Safety And Tolerability Of Cannabis
More than any other intervention reported in this review, safety concerns make the use of cannabis controversial, though certain adverse effects are dependent upon the method of ingestion. Open-label studies of inhaled marijuana cite common side effects of dizziness and drowsiness, plus smoking-related complications of cough or a foul taste in the mouth . The study by Carroll and colleagues used a THC-containing product and reported more than double the adverse effects in the experimental group, including physical as well as psychological effects.
Pure cannabidiol, however, is non-psychotropic and generally well tolerated up to doses of 1500 mg/day . Open-label studies report few side effects, though only one trial to date has specifically evaluated safety and tolerability. This recently published, open-label study of cannabidiol by Leehey and colleagues reported various adverse effects in all 13 patients included in the trial. Symptoms were generally mild, but included diarrhea , somnolence , fatigue , weight gain , dizziness , abdominal pain , and headache, weight loss, nausea, anorexia, and increased appetite .
Instructions To The Class And Monitoring
The investigators coached and supervised the training session for 2 months. Both investigators had more than 5 years of experience in physical therapy, cardiopulmonary resuscitation, and first aid. Participants were asked whether any discomfort was faced and their responses were recorded after the end of the training session. Changes were made on an individual basis in the program.
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How To Exercise With Parkinsons
Whether you’re a first-time exerciser or a lifelong athlete, the key to working out with Parkinsons is to safely and regularly move your body in a variety of ways. Your fitness regimen should include these four main categories of exercise:
- Aerobic activity
- Balance, agility, and multi-task exercises
People with Parkinsons should strive to perform aerobic activity at least three times weekly and to complete exercises from the other categories two to three times each week.
In total, the Parkinsons Foundation suggests performing 150 minutes of moderate tovigorous exercise weekly.
To help you achieve this goal, try these helpful tips:
- Invest in a treadmill, elliptical, or exercise bike. This will make it convenient to perform aerobic exercise from your home, regardless of the weather.
- Obtain a set of light hand weights from a local exercise shop or thrift store. These can be used for a wide variety of strength training exercises.
- Follow along with one of the many online exercise classes on YouTube that are tailored to people with Parkinsons disease. The Parkinsons Foundation and the Davis Phinney Foundation offer many great online exercise videos.
- Connect with a workout buddy by finding a local Parkinsons support group associated with the American Parkinson Disease Association
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Brian Grant Foundation Exercise Videos
Cost: Free for 9 videos $29/month or $290/year for online streaming
The nine free classes include boxing fundamentals, HIIT , chair fit, tai chi, core, yoga, stretching/mobility. The free classes are 13 to 30 minutes. Classes are led by a physical therapist with Parkinsons specific certifications.
Paid classes incorporate PWR! Moves, cognitive dual task training, balance training, intensity training, and flexibility. For subscribers, new 20-25 minute videos are released weekly.
Dance exercise class videos on YouTube. Each is fewer than 10 minutes long. Nearly 30 videos as of October 28, 2020.
Rachelle was featured at the Davis Phinney Foundation Victory Summit Albany in October, 2020. Watch an interview with Rachelle here, and Rachelle’s 25 minute Dance Beyond Parkinson’s Summit presentation here.
Six seated dance exercise class videos on YouTube. Each is about one hour long. All are with the same instructor.
Cost: Free for 16 videos $50 for 100+ videos
Sixteen archived exercise classes are available for free viewing. Classes are designed to increase coordination, balance, flexibility, and strength through music and movement from a broad range of dance styles. 100+ archived classes and additional benefits are available for a $50 membership.
Imaging And Acupuncture In Parkinson Disease
Researchers have used various imaging modalities to assess the effects of acupuncture on patients with PD, including single-photon emission computerized tomography imaging, functional magnetic resonance imaging , and resting-state fMRI. In 2009, Huang and colleagues published data on five patients with PD receiving levodopa and five patients with PD receiving levodopa plus acupuncture, showing increased glucose metabolism in the bilateral frontal and occipital lobes, and the temporal lobes, thalamus, and cerebellum on the less affected side. In a subsequent study, they found an increase in cerebral blood flow in the frontal lobe, occipital lobe, basal ganglia, and cerebellum in the more affected hemispheres of ten patients with PD who had received 5 weeks of EA, compared with ten patients on levodopa alone . This did not show any change in basal ganglia dopamine transporter activity using 99mTc-TRODAT-1 SPECT imaging, suggesting that acupuncture has no effect on the pathophysiologic mechanisms underlying PD.
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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.
What Is Tai Chi
Tai Chi is a balance-based exercise, originating in China as a martial art, that is gaining more and more notice with Parkinsons disease researchers and health care professionals.
While there are several different styles and expressions of Tai Chi, all are characterized by slow, relaxed and flowing movements. Practiced by people of various physical capabilities, it has become notably more popular with the Parkinsons community in the past several years due to the discovered balance and movement benefits associated with the practice.
Tai Chi is a weight-bearing exercise and involves continually shifting weight from one leg to the other. This facilitates improved balance and strength in the legs, ankles and feet. Tai Chi also improves torso and limb flexibility along with range-of-motion, which is essential for postural control.
In the past several years there have been numerous studies conducted by a wide range of researchers proving the benefits of Tai Chi for Parkinsons disease patients, as well as various mind/body issues due to aging. From Hong Kong, to the University of Vermont to, most recently, the Harvard Medical School, study after study demonstrates the increase in balance and motor control with Tai Chi practice.
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How Can It Help In Parkinsons
To date there is limited research into the benefits of Tai Chi for Parkinsons but because it enhances balance and body awareness, it is believed by many to reduce the risk of falls, improve balance and confidence when walking and also improve gait and posture. Some people with Parkinsons have reported improvements in sleep too.
Unlike most sports or exercises, Tai Chi does not rely on strength, force or speed, which makes it possible for a range of abilities, ages and strengths. Even a small amount of practice can bring benefits in health and fitness, enabling the mind and body to relax. This in turn may improve emotional wellbeing and overall quality of life.
As with all physical therapies, you may find some of the activities challenging, but techniques may be adapted to suit individuals your teacher should be able to advise on this. Special care may be needed if you have severe osteoporosis, a hernia or are pregnant
Tai Chi For Parkinsons Disease Recommended By The National Parkinsons Foundation
In a checklist by the National Parkinsons Foundation, the benefits of Tai Chi for those with Parkinsons disease are the following:
- Promotes conscious awareness of movement and actions
- Increases awareness of proper body alignment/posture
- Improves balance with reduced fall risk
- Enhances flexibility
- Affords a greater sense of well-being
- Offers relaxation which can help to lessen Parkinsons symptoms manages medication side effects such as dyskinesia
- Improves breath support and control
- Helps to build healthy bones through weight-bearing activities
- Increases strength, especially in core muscles
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Ethics Approval And Consent To Participate
The original protocol of the study had been approved by the Gaomi People’s Hospital review board. An informed consent form was signed by all participating patients or their relative regarding non-treatment interventions, evaluations, and publications of the study in all formats irrespective of time and language. The study adhered to the law of China, the strengthening the reporting of observational studies in epidemiology , cohort study statement, and the 2008 Helsinki Declaration.
Measurement Of Physical Performance
Physical performance was measured by three tests: the 50-foot speed test, which estimates the time by the patient takes to walk a 50-foot distance the timed up-and-go test, which evaluates the time required by a participant to stand up from a chair, walk 10 feet, and come back and sit down on the chair the functional reach test, which measures 16 common functional activities, e.g. unloading groceries, making a bed, climbing 3 steps onto a platform with luggage, etc. . Incidence of falls was also recorded before intervention and within 6-months . Participants were helped and assisted to perform the tasks whenever needed.
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It Can Reduce Systemic Oxidative Stress And Inflammation In Parkinsons Disease
Increased oxidative stress and inflammation accelerate degeneration of brain cells in conditions like Parkinsons disease.
Tai chi is known to mitigate cellular inflammation.
An experimental trial conducted on older adults showed that practising Tai chi for 16 weeks on a regular basis helped reduce inflammatory mediator, interleukin in the blood.
Researchers have also put forth the idea that better sleep and Tai chi improve health by reducing inflammation at a faster pace.
Various scientific findings indicate that practising mind-body therapies like Tai chi helps reduce inflammatory responses thereby improving behavioural and psychological health.
These therapies reduce circulatory levels of inflammatory mediators, decrease expression of genes regulating inflammation and prevent signalling of inflammatory factors.
Oxidative stress caused by excessive free oxygen radicals that accelerate the process of ageing damages neurons in the brain and is involved in the pathogenesis of medical conditions like atherosclerosis, hypertension, diabetes and cancer.
Physical exercise tremendously influences oxidative stress levels.
According to a study published in the Journal of Physical Therapy Science, the weekly practice of Tai chi on a regular basis helps fight oxidative stress and damage in healthy individuals.
Many individuals prefer walking more than those intensive training exercises.
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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Acupuncture For Gait And Balance In Parkinson Disease
In addition to targeting general motor disability related to PD, other trials have focused more on the specific issues of gait dysfunction and balance impairment. An open-label trial of acupuncture in 27 patients with PD demonstrated an immediate 10% improvement in gait speed, 8% improvement in step length, 11% increase in floor reaction force, and two additional steps per minute on testing of cadence . In a small, sham-controlled trial, Toosizadeh and colleagues found that weekly EA treatments over a 3-week period resulted in improved balance based on measurements of sway, and a significant improvement in mUPDRS when compared to patients receiving the treatment at non-acupuncture points. The same group incorporated wearable sensors in 15 patients to demonstrate improvement in gait after three weekly electroacupuncture sessions, measured by gait speed , stride length , and mid-swing velocity . These results are encouraging but should be validated in longer duration, blinded trials.
Dance For Pd Instructional Dvds/streaming
Cost: vol. 1 DVD $29.99, vol. 2 DVD $59.98, vol. 3 $29.99 DVD, vol. 4 $24.99 stream or download , vol. 1, 2 or 3 streaming $23.99 each, full media bundle $120 .
Each volume is a complete class with movements that draw from ballet, modern dance, tap, jazz and improvisation to create accessible, stimulating dances for all.
Volumes 1 and 3 feature seated and standing dances, and a teacher is always on screen to demonstrate both seated and standing versions. Volume 2 is designed to be done seated. Volume 4 is the first all standing class, but can be equally enjoyed from a chair.
In early 2019, trained and licensed Dance for PD affiliate, Pamela Lappen, posted a series of twelve 30-minute videos on YouTube using the Dance for PD exercise model. Between March and September 2020, she posted five more exercise videos .
Cost: $39.95 for book/DVD set
This exercise program includes categories such as wake up call, walking and balance, cardiovascular, strength, facial and vocal, and night-time stretching. Suitable for any disease stage, with many levels of difficulty. Designed by certified trainer and orthopedic surgeon with PD.
Cost: $39.95 for book/DVD set
Fifteen chapters are organized by activity of daily living, including getting off the floor, getting out of a car, getting out of bed, freezing, moving about in big crowds, and getting dressed.
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What Does A Parkinsons
Its important to practice Parkinsons specific exercises rather than general exercise training to improve movement because of the type of brain stimulation each type of exercise produces.
Your brain has the ability to help you move better. It learns from all stimulation applied to it, including exercise, and has an enormous capacity to re-wire the neural connections for improved movement. You may not have noticed, but, getting off a low chair, rolling in bed and picking up a cup of water all require infinite amounts of fine-tuning as your brain prepares, conducts and evaluates the task. Your brain is receiving constant feedback about the environment so that it can move with the appropriate amount of speed, power and accuracy to be effective and efficient.
Dopamine deficiency can lead to the continuing reduction of movement, speed and power. Instead of getting up from the chair first time round, it may mean that you have to use your arms to push up, or rock back and forth a bit to get enough momentum to stand up. It is the chronic reduction in a movement that makes big movements like walking and small movements like writing so challenging.
Parkinsons specific exercise will teach you how to move with amplitude, power and speed in everyday tasks so that you can get back to doing the things you enjoy doing. By increasing your overall activity level, Parkinsons specific exercise may also slow down the symptom progression of your Parkinsons.
Medical History Of Patients
Among the enrolled PD patients, male to female ratio was 2.5:1. Some of the patients had started levodopa or equivalent treatment in the previous 6 months. The other demographical and clinical parameters are reported in Table 1. There were no significant differences for the parameters between both groups at enrollment .
by Case Adams, PhD·
Qigong. Photo by K. Kendall
Qigong and Tai chi are ancient exercises, with origins more than two thousand years old. There are similarities between these two therapeutic exercise arts, but also some subtle differences. Lets cover Qigong first.
The word Qigong is made up of two words:
1. Qi means the life force or vital energy that flows through and animates our body. This life force produces electromagnetic energy, heat and other forces. 2. Gong means the development of a skill through ongoing practice.
The actual exercises maintained in Qigong utilize the concepts of the bodys meridians. The Qi flows through our meridians. Each meridian contains numerous energetic spots. These are often referred to as acupoints. These are stimulated by acupuncturists in treatments. But they can also be stimulated by gentle and focused motion.
This is what Qigong attempts to do. It utilizes mindfulness and an attention to motion that synchronizes our spirit with our body.
This video takes you through some of the exercises involved in Qigong:
In this article
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Teaching Tai Chi And Qigong
Both practices overlap with the 3 regulations from traditional Chinese medicine:
- Physical body
- The mind
Both breathing and the mind make up meditative components of the practice. Qigong is used more than tai chi for health as it is easier to learn.
Both are performed in a group setting and can be run as standing or seated exercise classes. They can be done gently or vigorously to incorporate large and expansive movement as well as small, subtle moves.
There are more than a dozen forms of tai chi and qigong. The tutor will decide which style to use based on their experience of supporting people with medical conditions and their own teaching. They will be able to adapt and tailor the exercise to movement difficulties encountered by people with Parkinsons.
How Hard Should I Exercise If I Have Parkinson’s Disease
A rating of perceived exertion is a good way to measure intensity. On a scale from 0 to 10, 0 would be how you feel while sitting or lying down, while 10 would be the maximum effort you can give. Building up to an effort between 5 to 8 means you are exercising at a high intensity. A good gauge is, if you can have a conversation with someone while exercising, you should probably increase your intensity.
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Inclusion And Exclusion Criteria
All patients aged 18 years and above with confirmed PD ), severity level I to III , that could move independently, had no other severe neurological disorder, had not participated in any kind of physical therapy program in the previous 2 months, and did not have other severe orthopedic disorders were included in the analysis.
Patients with PD disease severity level IV and patients who had received any physical therapy exercise in the previous 2 months were excluded from the analysis.