Tuesday, May 14, 2024

Improving Balance In Parkinson’s Disease

What Types Of Exercise Can Help Manage Parkinsons Disease

Can we improve balance in Parkinson’s?

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

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Characteristics Of Included Trials

All 8 trials involved a total of 483 participants and investigated the effectiveness of physiotherapy treatment and Exercise on improving postural stability and balance in Persons with Parkinsons disease. All trials were conducted in between September 2005 and June 2015 .


The mean PEDro scores of the included trials were 7. Three studies blinded participants, two studies blinded therapists and the other five trials did not, due to innate difficulties. Concealed allocations of participants were stated clearly in only two studies and the intention to treat analysis was considered by only three studies . The quality assessment scores and the decisions of each item for the included trials are shown in Table .

Table 3 PEDro criteria and summary of quality assessment scores of Included studies



The experimental groups were treated with different treatment approaches. Five studies used postural adjustment and falls prevention strategies and balance training ,three studies used strengthening exercises , three studies applied gait training through overground walking and treadmill training only one study used PNF exercise and coordination training has been given for another one study .

Outcome measures

Table 4 Summary of results of included randomized controlled trials

Study Design And Participants

The design and outcomes of the RAS-supported multimodal balance trial have been published elsewhere., In summary, we performed a single-blind, randomized, controlled trial between July 2015 and May 2017 at the Movement Disorders Clinic of the University of São Paulo Faculty Medicine Clinics Hospital. The study was approved by the local ethical committee and participants signed an informed consent form before participation. The protocol was registered at clinicaltrials.gov .

We categorized patients as freezers or nonfreezers based on either self-report or when patients manifested freezing of gait during the Rapid Turns Test. Measurements were performed by a blinded assessor at 4 time points: baseline directly after the last training at 1-month follow-up and at 6-months follow-up. Both assessors and patients were instructed not to talk about the allocation. All participants were tested while taking their usual Parkinson medication , at least 1 h after ingestion of their regular dose of levodopa.

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How Postural Instability May Appear

Patients with PD experience symptoms in varying severities, and with the progression of the disease, the severity of the symptoms changes over time. Postural instability may show up during a variety of activities, including:

  • When rising from a chair
  • When rising from bed
  • While turning or pivoting, especially quick movements
  • While standing upright1

Postural instability may be apparent at diagnosis, but it is more commonly seen and worsens as PD progresses. The inability to balance and recover from variations in movement often causes falls, which can lead to hospitalization or death in people with PD. Because of this, postural instability is one of the most distressing symptoms of PD and greatly diminishes the individuals level of mobility.2,3

What Makes Pd Hard To Predict

Balance Rehab Program for Stroke &  Parkinson

Parkinsonâs comes with two main buckets of possible symptoms. One affects your ability to move and leads to motor issues like tremors and rigid muscles. The other bucket has non-motor symptoms, like pain, loss of smell, and dementia.

You may not get all the symptoms. And you canât predict how bad theyâll be, or how fast theyâll get worse. One person may have slight tremors but severe dementia. Another might have major tremors but no issues with thinking or memory. And someone else may have severe symptoms all around.

On top of that, the drugs that treat Parkinsonâs work better for some people than others. All that adds up to a disease thatâs very hard to predict.

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How To Prevent Falls From Common Hazards

  • Floors: Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its usual place.
  • Bathroom: Install grab bars and non-skid tape in the tub or shower. Use non-skid bath mats on the floor or install wall-to-wall carpeting.
  • Lighting: Make sure halls, stairways, and entrances are well-lit. Install a night light in your bathroom or hallway and staircase. Turn lights on if you get up in the middle of the night. Make sure lamps or light switches are within reach of the bed if you have to get up during the night.
  • Kitchen:Install non-skid rubber mats near the sink and stove. Clean spills immediately.
  • Stairs: Make sure treads, rails, and rugs are secure. Install a rail on both sides of the stairs. If stairs are a threat, it might be helpful to arrange most of your activities on the lower level to reduce the number of times you must climb the stairs.
  • Entrances and doorways: Install metal handles on the walls adjacent to the doorknobs of all doors to make it more secure as you travel through the doorway.

Improving Balance Issues And Preventing Falls In Parkinsons

As people age, their risk of falling increases. However, people with Parkinsons disease experience twice the risk of falling as compared to their peers, with about 60 percent of people with Parkinsons falling every year. There are different motor and nonmotor symptoms of Parkinsons disease that contribute to a loss of balance and an increased risk of falling.

As one member of MyParkinsonsTeam wrote, I have fallen at least a dozen times, and thankfully, have not broken anything. A good day is one without falls, said another member.

As Parkinsons disease progresses, so does the possibility and fear of falling. However, not all people with Parkinsons will experience falls. While individuals with Parkinsons are at an increased risk of falling, there are many methods for preventing these accidents and their resulting injuries.

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Which Types Of Exercise Are Best For Parkinsons

It is important to state upfront that there is no one best type of exercise for people with PD. It is most important to choose an exercise regimen that you enjoy, and will continue to do.

However, beyond doing exercise that you will stick with, there are some additional concepts to consider when designing an exercise program for someone with PD.

Are There Treatments To Improve My Balance

Parkinsons Disease Exercises to Improve Standing and Walking | Occupational Therapy

Physical activity is the only treatment available to improve balance. Personalized activities help you increase your range of motion and develop postural strategies that compensate for loss of balance.

There is no medication to directly improve balance, but your neurologist can review your Parkinsons medication dosages to increase your mobility and natural postural adaptation. Your doctor can also review the medications you are taking and reduce the doses of those that cause low blood pressure or dizziness.

You need to reduce the dangers that could cause your loved one to fall in their immediate environment, such as at home.

  • Remove decorative rugs or other objects from the floor to prevent tripping and falling.
  • Make sure that their house is bright enough so they can properly see around them.
  • Install grab bars in bathrooms and other small rooms.
  • Put a non-slip mat in the shower.
  • Keep regularly used items close at hand, not deep in the cupboards.

It is difficult for people living with Parkinsons disease to do several things at the same time, so dont try to maintain a conversation when you walk with your loved one. This increases the risk of falls.

If you notice that your loved one is falling more frequently, discuss the use of a walking stick, cane or walker. This equipment increases support points and reduces balance loss.

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Enhancing Neuronal Survival Processes

An alternative to stopping the spread of pathology, is to try and help neurons continue to function despite the presence of pathological alpha synuclein, i.e., to provide some form of trophic support. There are several classes of drugs being repurposed , which may achieve this.

There has been a lot of publicity surrounding the potential of Glucagon-like peptide 1 receptor agonists in PD . These drugs are licensed for the treatment of Type 2 diabetes and have neuroprotective properties across the whole range of animal models of PD, including 2 alpha synuclein models. There is some evidence that this action may relate to an improvement in brain insulin signaling which enhances Akt activity while additional data indicate these drugs may also act in parallel through a positive effect on neuroinflammation . Indeed, the increased risk of developing PD among T2DM patients may be ameliorated according to the choice of anti-diabetic agent used .

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Rigidity Results In Biomechanical Impairments

Excessive, inflexible axial postural tone, called rigidity, results in many biomechanical impairments affecting postural control such as abnormally stooped postural alignment, forward head, Pisa syndrome, reduced joint range of motion, and low back pain. Stooped posture, due to excessive, static flexor muscle activity, is associated with increased velocity and jerkiness of postural sway in stance . Automatic postural responses to external displacements are also impaired by a stooped postural alignment. The postural stability margin, which is defined by the difference in displacement of the center of pressure under the feet and displacement of the body CoM in response to external perturbations, is reduced in healthy subjects who assume a stooped posture like PD . This observation suggests that a stooped posture, per se, has a destabilizing effect on postural control and is not an attempt to compensate for postural instability. Responses to backward body perturbations are especially compromised by a stooped posture, perhaps due to a shortening of the tibialis anterior muscle, which is critical for bringing the backward falling body back to equilibrium.

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New Types Of Exercise For Parkinsons

Researchers are continually studying different types of exercise for PD and APDA works to keep you informed about these new findings.

Bradykinesia And Freezing Impair Gait

Exercise for Parkinson

Dynamic balance control involves controlling the body CoM with respect to, but not necessarily over a moving base of support. Walking becomes less automatic in PD so it requires more attention, particularly for challenging tasks such as turning, walking between obstacles, and dual-tasking. Newly diagnosed patients with PD show signs of bradykinetic gait features, such as reduced trunk rotation, decreased arm swing, and slow turns, even when walking speed is normal . Extent of arm swing on the most involved side may, in fact, be the most sensitive early sign of gait affected by the disease. Bradykinesia results in slow gait velocity and shuffling of the feet that progresses with the disease. Freezing of gait is not usually only lack of stepping but often includes high frequency trembling of the legs as the patients attempt to get their feet moving. These quick motions may represent repeated, multiple APAs that get larger and larger until a step is finally triggered .

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The Basic Elements Of Exercising With Parkinsons

There are four core elements of exercise that are important for people with PD:

  • Aerobic e.g. brisk walking, stationary cycling activities that get the heart pumping
  • Strengthening e.g. using weights or resistance bands to improve muscle strength
  • Balance e.g. tai chi, dance to help you be more steady on your feet
  • Stretching e.g. mat exercises, yoga to provide flexibility
  • Including all four of these elements in your exercise regimen is ideal .

    Aerobic activity or high-intensity exercise may be particularly important for Parkinsons and general health

    High-intensity exercise has been formally studied in PD with impressive results. The Study in Parkinson Disease of Exercise Phase 2 enrolled 128 people with early PD, who were not yet on dopaminergic medication into three groups:

    • a high-intensity treadmill exercise group, in which people exercised at 80-85% of their maximum heart rate
    • a moderate-intensity treadmill exercise group, in which people exercised at 60-65% of their maximum heart rate
    • a wait-list control group

    After six months, the high-intensity group had essentially no change in their motor scores, whereas the control group had a three-point worsening of their motor scores.

    Currently, the SPARX3 trial is enrolling participants and underway. This trial is similar to SPARX2, but with a goal of studying many more participants.

    Forced exercise

    A Way To Slow Parkinsons

    Blocking Specific Form of a Brain Chemical Could Slow Brain Cell Loss, Researchers Find

    Sept. 12, 2006 Blocking a specific form of a brain chemical slows brain cell loss in an animal model of Parkinsons disease, Texas researchers report.

    In the animal model, the researchers found they could slow the death of affected brain cells by about half by blocking the chemical, called soluble TNF.

    The finding offers a target for new drugs that could slow the progression of the debilitating and deadly disease. And it may apply to Alzheimers diseaseAlzheimers disease as well, suggest University of Texas Southwestern Medical Center researchers Melissa K. McCoy, Malú G. Tansey, PhD, and colleagues.

    The finding may unveil opportunities for development of new therapeutics to treat human neurodegenerative diseases like Parkinsons disease and Alzheimers disease, McCoy and colleagues say.

    The researchers report their study in the Sept. 13 issue of The Journal of Neuroscience.

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    How Can Hospice Help Your Loved One In The Final Stages Of Parkinsons Disease

    Hospice care is an extra layer of support to help you care for your loved one with end-stage Parkinsons disease. It is a special kind of care that provides comfort, support, and dignity at the end of life.

    The comprehensive program focuses on physical, emotional, and spiritual quality of life through the help of a team of experts. The team includes a board-certified physician, nurse, social worker, certified home health aide , spiritual support counselor, and volunteer.

    The nurse will explain the prognosis and what to expect in the upcoming days or weeks. They will also monitor pain and other symptoms. The CHHA helps with personal care needs like bathing and changing bed linens. The social worker helps address social, emotional and practical challenges including complex and inter-related needs. The spiritual support counselor helps explore spiritual concerns.

    Most importantly, the hospice team will be there for you during this difficult time, bringing you peace of mind. The team is on call 24 hours a day even at 2:00 am.

    Hospice is about making your final months and weeks as good as possible. This means focusing on what really matters to you.

    Slowing The Spread Of Alpha Synuclein Pathology

    Stroke? Parkinsons? Elderly? How to Improve Balance & Prevent Falls.

    There is a mantra that disease modifying treatments must be initiated early if they are to be of any use in preventing disease progression. This is because post mortem specimens suggest that> 50% of SNc dopaminergic neurons are already lost by the time that patients present with the classical motor features of the disease . Given that there are many effective symptomatic treatments to help the motor, dopaminergic deficits in PD, it can be argued that the important unmet needs in PD relate to cognitive, speech, gait and balance difficulties and autonomic failure. In this case any treatment that prevented onset/worsening of these symptoms, would be highly relevant even in patients with established motor PD, and would be addressing the major challenges that patients face in its long-term management. From another perspective, since many of these non-motor features of PD may precede the onset of motor symptoms, we may have an even earlier window to start therapy, and have an opportunity to slow or stop the development of even the first motor symptoms of PD.

    Beyond this, the companies will have to look carefully at the emerging data to decide whether a strategy of enrichment might be advantageous, and/or whether to risk extending trial eligibility to patients with more established disease than those currently being recruited.

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    Parkinsons Disease Symptoms: Life Expectancy

    Even though Parkinsons disease is a serious, progressive condition, it is not considered a fatal illness. People who have Parkinsons disease usually have the same average life expectancy as people without the disease.

    But when the disease is in its advanced stages, Parkinsons symptoms can lead to life-threatening complications, including:

    • Falls that lead to fractured bones
    • Pneumonia
    • Choking

    Thinking about the progression of Parkinsons disease can be frightening. But proper treatments can help you live a full, productive life for years to come. And researchers hope to one day find ways to halt the progression of Parkinsons and restore lost functioning.

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    Should I Talk To My Healthcare Provider Before I Start Exercising If I Have Parksinsons Disease

    Talk to your neurologist and your primary care provider before starting a new exercise regimen. They can:

    • Counsel you on how intense your exercises can be.
    • Recommend exercises appropriate for your individual health.
    • Refer you to a physical therapist to create a personal exercise program.
    • Warn about exercises to avoid based on your particular challenges or limitations.

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