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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.
The Basic Elements Of Exercising With Parkinsons
There are four core elements of exercise that are important for people with PD:
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.
Cognitive challenges in exercise
Assessment Of Gait Parameters
Stride time , percentage of double stance time , stride length and the coefficient of stride length were assessed at different walking speeds on a motorized medical treadmill ergometer. There is sufficient evidence that gait variability is increased in basal ganglia disorders . Furthermore, increased stride-to-stride variability might reflect a failure of automatic stepping mechanisms . Increased gait variability can be seen throughout the course of Parkinson’s disease and has been found to be one aspect of walking, closely associated with risk of falls in the elderly .
For better comparison of the training effects patients walked at 6 different walking speeds prior and after the training period. The treadmill was equipped with force platforms, that allowed an accurate determination of foot-ground contact. Patients were not allowed to use the handrails of the treadmill for support.
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Guidance From An Accredited Exercise Physiologist
Its important to contact a health professional before commencing exercise to ensure your safety. An Accredited Exercise Physiologist can assess and tailor an exercise program specific to your individual needs. They will supervise your exercises and ensure you start at a light intensity, gradually increasing your prescription based on your progress. Sometimes individuals with Parkinsons may need to be cautious during hot temperatures, around trip hazards and if they are fatigued or unwell. Your Accredited Exercise Physiologist will adapt your program and always be there to guide you.
to find an exercise physiologist near you.
What Are The Best Exercises For Parkinson’s
An example of one of the best exercises for Parkinsons disease is the toe up, which gets the patient to raise his or her toes when taking a step. Stretches for the neck, arms and legs are also important, although some may be difficult for the patient to perform. Other exercises for Parkinsons include practicing being in small spaces, using small steps when turning and practicing any daily activity that is difficult.
The toe up exercise is one of the most important for people who suffer from Parkinsons disease. To perform the exercise, the person walks slowly while ensuring that the foot lands on the heel and rolls forward to the toe. Also, when performed slowly, the exercise can be used as a stretch for the lower leg muscles, which can help with leg cramps.
Practicing taking steps in the correct way is also important for someone with Parkinsons. In general, the person should use short steps only when turning, and long steps for regular walking. This can take some practice, but can reduce the chance of the patient falling over.
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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.
Adverse Side Effects Of The Training
Two patients of the NW group and one patient of the walking group experienced exercise-induced hypotension after intense walking uphill in hot weather. Patients felt dizzy but did not lose consciousness and recovered after fluid intake within 10min.
During the supervised 6-month training period, four patients of the NW group fell due to obstacles. The falls did not lead to severe injuries. Five patients twisted their ankles during cross-country walking, but only one patient complained of pain and missed three training sessions. Two patients of the NW group developed shoulder pain which required medical treatment with nonsteroidal anti-inflammatory drugs. Both patients abstained from sports activities for one week.
Four patients of the walking group had falls during the supervised 6-month training period. Two patients tripped over roots and two patients slipped on wet ground while walking downhill. There was one fall in the flexibility and relaxation group during an attempt to stand up from the floor.
Muscle soreness was reported in all groups by 15% of the patients during the first three weeks of exercising.
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So What Type Of Exercise Is Best
There are many different forms of exercise, but what type is right for you? Every individual is different! Its important to remember that although a combination of aerobic, resistance and balance exercises have the best overall effect, you may need to modify each element to your suit your unique circumstance.
Aerobic exercise is described as continual movement to assist in the improvement of cardiorespiratory function. This includes walking, cycling, swimming and even dancing! Exercising to music specifically has seen some fantastic results in managing Parkinsons symptoms. Dance for Parkinsons Australia run specialised dance classes across Australia, providing a social environment so share stimulating activity.
Maintaining strength is not only important to keep our muscles healthy, it also helps with daily activities like getting off the toilet and getting out of the car. Resistance exercises can be performed using your body weight, light hand weights, resistance bands, various machines found in a gym setting or even using common household items like cans of food. Moving your muscle under a greater resistance promotes an increase in muscle mass. You may like to participate in group setting, a home program, or a combination of both.
Exercise for Neuroplasticity
Best Physical And Occupational Therapy Exercises
Physical therapy exercises target your areas of concern. They can help develop your strength, balance, and coordination. Youll also enhance your functional mobility by improving concentration, flexibility, and range of motion.
Occupational therapy exercises are intended to help you perform daily activities related to work, school, or home with greater ease.
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Aquatic Exercisecan Improve Your Balance
According to the APDA, exercising in water is a safe and effective way to improve balance and strength in people with Parkinsons disease. In general, the organization says, buoyancy from simply standing in the pool can help support weaker muscles and improve a persons balance and posture.
Swimming, or even performing some strength and flexibility exercises in the water with the water providing resistance enhances muscle tone, balance, and mobility with minimal stress on the body. The APDA offers a brochure with suggested aquatic exercise routines and general tips.
Expert Exercises For Parkinsons Disease
In the past two decades, scientific studies have shown again, and again that exercise and physical activity can have dramatic impacts on the outcome and well-being in Parkinsons disease . The benefits of exercise are so widespread, as listed below, that exercise should be thought of as medicine, but with almost no side effects. I have many PD patients who are so dedicated to improving their neurological health with an exercise regimen that they become more physically fit than before they were diagnosed with PD. These patients often report, anecdotally, that they feel worse regarding their PD when they dont have the opportunity to exercise consistently.
Benefits of exercise include:
- Improved gait and balance / reduced freezing of gait / reduced risk of falls
- Improved flexibility / reduced rigidity / reduced risk of contractures
- Improved endurance / energy
- Improved ability to complete activities of daily living / improved sense of well-being / improved quality of life
- Improved working memory and decision making
- Improved attention and concentration
- Improved mood / reduced depression and anxiety
- Improved quality of sleep
Direct effects of exercise include:
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Try Seated Exercises If You Have Limited Mobility
Performing strength and flexibility exercises while sitting can help you stay fit and improve your range of motion all with minimal stress and wear and tear on your muscles and joints.
An example of a seated stretching routine recommended by the Parkinsons Foundation is the hamstring stretch. To do this stretch:
An example of a strength exercise you can perform while sitting down is the shoulder blade squeeze. To perform this exercise:
Your physical therapist can recommend additional seated exercises.
Assessment Of Technical Skills
The technique of the Nordic walking training appeared to be very challenging for the patients. Patients had difficulties in opening the hands during the push-off phase. Furthermore, patients tended to carry the pole without weight loading with the more affected hand. However, the group managed to learn the Nordic walking technique, but the level of performance differed between the patients. 17 of the patients mastered the NW technique very well, 10 patients showed a good technical performance and 3 patients performed poorly. Both the NW group and the walking group had difficulties in employing a diagonal sequence and an interlimb coordination. Patients did not notice the technical deficits and depended on the coaching of the instructors.
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Calf Stretches For Parkinsons
Seated Option: Calf Stretch with Strap
Standing Option: Wall Push-offs x 20
*To increase the intensity of the stretch, back away from the wall until you reach a distance where you feel a strong stretch in your calves when youre leaning forward against the wall. Be sure to keep your heels down throughout the exercise.
Balance Exercisescan Improve Your Mobility
Balance is an important aspect of mobility, and people with Parkinsons commonly experience balance problems when standing or moving around, the APDA notes. Dance and tai chi are two activities that can help you improve balance, and the APDA recommends performing balance-related activities two to three days a week for 20 to 30 minutes each time.
Balance training can help you prevent falls, Subramanian notes.
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Top Three Exercises For Parkinsons Patients
Posted By C-Care
Parkinsons disease is a common neurodegenerative condition, which mainly affects the motor system and can make simple physical tasks difficult over time. Since Parkinsons is degenerative, symptoms advance and change over time. Symptoms of Parkinsons include:
- Mood alterations
Parkinsons is a challenging disease both for those who suffer from it, and for their family members. When diagnosed early, there are many things you can do to minimize symptoms, including exercises, some of which well list here.
Walking is also an all-around healthy way to get exercise, and should always be part of your daily routine.
Seated Hamstring Stretch: Sitting at the edge of a chair, extend one leg straight, keeping the heel on the floor, while your other legs stays bent. Placing your hands on your bent knee for support, lean forward until you feel the stretch in your hamstring. Hold for 5-10 deep breaths.
Parkinsons Disease Stretching Exercises
Here is a selection of some functional Parkinsons disease stretches notice that you should follow our general stretching guide when performing the Parkinson Exercises described below :
In general, you should have in mind that, since stiffness is a major enemy which can potentially result in Parkinsons disease, it is vital to keep as many of your body areas stimulated as possible for instance, try using your hands, palms and fingers for daily tasks, squeezing a small ball in your palm, marching in place with your knees high and many more!
Watch the photos below for a better understanding of the stretches described above! Its crucial to perform the exercises as accurately as possible in order to grab the usual Stretching Benefits
The pics and the video below make it easier for our visitors to find how each stretche described above can be executed! So have a careful look on them:
Other Parkinsons Disease Treatment Options
Apart from the above described stretches, additional Parkinsons disease treatments may include:
- Medications, which aim at supplementing or substituting dopamine, the neurotransmitter which, as mentioned previously, Parkinsons disease sufferers have deficiency in
- Supportive therapies, which are designed for making the sufferers routine easier help you cope with everyday life
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Flexibility / Stretching Exercises
1. Body TwistSit on the edge of a seat. Sit tall. Turn your shoulders to the right. Place your right hand behind you. Twist your body and head to the right as far as you can go without any pain, only a stretched feeling. Hold. Try to relax and breathe.
2. Wall HangFace a wall and stand with your feet about 30cm from the wall. Lift your hands straight above your head and place palms on wall, as high as possible. Lean forward without arching your back. The stretch should be felt under the arms and in your chest. If this is too easy, take the feet further back from the wall.
If you can reach, rest your hands on the frame at the top of the door. Keeping your arms straight, slowly lean forward until you feel a gentle stretch. Hold. Do not over-stretch.
3. Doorway Bend
Stand near a doorway. Lift your arm to the side, up to shoulder height. Bend your elbow to 90 degrees and place the entire forearm on the door frame. Gently turn your body away from the arm and feel a stretch in the shoulder and chest. Hold. Repeat on the other arm.
4. Side Bend
Sit tall in a chair that doesnt have arms.Lift one arm over your head and curve your body to the side.Keep your buttock firmly on the seat so you dont tip the body.A stretch should be felt on the side of the body. Hold. Repeat for the other side. Do not lean forward or backwards.