Frequently Asked Exercise Questions
Q: If one part of my body needs more attention what should I do?
If you have noticed more symptoms in one particular arm or leg, you may wish to focus on that limb more intensively during each exercise station. Make sure that the particular limb you are focusing on is leading the exercise in effort and amplitude and that you have symmetry between both sides. You may also wish to double the repetitions on that side, especially if there is a marked difference from one side to the other.
Q: How do I avoid injuring myself?
It is really important that you warm up first and follow the instructions for each exercise to avoid injury. If you are just starting out, be gentle on yourself, especially if you are new to exercise or dont exercise regularly. As you become more confident with the exercises you can start to work towards an effort level of 80% and full range of movement weight shift and amplitude. If anything hurts while you are doing the exercises or you feel unbalanced stop immediately. All of the exercises can be modified to be made easier as well as harder so listen to your body.
Q: What about my medication. Is there a better time to do the exercises?
Q: What Clothing & Footwear Should I Wear?
Wear loose, comfortable clothing that breathes well. Layers may help if you have extremes of temperature where you train or are prone to overheating. Your footwear needs to be supportive such as trainers or walking shoes.
Aerobic Exercise Positively Alters Parkinsons Brain
Getting regular exercise is essential to managing Parkinsons disease . It is well established that exercise promotes aerobic conditioning, strength, balance, flexibility and mobility, which can substantially improve overall quality of life.
Multiple clinical trials have demonstrated that aerobic exercise in particular, can enhance cognitive functioning, such as learning, thinking, remembering and problem solving. Further, a 2019 PD clinical trial called Park-in-Shape, investigating the effectiveness of remotely supervised aerobic exercise resulted in a reduction of PD movement symptoms.
We know brain heath and cardiovascular fitness are connected. What we dont know is how and where in the brain aerobic exercise is enhancing cognitive functions and reducing motor symptoms for people with PD.
A study recently published in the Annals of Neurology, Aerobic exercise alters brain function and structure in Parkinsons disease: A randomized controlled trial investigated how aerobic exercise may influence PD-related functional and structural changes in the brain. The study also explored the effects of aerobic exercise on the substantia nigra, which helps the brain produce with dopamine. Movement disorders specialist Bastiaan R. Bloem, MD, PhD, from Nijmegen Parkinson Center a Parkinsons Foundation Center of Excellence is one of the studys authors.
Results
Pharmacological Treatment Of Parkinsons Disease
There is currently no proven disease-modifying or neuroprotective therapy for PD. A summary of previous neuroprotection trials is given in a recent review article. Current evidence-based treatment for PD is symptomatic and mainly based around dopaminergic replacement or modulation . The evidence base is summarised in recent guidelines from the National Institute for Health and Care Excellence and the International Parkinson and Movement Disorder Society. Levodopa, dopamine agonists and monoamine oxidase B inhibitors are all licensed for use as initial therapy in PD. Anticholinergics are no longer routinely used due to the risk of cognitive decompensation.
Pharmacological therapies currently used for initial and adjunctive treatment of motor symptoms in Parkinsons disease
Dont Miss: Does Dennis Quaid Have Parkinsons
Also Check: Drug Holiday For Parkinson Disease
Parkinsons Foundation Accredited Exercise Education Programs
These programs have met the rigorous requirements of the Parkinsons Foundation Exercise Competency Framework. These comprehensive programs provide and assess knowledge and skill acquisition, allowing participants to become accredited exercise professionals of their program. Participants are assessed on an on-going basis to maintain certification. These courses can also fulfill a continuing education requirement for a certified exercise professional.
Movement-Revolution
The Neuro Exercise Specialist training program sets a professional standard for exercise professionals servicing the Parkinsons community. It provides trainers with a comprehensive skill set to address the diverse needs, goals and symptoms of those with Parkinsons. Learn more.
PWR!Moves®
The PWR!Moves curriculum integrates PD-specific functional skill training into a multi-modal exercise program . The specificity of training begins by targeting four motor control skills shown to deteriorate and adversely affect everyday movement for people with PD. Learn more.
Rock Steady Boxing
Rock Steady Boxing Head Coach Training Camp prepares participants to run a RSB Affiliate gym in their local community. This training provides full understanding of PD and its relationship to exercise. Learn more.
Aan 2019 And What It Means For Breakthroughs In Parkinsons Research
The American Academy of Neurology Annual Meeting took place last week in Philadelphia, PA. This AAN meeting brings together neurologists and neuroscientists across all subspecialties of Neurology, including Movement disorders and Parkinsons disease . Research findings are presented at the meeting, often for the first time, and it was exciting to hear and see the latest reports on the promising research being done for people living with PD.
We have compiled a selection of what we thought were the top 12 highlights from AAN 2019, along with takeaways that help you understand what these results can mean for the Parkinsons community.
Also Check: How Do Parkinson’s Patients Feel
Pathophysiology And Presenting Features
Classic presenting features of PD include motor symptoms, such as bradykinesia, rigidity, rest tremor and postural instability. However, non-motor symptoms, such as depression, cognitive impairment, pain and autonomic disturbances, are also often present and they can severely affect a patients quality of life. There are several information sheets available for patients that cover the management of multiple common types of pain in PD.
The motor symptoms are largely caused by the progressive loss of dopaminergic neurons in the substantia nigra compacta, which ultimately reduces dopaminergic input to the striatum and other brain regions. Compensatory mechanisms in the brain are so effective that the clinical symptoms of PD may only develop when around 80% of dopaminergic neurons have degenerated. By contrast, the Braak theory of PD suggests that the disease process starts in the olfactory bulb and lower part of the medulla, and it is not until stage 3 that the substantia nigra becomes involved in the process. There is also direct evidence of Parkinson pathology being spread from the gastrointestinal tract to the brain in rodents. There are therapeutic implications of gut involvement it is known that swallowing and the stomach are the two main problems of PD therapy and lead to the use of non-oral therapies.
Therapeutic And Formalized Pattern Exercises
The SPARX study enrolled 128 de novo patients and compared high- and moderate-intensity treadmill exercises with a wait-list control group. After six month of 3 days per week exercise, the results showed that the high-intensity group, who exercised at 80 to 85% maximum heart rate, had less change in motor symptoms compared with the usual care group9898. Schenkman M, Moore CG, Kohrt WM, Hall DA, Delitto A, Comella CL, et al. Effect of high-intensity treadmill exercise on motor symptoms in patients with de novo Parkinson disease: a phase 2 randomized clinical trial. JAMA Neurol. 2018 Feb 1 75:219-26. https://doi.org/10.1001/jamaneurol.2017.3517 . The Park-in-shape trial , a home-based study, recruited 130 PD patients in Hoehn & Yahr stage 2 who were randomized either to exercise on a stationary cycle or stretching at least three times per week. After the 6-month program, the MDS-UPDRS motor score change was smaller in the aerobic group, resulting in a between-group adjusted mean difference of 4.2 points favoring the cycling group9999. Van der Kolk NM, de Vries NM, Kessels RPC, Joosten H, Zwinderman AH, Post B, et al. Effectiveness of home-based and remotely supervised aerobic exercise in Parkinsons disease: a double-blind, randomised controlled trial. Lancet Neurol. 2019 Nov 1 18:P998-1008. https://doi.org/10.1016/S1474-442230285-6 .
You May Like: What Part Of The Brain Does Parkinsons Disease Affect
You May Like: Local Support Groups For Parkinson’s Disease
Description Of The Analytic Process
In August 2017, the AAN Guideline Subcommittee recruited a multidisciplinary panel of authors to develop this guideline. The panel included content and methodology experts, patient representatives, and a staff representative from the Michael J. Fox Foundation for Parkinsons Research. As required by the AAN, a majority of the members of the panel and the lead author are free of conflicts of interest relevant to this practice guideline. Five of the guideline developers were determined to have COI, but the COI were judged to be not significant enough to preclude them from authorship . Whereas the development of this guideline primarily followed the 2017 edition of the AANs Clinical Practice Guideline Process Manual, this edition of the manual was not published by the time of the guideline initiation. Therefore, disclosures were reviewed following the previous process found in the 2011 Clinical Practice Guideline Process Manual. The full author panel was solely responsible for the final decisions about the design, analysis, and reporting of the systematic review and practice guideline, which was submitted for approval to the AAN GS.
Medical Marijuana For Parkinsons
APDA resources: Despite little clinical trial data, medical marijuana is used frequently by people with PD for various symptoms. People with PD are eager for more information on whether and how to use this treatment to help PD. To help you better understand this popular topic, we have written articles about medical marijuana and cannabidiol so you can learn what they are, how they work, and how they may, or may not help people with PD.
AAN highlight: Leehey MA et al presented Tolerability and Efficacy of Cannabidiol on Motor Symptoms in Parkinson Disease: Interim Report on Tolerability. In this poster, the preliminary results of a clinical trial investigating the use of cannabidiol for the motor symptoms of PD are presented. Cannabidiol was well tolerated by people with PD. Takeaway: We await the results of this study to inform us as to whether medical marijuana is a useful medication for treatment of motor symptoms of PD.
Dont Miss: Beginning Symptoms Of Parkinsons Disease
You May Like: Supplements For Parkinson’s Patients
Working With A Physical Therapist To Create An Exercise Plan
Physical therapists are experts in getting people moving. While most people think physical therapy is just for rehabbing after an injury, its an important part of preventive care and treatment for patients with chronic conditions like Parkinsons disease.
Your experience with Parkinsons disease is unique. A physical therapist can help with Parkinsons by designing a personalized program for you. Theyll teach you specific exercises to manage your unique symptoms and keep you engaged in activity.
How often should you meet with a physical therapist? Checking in at least once or twice a year can help you develop an exercise plan that fits with your current level of mobility and the season.
How To Stay Motivated
Make exercise a regular part of your day
Set a consistent time to exercise every day. Keep it the same time so that you know how it works in around your medication and is timed when you are typically feeling at your best.
If you are really busy, you might find breaking your programme down into several manageable 10minute chunks suits you better. There is good evidence to show that this is still effective to receive a cardiovascular and strength training. For amplitude and motor output training this is sufficient as well. Perhaps you might schedule a few exercises for when you wake up in the morning, another round at midmorning, lunch, midafternoon, and then evening. See what works best for you with your lifestyle and medication schedule, but make sure you plan it, do it and record it.
If you are particularly short of time, avoid the temptation to throw in the towel completely. Do what you have time to do. Something is better than nothing at all. Even five minutes of targeted exercises done well may yield results when done consistently.
Stay Motivated with Goal Setting
Start Recording and Charting in Your Diary
Record each of your sessions in the back of this booklet. Even if it is only a 10-minute session. It is important that you can add up the total number of minutes spent exercising at the end of each week.
Workout with a buddy
Building a Strong Foundation
You May Like: Big And Loud Parkinsons Exercises
Fitness Tips To Manage Pd Symptoms
- Choose an exercise program that you will actually do! Dont design a great, Parkinsons-specific program and then skip it because its too hard or not fun.
- Follow a varied routine. Perform simple stretches and posture exercises daily, and make sure to include aerobic and strengthening exercises several times per week.
- Keep intensity at a level that feels somewhat hard for you.
- Consider joining an exercise class or group. Classes are good motivation and also provide an opportunity to socialize. Trained instructors give clear guidelines and offer modifications.
- Try exercise videos or home exercise equipment if it is difficult to get out.
- Music can enhance performance by providing rhythm to coordinate movement.
- Be creative with your fitness. Challenge yourself and have fun!
- Consider attending Moving Day, a Walk for Parkinsons, in your area to keep moving and strengthen your PD fitness community.
Sponsored by Kyowa Kirin. Content created independently by the Parkinson’s Foundation.
Impact Of Exercise On Cognition
Currently, there are no approved pharmacologic therapies that alter disease outcomes for patients with PD and mild cognitive impairment or PD dementia . The prevalence of cognitive impairment in PD varies, but some estimate that up to 30% of patients with PD have cognitive impairment at initial presentation.23 Exercise has been shown to have beneficial effects on cognition in the general population. Aging is associated with progressive reduction of gray matter volume, whereas exercise and cardiovascular fitness are associated with greater cortical gray matter and hippocampal volume.3 Prospective studies have shown increased cortical gray matter or hippocampal volumes in seniors randomized to 6 to 12 months of exercise compared to less active controls.3 Likewise, blood volume of the hippocampal dentate gyrus was increased at the end of a 3-month exercise program, which correlated with aerobic fitness defined by peak VO2.3 In addition, there is less brain atrophy in patients with AD who are cardiovascularly fit.3 These studies suggest that improved cardiovascular fitness preserves brain tissue in regions vital for memory and cognition.
You May Like: Does Parkinson’s Cause Tinnitus
Tapering And Discontinuing Das
Recommendation 5 Rationale
Adverse effects associated with DAs can lead to substantial impairments in psychosocial functioning, interpersonal relationships, and quality of life for the patient and caregivers. The consequences of medication-related adverse effects may be mitigated through adjustments to prescribed medications, including DAs, or through additional behavioral or pharmacologic interventions, if appropriate.
Patients may experience undesirable side effects when attempting to decrease dopaminergic medications, especially DAs, including dopamine agonist withdrawal syndrome or low mood and apathy. These side effects can make it difficult to taper or discontinue DAs. Staged reduction in dosing may reduce the severity of withdrawal symptoms and improve compliance with medication recommendations.
Recommendation 5 Statements
-
5a. Clinicians should recommend tapering or discontinuation of DAs if patients experience disabling medication-related adverse effects, including ICDs, EDS, sudden-onset sleep, cognitive impairment, or hallucinations .
-
5b. When DAs must be discontinued due to adverse effects, clinicians should monitor patients for symptoms of DAWS and, when possible, gradually decrease the dosage to minimize symptoms .
Exercise For Parkinsons Recommendations For Managing Symptoms
This 8-page booklet includes an overview of exercise for Parkinsons Disease , a word on PD exercise research, safety considerations, recommendations PD exercise, PD exercise principles, a table of PD symptoms and suggested movement and activities to help manage them, and links to Exercise for Parkinsons Training for Professionals and to free online exercise videos.
Read Also: Parkinson And Degenerative Disc Disease
How To Start Exercising If Youre Living With Parkinsons
Safety is key. The first thing you need to do is talk with your neurologist and primary care doctor to make sure that the exercise regimen that you embark upon is safe for you.
Next, ask for a referral for physical therapy. A physical therapist will be able to figure out what movement challenges you may have and design a program to help you improve. There are certain physical therapists with additional training in Parkinsons. Your physical therapist will work with you for your allotted sessions, and then can help you plan your ongoing exercise regimen that is tailored to you. You can contact the APDA National Rehabilitation Resource Center for Parkinsons Disease for help finding resources in your area.
Additionally, physical therapy can help counteract the tendency for people with PD to reduce the size of their movements. The Lee Silverman Voice Technique has designed a program called LSVT-BIG which trains participants to make big movements. You can search for an LSVT-trained professional near you.
Anyone starting out on an exercise program could benefit from APDAs Be Active & Beyond exercise guide which includes clear photos with simple instructions that are easy to follow, with exercises that address all levels of fitness.
Manual Therapy And Exercise
Chiropractic manipulation, osteopathic manipulation, and Trager therapy have been suggested to benefit patients with Parkinsons disease. No studies exist, however, to refute or confirm this position. The Alexander technique has shown some benefit and patient improvement has been noted in some studies.
Standard physical therapy, as well as occupational therapy, did result in improved functional outcomes, but the benefit was small and was not sustained when the exercise therapy stopped.
Read Also: Does Michael J Fox Have Parkinson’s
Parkinsons Foundation Accredited Exercise Continuing Education Courses
These providers meet the requirements of aligning their curriculum around the majority of the Foundations competency standards. These courses provide knowledge in a particular Competency Standard. These courses fulfill a continuing education requirement for a certified exercise professional attendees do not receive a certification or title upon completion.
MDT Education Solutions
Continuing education courses that equip health and fitness professionals to lead community-based exercise programs that help people with Parkinson access safe and tailored exercise programs. The Community Exercise for People with Parkinson Disease course provides fitness leaders with the tools and evidence-based guidelines to apply and modify many different types of exercises to meet the specific needs of people with PD. Learn more.
Total Health Works
Evidence-based Course on Parkinson’s that showcases the methods and techniques to help people living with Parkinson’s gain control over symptoms, maintain/regain independence and manage disease progression. Learn more.