How To Improve Walking With Parkinson’s

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.

To Prevent Falls Exercise

Exercise is the only intervention that significantly reduces a persons risk of falling, among older people without PD as well as people with Parkinsons. Research is beginning to show how exercise changes the brain for the better and can help people with PD gain back some of their automatic balance reflex.

In a study, Dr. Horak and her team asked participants with PD to stand on a quickly moving treadmill, until they began walking. Participants initially took too-small steps, but with one hour of practicing, they improved, taking bigger steps to stay balanced while walking.

Many kinds of exercise can improve a persons balance. Consider trying:

• Tai Chi: a moving meditation where movements involve shifting the bodys center of mass back and forth over the feet. Studies found fewer falls among people with PD who practiced Tai Chi three times a week.
• Dance: to dance tango, a person has to walk backward and sideways, take big steps and both follow and lead good ways for people with PD to practice balance control.
• Boxing: the rapid arm movements provide good balance training.
• Agility boot camp: completing different tasks in a series of stations can improve balance.

Tip: People with PD may have other medical issues that affect their ability to exercise, such as arthritis or neuropathy. Work with a physical therapist to find an exercise that suits your needs.

Sensory Feedback During Walking And Turning

Asymmetric proprioceptive input elicited by vibration of axial muscles produces steering and turning , whereas proprioceptive input from the leg contributes to fine adjustment of the spinal pattern generators for walking . Input from axial muscles would play the role of a servo-mechanism, whereby minor asymmetries initiated by asymmetric foot placement would affect the spinal generators to produce the necessary fine changes in leg and foot kinematics accompanying heading changes.

Whether or not continuous walking along a circular trajectory is also favored by a shift in our straight-ahead goes beyond the scope of this short review, but we would note that a shift in subjective straight-ahead occurs after a period of stepping in place on a rotating treadmill . In turn, it is not unlikely that a shift in the straight-ahead is produced by the feedback from the muscles producing the rotation of the pelvis and trunk over the standing leg when walking along a curved trajectory or when stepping in place and turning . Vision is obviously not necessary for implementing a curved trajectory , but the continuous visual field motion would nonetheless favor the fine tuning of the gait synergies underpinning the production of the circular trajectory .

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What Is The Quality Of The Reviewed Studies

Overall, quality scores were mediocre for both non-intervention and intervention studies. The main points that studies scored low on were sample size justification, electrode placement procedures and signal processing techniques. Individuals with PD exhibit great heterogeneity and generally high inter- and intra- subject gait EMG variability necessitating greater sample sizes than for HOA. However, the median sample size was only twenty-two and no study in this review performed power analysis to justify their selection of participant number. Most studies included a greater proportion of males, reflecting the gender bias in PD although some studies did not specify gender. Gender differences in muscle activity during walking have previously been reported, indicating it is an important factor. Only four studies determined electrode location using validated guidelines such as the SENIAM guidelines. Identification of the optimal electrode site helps ensure the signals with higher signal to noise ratio are recorded from the selected muscle with minimal cross-talk from adjacent muscles.

Over half of the studies did not report any signal normalisation methods,,,,,,,,. Such normalisation is essential to allow comparisons of EMG between muscles, sessions and participants as factors such as thickness of adipose tissue, presence of oedema and number and orientation of muscle fibres will modify amplitude,. Excluding normalisation can invalidate subsequent results.

B: Pick Your Own Music

Now that youve seen the full effects of walking to a beat, take your pick of music.

Below I have laid out a list of songs you can try out that have a range of tempos. There is a slow, medium, and fast playlist. Start walking to a slower song . As you get comfortable, you can increase the tempo.

The end goal is to walk to a beat that is slightly faster than your stride. Not only will this push you to transcend your normal Parkinsonian gait, it will also give you a longer lasting therapeutic effect after you stop listening.

Here are the playlists:

You can, of course, choose your own songs. In fact, once you practice a few times with these songs, I encourage you to start using your own selections .

Either way, I want you to look forward to turning on your iPod or Android, and that means having songs that make you want to dance, to move, to run. If you dont know the tempo of a song you like, you can measure the beats per minute at songbpm.com. If you want to change the tempo of a song that is too fast or too slow, I like to use the app “TempoSlowmo.” You can download it for free in the Apple App Store for your iPod or on Google for your Android.

Good luck. If you have any questions or comments about the post, Id love to see them! Write them in the comment section below and Ill respond as soon as I see it!

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What Kind Of Exercise Can I Do If I Have Trouble Standing Or Walking

Even with advanced Parkinsons symptoms, you can still reap the benefits of some activities. If you have trouble walking or balancing, hold a bar or rail to exercise and stretch. If standing or getting up is tough, exercise and stretch in a chair or bed. Physical exercise performed in a seated position, such as biking on a recumbent bike can allow you to exert yourself in a safe manner.

Facial exercises may help combat difficulties speaking or swallowing:

• Chew your food longer and more vigorously.
• Exaggerate your face and lip movements when you speak.
• Make faces in the mirror.
• Sing or read out loud.

Mental exercises give your brain a workout and can improve memory. For example:

• Name as many animals as you can in 1 minute.
• Play brain games and do puzzles.
• Solve math problems in your head.

You can also add activity in small bits throughout your day:

• Park further away from stores so you walk longer distances.
• Stretch or do leg exercises while watching TV.
• Swing your arms more when you walk, and take long strides.
• Take the stairs instead of the elevator.

How Does Parkinsons Disease Progress

The Parkinsons Foundation states there are typical patterns of progression of Parkinsons disease that can be defined in 5 stages:

Symptoms are mild and do not interfere with the persons quality of life.

Symptoms worsen and daily activities become more difficult and take more time to complete.

Considered to be mid-stage Parkinsons disease. The individual loses balance, moves more slowly, and falls are common. Symptoms impair daily activities, for example dressing, eating, and brushing teeth.

Symptoms become severe and the individual needs assistance walking and performing daily activities.

The most advanced stage of Parkinsons disease. The individual is unable to walk and will need full-time assistance.

With proper treatment, most individuals with Parkinsons disease can lead long, productive lives for many years after diagnosis. In fact, life expectancy for those affected by Parkinsons is about the same as for people without the disease. Its the quality of life of those affected by Parkinsons disease that suffers, so how can we tackle all the challenges the disease poses to ones quality of life?

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Balance And The Brain

Difficulties with balance and walking are linked to the brain changes that take place with PD. For people who dont have PD, balance is automatic, a reflex. But Parkinsons affects the basal ganglia . To compensate, the brain assigns another brain area an area used for thinking to take over. The thinking part of the brain, mainly the frontal cortex, cant control balance automatically. The result: for many people with PD, balance becomes less automatic.

This means that when people experience freezing and fall, they cant adjust their balance automatically. Taking small steps to try and regain balance can make things worse, because it involves shifting weight with each step. The brain changes from PD inhibit their ability to take a big step to catch their balance and avoid a fall. For some, the drug levodopa can help prevent freezing, but does not improve balance.

A person whose balance is less automatic must pay more attention while walking. For everyone, walking slows down when were talking and thinking slows down when were walking. This is called the dual-task cost and its higher in people with PD. That tells us that people with PD are using more attention and more cognitive control for balance and gait.

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

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Protocol Considerations For Emg

• Real-world walking. Investigating gait during real-world activity is desirable to understand motor strategies in a natural environment although current technological limitations make long term recordings challenging.

• Sample size. Greater numbers of participants and more stride cycles are necessary.

• Muscle selection. Muscles representing all major muscle groups acting on the ankle, knee and hip joints in the sagittal and coronal planes should ideally be recorded to permit analyses of multi-muscle activation patterns and underlying neural control systems to be undertaken.

• Electrode placement. A clear statement must be included regarding methods used to identify electrode placement and established guidelines followed.

• Longitudinal studies. This will inform us how motor patterns change with age and disease progression and help establish EMG characteristics as biomarkers.

• Additional gait and cortical parameters. Parameters such as joint kinematics and kinetics as well as cortical activity measured with mobile, wireless systems such as functional near infrared spectroscopy or electroencephalography will enable us to relate EMG to gait impairment and cortical processes.

What Is Nordic Walking

Nordic walking is a style of walking where you use a specially designed walking pole to help you move forwards. This means that you use your arms as well as your legs and, as the poles propel you, they help you to walk faster and more steadily than you may do normally. When properly used, the poles take the weight off the knees and lower body joints, which can make you feel lighter on your feet.

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How Is Muscle Activity Modified By Interventions

Only one study assessed variability of gait EMG following dopaminergic medication. Pourmoghaddam et al. observed decreased multi-muscle regularity, determined through nonlinear analysis methods, during the ON state. This implies increased variability of EMG patterns which could contribute to postural stability not being well controlled by dopaminergic medication, although more evidence is needed in support. Two studies have reported that step time variability decreased with dopaminergic medication and Gilat et al. observed this variability was associated with altered striatal, limbic and cerebellar activity,.

Have You Ever Thought How Challenging Drinking A Glass Of Water Can Be For Someone Suffering From Parkinsons Disease

On World Health Day, youll likely read about how healthy habits like exercising or drinking more water, can improve your health. While these are helpful tips and important topics to cover, we decided to take things a step further. What if you couldnt drink that glass of water by yourself? It can be daunting to consider, but this scenario can become all-too-real for a person suffering from Parkinsons disease. There are 10 million people in the world suffering from this disorder which is why, today, we decided to share with you how Parkinsons Disease can affect mobility and balance, and what can be done when the disorder is detected in its early stages. That is why raising awareness for this degenerative disease is important, and, while there is still much research to be done, we have high hopes that researchers will find a way to reduce the symptoms of Parkinsons disease, and eventually find a cure. This is becoming more and more urgent, given the fact that life expectancy is rising and the number of individuals with Parkinsons disease will only increase in the future. But is there another solution in sight?

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What Causes Gait To Change

PD causes damage to the nerves in the brain and in the body, as well as causing accumulations of the protein alpha-synuclein, called Lewy bodies.

The motor symptoms of PD, like Parkinsonian gait, are caused by damage to the part of the brain called the substantia nigra pars compacta. The neurons in the substantia nigra produce dopamine, a neurotransmitter that transmits signals from the substantia nigra to other parts of the brain to produce smooth, purposeful movement.2,4

Damage to the neurons in the substantia nigra causes a reduction in dopamine, creating the motor symptoms seen in people with PD.2,4

A New Dopaminergic Therapeutic Target For Gait Dysfunction In Parkinson Disease

Stiffness and freezing in place can cause falls and restrict the activities of people with Parkinsons disease. Unfortunately, the therapies available to help other motor symptoms dont usually correct these walking problems.

Neither levodopa, the medication designed to replace the loss of the brain chemical dopamine, or deep brain stimulation, a surgical treatment for Parkinsons disease, are very effective for improving freezing of gait.

At the University of Calgary, PhD student Linda Kim is investigating a new target for therapies to alleviate these walking difficulties.

In our lab, were discovering a region in the brain that hasnt been studied traditionally for motor control implications, says Kim.

Shes exploring a group of cells in the brain called the A13 nucleus. Using mouse models, Kim and her colleagues have discovered that when they use a type of gene therapy to target A13 in the brain and activate it using a light, mice walk better.

Kim believes A13 is an additional walking pathway in the brain that connects to the brainstem. By using 3-D imaging to study this region of the brain, she will learn how it delivers its information to the brainstem. She hopes that information will lead her to a way to activate A13, allowing it to take over from the parts of the brain losing other dopamine-generating cells that control movement.

Just having that potential to provide an alternative therapy is inspiring enough for me to keep doing the work.

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Ten Tips To Put The Freeze On Freezing

Try another movement raise an arm, touch your head, point to the ceiling then re-start

Change direction: if you cant move forward, try stepping sideways first, and then go forward

Carry a laser pointer in your pocket when you freeze shine the laser in front of your foot and step on the light this visual cue can help you re-start.

Visualize an object on the ground in front of you and try to step over it.

Wear a metronome on your belt or carry a small one in your pocket turn it on and the external beat can help you re-start.

Try humming a song and time your re-start with the beat of the music

Count 1-2-3-go and then step forward

Shift your weight from side to side to help initiate taking a step

Dont fight the freeze by trying harder to step forward shift your attention from moving the legs to moving the arms then resume walking forward

While these methods can be helpful to get out of a freeze that is already underway, physical therapy techniques that incorporate these types of cueing strategies are utilized to reduce freezing of gait overall. Rhythmic auditory cueing is one such technique which utilizes rhythm and music to improve gait in PD and other neurologic diseases.