Parkinson’s Physical Therapy Exercises

Risk Of Bias Within Studies

In most studies, the risk of bias was not high. Among the risk of bias domains, blinding of the participants and personnel and selective reporting revealed methodological concerns. Nine articles were classified as âunclear risk of bias’ in the random sequence generation because there was no specific description of the randomization method. Eight studies were classified as âunclear risk of biasâ in the allocation concealment. Another study that did not conceal the assignment order was classified as âhigh risk of bias.â Most studies were classified as âhigh risk of biasâ in the blinding of participants . In the incomplete outcome data , one study was evaluated as âhigh risk of biasâ and all the remaining studies were evaluated as âlow risk of biasâ. In the selective reporting , one study was rated as âhigh risk of biasâ and the rest of the studies were evaluated as âunclear risk of bias.â A summary of the risk of bias is shown in Figure 2.

The graph of risk of bias the summary of risk of bias: â+â=low risk of bias, âââ=high risk of bias, and â?â=unclear risk of bias.

Strength Training Helps Build Muscle Mass

Strength training can involve lifting weights, using machines at the gym, using your own body weight for resistance, or even using common household items like a milk jug filled with sand, the Parkinsons Foundation notes. Your strength training should focus on the following muscle groups:

• Core muscles
• Arm muscles
• Hands and wrists

In general, strength training should be done two to three times per week, but scheduled so that youre not targeting the same muscles on consecutive days, as your muscles need to rest and recover, the foundation advises.

As with stretching exercises, strength training can be performed while standing, sitting, or while on the ground.

The Wisconsin Parkinson Association recommends several exercises to help strengthen your grip and improve your reach. Tasks such as handwriting and reaching for items on higher shelves can be a challenge for people with Parkinsons disease, and hand exercises can help minimize these issues.

In general, resistance training helps build and maintain muscle mass, Subramanian says. The stronger you are, the more independent youll be.

Apda In Your Community

APDAExercise & Parkinson’sWhat types of exercise are best for people with Parkinsons disease?

In last weeks blog, we addressed the reasons why it is vital for people with Parkinsons disease to exercise, including improving particular motor and non-motor symptoms such as impaired balance, gait disorders, depression, and cognition.

Today, we will tackle another important question what types of exercise are most beneficial to help people with Parkinsons disease improve their quality of life? Well also address several specific types of exercise designed for people with PD and some tips on how to get started with an exercise program.

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Make It To Your Appointments

The number of physical therapy appointments you need depends on your condition and goals. Generally, your first appointment will include an evaluation and exercise recommendations. In following appointments, your physical therapist will check your progress and add or modify exercises according to your needs. Make sure you attend all of your appointments to stay on track.

Should I Talk To My Healthcare Provider Before I Start Exercising If I Have Parksinson’s 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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Effects Of Physical Exercise On The Treatment Of Parkinsons Disease

Other therapeutic strategies have been evaluated clinically and scientifically in recent years in the search for an action to reduce clinical problems of PD, such as, non-pharmacological interventions like physiotherapy and physical exercise . Rehabilitation through physical therapy has a variety of goals and methods that generally promote benefits in parkinsonian mobility, posture, and balance. However, some limitations have been observed in a consensual way by some researchers in two topics: in relation to the benefits that seem to be more immediate , and the variety and low methodological quality of the studies . Other nonpharmacological approaches to rehabilitation in Parkinson’s disease are the practice of different modalities of physical exercises such as walking, running, strength training, whole body vibration and functional exercises, which are related to the reduction in the risk of falls, decreased motor symptoms, motor performance improvements, balance and gait improvements, positive repercussions in quality of life and executive functions .

Kurtais et al. investigated the effects of six weeks of supervised treadmill walking, three times a week for 40 minutes in patients with mild to moderate PD, and observed significant improvements in lower limb functional parameters such as walking, balance, and agility, and in related parameters, the adaptations promoted by aerobic exercise as increase of peak VO2 and caloric expenditure in METs .

Types Of Physical Therapy For Parkinson’s Disease

Parkinson’s disease is a nervous system disorder that affects over 1 million Americans. This disease involves the part of the brain that controls movement. The main symptoms include tremors, muscle rigidity and difficulty with coordination, balance and walking.

Although there is no cure for Parkinson’s disease, various treatments can relieve symptoms and help patients maintain their quality of life. Physical therapy is one form of treatment known to help individuals with Parkinson’s disease increase mobility, strengthen their muscles, improve coordination and balance, and ultimately, remain independent. This post explores the different types of physical therapy and how to make the most of a rehabilitation program.

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History Of The Role Of Exercise In Parkinsons

The benefits of exercise in PD have not always been well characterized. Despite the American Academy of Neurology encouraging the use of exercise as an adjunctive therapy for Parkinsons patients in the 1990s , systemic reviews from the Cochrane collaboration released in 2001 found insufficient evidence to support or refute the efficacy of physiotherapy in PD . Although most of the individual trials analyzed in these reviews appeared to find a beneficial effect of physiotherapy, it was determined that many of the studies had methodological flaws and biases that prevented any firm conclusions of the validity of physiotherapy . Interestingly, this led to a situation in which physicians were instructed to encourage regular exercise, despite little evidence of its efficacy in slowing disease progression or improving activities of daily living .

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.

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What Type Of Physiotherapist Should I See

Any physiotherapist you see should ideally specialise in Parkinsons.

Like many other healthcare professionals, physiotherapists specialise in different areas of practice. Some work specifically with people with neurological conditions like Parkinsons, and some have additional qualifications in exercise and fitness training, especially those working in gym settings.

Your physiotherapist will assess how Parkinsons affects your movement, whether youre newly diagnosed, or youve had the condition for some time. This means they can help to keep up your fitness levels, and maintain good posture and balance as your condition progresses. This will help you remain independent.

You may feel that your mobility is very good and that you are exercising without any problems. But a physiotherapist can also help you maintain your mobility to help avoid any future issues.

Your physiotherapist should form part of your support network, involving your family and carers, in helping you manage your Parkinsons.

Seeing a physiotherapist can have a number of benefits for people with Parkinsons and their carers. These are outlined below.

Physical Therapy For Patients Suffering From Parkinsons Disease

Physical therapy exercises that challenge patients to change tempo, activity, or direction benefit those with Parkinsons disease. It is important to keep variety in exercise activities, this is necessary because individuals with Parkinsons disease often have difficulty in shifting from one activity to another. Exercises that require balance and preparatory adjustment of the body are also important along with rhythmic activities such as dancing, skipping and cycling.

Parkinson disease is the second most common degenerative brain disorder, after Alzheimers disease. More common in men than women, Parkinsons disease is related to loss of nerve cells in the brain that produce dopamine, which plays important role in controlling movement. PD symptoms typically include stiffness , shaking , slowness with movement, and balance problems. Treatment may include medication and physical therapy.

Recommended Exercises for PD include:

• Walking

• Dancing

• Sports

• Aerobics

As one ages, more exercise must be performed to maintain muscle mass. Muscle mass and strength allow an individual to complete daily chores and to maintain balance.

To Maintain Muscle Mass Try These Alternative Strength Exercises:

• Activities in a standing position strengthen legs

• Pushing up to rise on the toes

• Modified squats

• Repetitively rising and sitting from a chair

• Wearing ankle and wrist weights around the house or out on a walk

• Push-ups or wall push-ups for arms

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Tips For Exercising Safely

Before starting an exercise program, consult with your neurologist and primary care doctor about any health concerns and ask for recommendations, the Parkinsons Foundation advises.

Ask your doctor to refer you to a physical therapist who knows about Parkinsons together, the two of you can identify any concerns and physical limitations you may have. Your exercise regimen should be targeted to address your symptoms and physical limitations.

You should stop any exercise or stretch that causes pain, and take steps to prevent falls while exercising, such as:

• If indoors, remove area or throw rugs
• Work out in well-lit areas
• Dont use rolling chairs
• Work out with friends or buddies, particularly when performing outdoor activities
• Stay hydrated
• Avoid overexertion

Can This Injury Or Condition Be Prevented

To date, there is no known way to prevent PD. Studies have shown improved walking, balance, strength, flexibility, and fitness in people with PD, who participate in a regular exercise program. However, these studies also indicate that people with PD gradually lose the gains they make when their supervised exercise program ends. Its important to work with your physical therapist to help develop good long-term exercise habits.

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Where Can I Find Support If I Have Parkinsons 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

Are There Any Risks Of Exercising With Parkinsons Disease

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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Are There Any Parkinsons Specific Exercises

There are a number of Parkinsons specific programmes that aim to improve movement. Overall there is limited research evidence on the specific benefits of these programmes, and we dont yet know if they are more beneficial than other types of exercise, but people have told us they found them to be of use.

We have provided examples below of the more common programmes specific to the needs of people with Parkinsons, but you may find classes with different names that are run by physiotherapists near you and offer similar exercises by trained therapists.

LSVT®BIG training is administered over the course of a month by a qualified physiotherapist or occupational therapist. It involves repetitive intensive high-amplitude movements and aims to restore normal movement amplitude. Studies into LSVT BIG training have been small in size but there is some evidence it may improve daily activities and motor symptoms.

It is claimed that this training provides greater improvements in motor performance than either Nordic walking or non-supervised in-home exercises. However, another study found that an 8-week Nordic walking course and a 4-week LSVT BIG course produced similar improvements in reaction time.

PD Warrior is exercise treatment designed to slow Parkinsons down. It was developed by Australian physiotherapists but practitioners can now be trained in the UK. Its a complete rehab program designed to improve your function, quality of life and long term exercise behaviour.

Ways Physical Therapists Help Slow The Progression Of Parkinsons Disease

It is well-known that exercise of any kind is good for each persons health, both body and mind. But did you know that it is even more important for those living with Parkinsons disease? Physical therapy is key to slowing down the disease. And it helps those affected to stay as independent as possible.

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The Benefits Of Yogafor Parkinsons Disease

According to the Parkinsons Foundation, yoga can help with flexibility, breathing, and posture as well as relaxation and stress reduction. Best of all, its a self-paced activity, the foundation adds, which means you dont have to perform certain exercises if your physical limitations get in the way. Bonus: Your routine can be modified depending on your needs for example, doing seated yoga in a chair.

Yoga is really my go-to, Subramanian says. Mind-body exercises are really beneficial for mental health, which is important given the risk for anxiety and depression in Parkinsons disease.

Parkinsons On The Move

Publisher: Parkinsons On The Move

Cost: Free

Thirty-one archived workouts for those with Parkinsons. 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 Parkinsons On The Move Exercise Library. This collection of 58 short videos each focus on stretching or strengthening a specific part of the body.

Publisher: JCC Tampa Bay on the Cohn Campus

Cost: Free

Suzanne Chen leads 43-minutes of stretch and strengthening exercises for those with Parkinsons. Equipment to follow along include an elastic band, light weights , a 8-9 inch soft ball , and a stable chair with no arms.

Publisher: JCC Greater Boston

Cost: Free

Eight YouTube exercise videos for those with Parkinsons, including four focused on neuromuscular integration, two total body conditioning and one seated strength. Most videos are about 30 to 45 minutes.

Publisher: PD Warrior PTY LTD, Australia

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 Parkinsons 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.

Publisher Parkinsons Foundation of the National Capital Area

Cost: Free

Publisher: Power For Parkinsons

Cost: Free

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Benefits Of Exercise For People With Parkinsons Disease

Exercise has been shown to have several significant benefits for people with Parkinsons disease. These helpful effects seem to stem from two specific neurological changes that occur when you work out:

• The release of a chemical called dopamine: This positively impacts your movement, mood, and sensation of pain.
• Growth and change in the cortical striatum:This is an area of the brain that controls your voluntary movements.

These two exercise-related changes can result in many concrete advantages for people with Parkinsons, including:

• Improved balance
• Reduced sleep disruptions

Tips For Getting Started

• First, be safe. Before starting an exercise program, we recommend you to see a physical therapist specializing in Parkinsons for full functional evaluation and recommendations..
• Use a pedometer and figure out how many steps you take on average each day, then build up from there. Many smartphones or smartwatches have a built-in pedometer feature or an application that can be downloaded.
• Exercise indoors and outdoors. Change your routine to stay interested and motivated.
• Again, most importantly pick an exercise you enjoy.

Seek out local PD exercise classes. Across the country, dance classes and boxing groups designed specifically for people with PD are growing in popularity. Contact the Parkinsons Foundations toll-free Helpline at 1-800-4PD-INFO or to find one near you.

Page reviewed by Dr. Bhavana Patel, Movement Disorders Fellow at the University of Florida, a Parkinsons Foundation Center of Excellence.

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