making sure that your back stays straight and your spine remains in a neutral position.

2. Walking

The best exercise to improve your walking in Parkinsons disease is toes up! The rule is to stride forward, striking the heel and rolling the foot as you transfer weight forward to the toe. This is a good way to avoid commonly occurring calf cramps or freezing, making the lower leg active. In addition, always practice walking briskly, with both arms helping to elevate the strides. To aid balance, legs should always be further apart while walking.

3. Sitting and standing
4. Posture and tight muscles
5. Fine motor skill: Working the hands and fingers for everyday tasks
6. Facial exercises
7. Voice exercises

What Types Of Exercises Are Recommended For People With Parkinsons

Above all, do what you enjoy! When you engage in activities that make you feel safe and confident, exercise can be fun as well as healthy. For people with Parkinsons, aerobic exercise, stretching, and strength and balance training form the foundation of a good exercise program. Here are some suggestions for building a good foundation for your Parkinsons exercise program:

How Your Support Made This Research Project Possible

The New Investigator Grant from Parkinson Canada will allow Ehgoetz Martens to conduct independent research in a new lab, with new collaborations with engineers at Waterloo and other colleagues in southwestern Ontario.

Its really kickstarting my clinical research program, she says.

This grant is the only grant that I hold that will give me the opportunity to continue to investigate freezing, and it builds off of at least 10 years of Parkinson Canada funding, she says. Weve been chipping away at this problem with post-doc funding as well as PhD funding.

Based on the work shes done through Parkinson Canadas support, Ehgoetz Martens was recently invited, along with other key researchers studying freezing of gait around the world, to participate in a review paper trying to tease out the non-motor factors that contribute to freezing of gait. She hopes the paper will help to propel the field forward in understanding the diverse causes of freezing of gait.

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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

Study Design And Participants


This was a prospective, single-center, parallel-group, single-blinded RCT conducted between June 2018 and April 2019. Freezers were recruited from the Movement Disorders Clinic in the School of Medicine at University of São Paulo. The diagnosis of idiopathic PD was confirmed by a movement disorders specialist in accordance with UK Parkinsons Disease Society Brain Bank diagnostic criteria. A movement disorders specialist assessed probable FOG using videos of objective tests and the NFOGQ. Individuals with PD were classified as freezers if FOG was observed in the videos and if they answered affirmatively item 1 and scored > 1 on item 3 and 5 of the NFOGQ during ON medication status. Eligibility criteria were: 1) Hoehn and Yahr stage range 34 2) stable dopaminergic therapy 2 months before and during the period of study 3) 4985 years of age 4) able to walk safely for 20 m without walking aids 5) absence of neurological disorders 6) absence of significant arthritis, musculoskeletal or vestibular disorders, severe tremor, claustrophobia, and metal in the body 7) high quality of brain volumes acquired during the fMRI 8) Mini-Mental State Examination score > 23 9) no physical exercise practice in the three months preceding study commencement. Individuals gave their written informed consent to participate. The study was approved by Universitys Ethical Committee , registered at the National Clinical Trial and at the Brazilian Clinical Trials Registry .

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Parkinson Society British Columbia Exercise Recordings

Cost: Free

Purchase Info:

Cost: Free

Features thirteen men and women with PD of different ages demonstrating both standard and advanced workout routines with twice-weekly variations. Intro reviews benefits of exercise and keys to success. Exercises were developed by physical therapist expert.

Cost: Free

Archived classes from March 2020 to the present include yoga, shadow boxing, multi-tasking/cognition, strength and coordination cardio, bigger and stronger.

Cost: Free

Four of the videos posted to the PASF YouTube channel are exercise videos. Each is 25 minutes long. Focus of the videos include strength and mobility, balance skills, seated and mat exercises.

Why Do People With Parkinsons Freeze

Some people are more prone to freezing than others. It tends to occur with increased frequency as Parkinsons progresses and appears to be linked to long-term use of levodopa. It can be experienced by people who do not take levodopa, so it is not simply a side effect of medication.

Whatever the cause, not everyone with Parkinsons will experience freezing and it is impossible to accurately predict those who will. Freezing seems to be more prevalent in those whose initial symptoms included gait problems, and less prevalent in people who initially present with tremor.

The exact cause of freezing is unclear, but it is thought to occur when there is an interruption to a familiar or automatic sequence of movements. During walking, freezing is mainly observed when:

  • you are walking towards doorways, chairs or around obstacles
  • you are turning or changing direction, especially in a small space
  • you are distracted by another task when you are walking
  • you are in places that are crowded, cluttered or have highly patterned flooring
  • the flow of your walking is interrupted by an object, by someone talking, or if you begin to concentrate on something else. All of these will stop you from being able to keep a rhythm going
  • your medication is ‘wearing off’ and no longer controlling symptoms as well
  • youre in a group situation or in conversation.

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How To Exercise With Parkinsons

Whether you’re a first-time exerciser or a lifelong athlete, the key to working out with Parkinsons is to safely and regularly move your body in a variety of ways. Your fitness regimen should include these four main categories of exercise:

  • Aerobic activity
  • Balance, agility, and multi-task exercises
  • Stretching

People with Parkinsons should strive to perform aerobic activity at least three times weekly and to complete exercises from the other categories two to three times each week.

In total, the Parkinsons Foundation suggests performing 150 minutes of moderate tovigorous exercise weekly.

To help you achieve this goal, try these helpful tips:

  • Invest in a treadmill, elliptical, or exercise bike. This will make it convenient to perform aerobic exercise from your home, regardless of the weather.
  • Obtain a set of light hand weights from a local exercise shop or thrift store. These can be used for a wide variety of strength training exercises.
  • Follow along with one of the many online exercise classes on YouTube that are tailored to people with Parkinsons disease. The Parkinsons Foundation and the Davis Phinney Foundation offer many great online exercise videos.
  • Connect with a workout buddy by finding a local Parkinsons support group associated with the American Parkinson Disease Association

What Can Be Done To Thaw One Out When Freezing Occurs

Exercises for Freezing: Session 3

There are various cues and/or tricks that can be tried with your physical therapist to determine which cue will work best for you. Examples of such cues include:

  • Visual cues: Provide feedback to through your eyes and visual system to provide you with a location to place your foot when stepping. Visual cues include: lasers on canes and U-step walkers, placing lines of tape on the floor, placing Xs of tape in a semi-circle in tight spaces, and stepping over the foot of the therapist while gait training.
  • Auditory cues: We rely on feedback through our ears to establish a rhythm step to the beat. These cues come in the form of music, counting out loud 1,2, 3.., or using a metronome. There are also applications for smart phones that can provide sounds like a metronome that your therapist can demonstrate for you!

Not every cue works for every patient! But it is important to consult with your PT to find which one will help you.

References:Lohnes CA, Earhart GM. The impact of attentional, auditory, and combined cues on walking during single and cognitive dual tasks in Parkinson disease. Gait and Posture 33 478-483.

Plotnik M, Giladi N, Balash Y, Peretz C, Hausdorff J. Is freezing of gait in Parkinsons Disease Related to Asymmetric Motor Function? Annals of Neurology. Vol 57 No 5, May 2005

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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: $25.95

Cost: Free

What Should We Focus On Treating

Not surprisingly, most current research trials are focused on symptomatic therapies for patients with established FOG , rather than exploring approaches to delay or prevent the onset of freezing. However, some data does exist about these at risk groups and identifying those patients who will go on to develop FOG is of great interest given that they may benefit from specific intervention approaches, such as physiotherapy or cognitive behavioural therapy .

Other novel approaches for identifying those patients at risk of developing FOG are also being described. One recent study found that compared to a non-freezer group, patients who developed freezing within 5 years demonstrated increased baseline anti-saccade latencies , whilst having equivalent motor and cognitive deficits . Indeed, this parameter alone was also strongly predictive for the presence of FOG and correctly classified 88% of non-freezers and 76% of eventual freezers , which is broadly consistent with earlier work showing anti-saccade errors in PD patients with FOG . Increased anti-saccade latencies were also correlated with decreased connectivity in the mesencephalic locomotor region-supplementary motor area network, one of the networks involved in gait control, and a compensatory increase in other networks years before onset of freezing, which might provide a potential neurobiological explanation for these associations .

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How Often And How Hard Should I Exercise

Any exercise is better than none! However, experts recommend that people with Parkinsons should aim for the following for how often and how hard to exercise:

  • Begin training in the early stages of Parkinsons
  • Train most days of the week for at least 150 minutes per week
  • Add mental and physical challenges when appropriate and safe
  • Train at higher intensity levels, meaning you can still talk while training but in short bursts

Are There Any Risks Of Exercising With Parkinsons Disease

Thawing Out Series: Exercises for Freezing in Parkinson

Some symptoms, like Parkinsons tremors, may seem worse during exercise. But exercise generally improves tremors and other symptoms in the long run.

Reduce challenges by stretching before and after exercise. Use good form to prevent injury. And avoid slippery floors, poor lighting and tripping hazards. If you have pain, stop and rest.

Pushing yourself too hard during exercise can lead to injury. Start slowly and increase intensity and duration over time. Keep a log to track your exercise choices and how you feel. Eventually, youll learn what works best for you.

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Database Management And Quality Control

Our research team will take effective measures to ensure the quality of research. Particularly, we will adopt the double entry method in order to ensure quality of data. The statistician will compare the two databases through the program, and in case of inconsistencies in the input results, he/she will check to identify the error. After final confirmation, the database will be saved and kept by a special person. Any future changes to the database shall be agreed upon, in writing, by the clinical study director, statistician, and data manager.

What Freezing Is Like For My Dad

Like many Parkinsons patients, my dad notices that he usually only freezes when hes not on his medication. It usually happens while hes moving through doors: When you pivot youre worried about losing your balance. Thats why we shuffle our feet and take baby steps initially. Once Im moving Im fine, he says.

Since hes worried about maintaining balance while navigating, its possible that theres a connection between fear and freezing. Continuous motion seems to bypass the risk of freezing, while shifting motion types can present challenges.

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Heres 13 Freezing Of Gait Tips To Help You Get Moving Again

1.Keep your movements BIG Scale Matters.

2. Develop the mindful skills to walk with purpose and with intent.

Using therapy programs to practice these skills there are emerging positive results using interventions like:

  • treadmill training
  • obstacle aquatic training a form of hydrotherapy
  • slackline training
  • walk bicycle

The findings of a large meta-analysis suggest that its a combination of approaches which are needed as in clinic exercises have a short term carry over. Meaning more sustained activities as well as in home work is needed as well.

3. Develop your circuit breaker toolkit.

Rather than trying to bust through the freezing, consider moving an alternative part of your body to circuit break the frozen movement. This may include:

  • Move another limb finger, move your gaze.
  • Take a deep breath in and shorter breath out.
  • Auditory or visual cues also can be used as well and covered later in this list

4. Pick a Destination

  • A point of focus, like a boat charting a course through difficult waters, map a path to get to your intended destination . This may be about the home for example. You want to get form the loving to that bathroom but you need to go through the kitchen to get there. Pick a visual target that leap fogs you to the next visual destination.

5. Verbal Cue and Prime yourself to GO!

  • This can be a countdown methods 3-2-1 GO! Please note the GO! is a LOUD and POWERFUL internal command you give yourself.

6. Leverage Assistive Technology

9. Plan Your Day

How Do I Create An Exercise Program

Parkinson’s Exercises to Help with Gait & Freezing | Exercise of the Week with Polly Caprio

A visit to a physical therapist is a good place to start building an exercise program. Physical therapists can talk with you about your symptoms and personal goals to design an exercise program that is effective and enjoyable. They can also help you find exercise classes in your area.

Incorporating activities that have been shown to address specific symptoms can help you practice and maintain everyday motor functions that directly impact quality of life. Some exercise principles to consider for your exercise program include:

1. Use BIG, full amplitude, whole-body movements to help slow, small movements.

2. Practice dual tasks and cognitive challenges when appropriate and safe.

3. Practice self-initiated and self-paced movement to help with freezing.

4. Practice reciprocal, coordinated arm and leg movements to help uneven arm swings.

5. Practice tall, upright posture to help with stooped posture.

6. Use strong voices while exercising to help with voice quality.

7. Improve sensory integration by varying surfaces and reducing visual input.

8. Practice fast movements to help with slow movements.

9. Build mind/body connections for self-awareness and relaxation.

10. Do activities that are challenging, engaging, fun, social and safe.

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Complex Exercises Reverse Gait Freezing In Parkinsons Disease Study

A challenging physical training program has helped reverse the symptom of gait freezing in study participants with Parkinsons disease, according to investigators from Brazil.

People with freezing of gait cannot move their feet forward despite the intention to walk, a problem that not only interferes with daily functioning but can lead to falls. Researchers at the University of São Paulo recently tested a 12-week exercise protocol that stimulates motor and cognitive skills at the same time.

The 32 study participants, who had stage 3 or 4 Parkinsons disease, performed adapted resistance training exercises that combined instability, weight lifting, motor coordination and cognitive demands. The exercises were done concurrently to create the complexity necessary to stimulate significant brain changes, explained doctoral candidate Carla da Silva Batista.

This demands considerable effort from the patient and confidence on the part of the trainer, who will invariably have to give patients some support so they dont fall, Batista said.

Significant functional improvements were found following the trial, including a 60% reduction in gait freezing and a 70% reduction in motor symptoms. Measurements of brain activity before and after the training program also showed changes in the brain regions linked to gait freezing, and enhanced brain activity and plasticity in the regions affected by Parkinsons disease, the researchers reported.

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