Top 10 Tips for Exercising with Parkinson’s Disease

1. Exercise is medicine, so don’t miss a dose.Exercise has been proven to build a healthier heart, lungs, and muscles, boost metabolism, prevent diabetes, and reduces disability. Research shows that exercise can slow many aspects of the physical decline of PD and new research also suggests that exercise may even be neuroprotective – that is, slowing the progression of PD in the brain.
   1. “…Exercise or other motor enrichment methods might delay the onset of parkinsonian symptoms or slow the degenerative process, but only when there are no substantial breaks in motor activity” (1763). – Motor Enrichment and the Induction of Plasticity Before or After Brain Injury (Kleim et al, 2004)
   2. “Our findings indicate that exercise reduces the behavioral impairments elicited by the dopaminergic neurotoxins as well as the loss of DA neurons” – Triggering endogenous neuroprotective processes through exercise in models of dopamine deficiency (Zigmond et al, 2009)
   3. “What is clear is that exercise can influence the multiple levels of support necessary for maintaining optimal neuronal function, which is unique among proposed interventions for aging.” (Anderson et al, 2010)
2. Be realistic – something is better than nothing.There is no perfect one-size-fits-all exercise for people with Parkinson’s. Don’t wait. Start walking around the block. Or dancing. Find a physical therapist that can design an exercise program that is right for you.
   1. “Considered together. These studies suggest that the type of activity may not be important, but rather that the performance of some sort of physical activity or exercise as opposed to being sedentary is critical.” (Dibble et al, 2008)
   2. It is important to find a physical therapist with expertise in Parkinson’s disease. Ask for a referral or consult a resource like http://www.neuropt.org for a physical therapist who specializes in neurological disorders – or who is board certified as a clinical specialist in neurologic physical therapy – or who typically works with people with PD in their day to day practice. (Ellis, 2010)
3. Have fun.Consistency is critical and if you don’t enjoy it, you won’t stick with it. Do something you like. Dance, yoga, tai chi, cycling and strength exercises have been shown to help with physical and cognitive symptoms of PD. And because Parkinson’s also robs you of energy, try exercising with a group. Research shows that people stick with exercise when there is encouragement and an expectation for you to show up.
   1. People with Parkinson’s disease who participated in 20 lessons of Tango experienced significant improvements in mobility, social support and health related quality of life – Health-related quality of life and alternative forms of exercise in Parkinson disease (Hackney & Earhart, 2009)
   2. “Maintaining a regular schedule of dancing into old age can preserve cognitive, motor and perceptual abilities and prevent them from degradation…beyond its ability to facilitate balance and posture, dance is a prime candidate for the preservation of everyday life competence of elderly individuals” (Kattenstroth et al, 2010)
4. Break a sweat:Movement only becomes exercise when it is done several times per week at an intensity that is high enough to be physically challenging. If you can carry a conversation with someone while exercising, you are not working hard enough. Because Parkinson’s is a disease of slowed movement, exercising at a slow rate may not provide the best results. Research shows that it’s not the exercise, but the level of the intensity of the exercise, that may be the most beneficial.
   1. Following forced, intense exercise, Parkinson’s symptoms improved 35%, whereas persons with Parkinson’s completing voluntary exercise did not exhibit any improvement. Despite only completing lower extremity exercise, the forced exercise group demonstrated improvements in upper extremity coordination as well as improvements in stiffness and speed of movement. These results were maintained 4 weeks after the forced exercise stopped. The control and coordination of grasping forces during the performance of a functional bimanual dexterity task improved significantly for patients in the FE group, whereas no changes in motor performance were observed following VE. Improvements in clinical measures of rigidity and bradykinesia and biomechanical measures of bimanual dexterity were maintained 4 weeks after FE cessation. – Forced, Not Voluntary, Exercise Improves Motor Function in PD Patients (Ridgel et al, 2009)
5. Do three major types of exercise.Do aerobic conditioning or cardiovascular exercise for 30 minutes, three times per week; strength or resistance training for 30 minutes, three times per week and stretching or flexibility exercises daily.
   1. An exercise program consisting of cardiovascular activities, stretching, strengthening, walking and balance training resulted in significant improvements in daily function and quality of life related to mobility. – Efficacy of a Physical Therapy Program in Patients with Parkinson’s Disease: A Randomized Controlled Trial (Ellis et al, 2005).
6. Start today, don’t wait.The sooner after diagnosis you begin exercising, the greater your physical reserve and self-motivation are likely to be. Don’t wait for the disease to progress further or for problems to emerge. Start strong to stay stronger longer.
   1. “…It is so encouraging to learn based on the observations of this study that exercise training can effectively reverse certain behavioral deficits, like impaired movement, imbalance and inconsistent gait pattern that are associated with the Parkinsonian syndrome in spite of the existing severe loss.” – Restorative effect of endurance exercise on behavioral deficits in the chronic mouse model of Parkinson’s disease with severe neurodegeneration (Pathakos, Kurz & Lau, 2009)
7. Find an exercise buddy.Exercise with people at a life station and physical ability similar to your own. Especially for people with young-onset Parkinson’s, exercising with peers may be more enjoyable, more motivating and more appropriate than finding a Parkinson’s-specific exercise group.
   1. “Consider developing an exercise buddy system which matches up [individuals] who are already exercising with patients who are just starting out. Such group support from patients with similar medical problems may help improve short-term adherence.” – Clinical Exercise Physiology (Ehrman, Gordon, Visich & Keteyian, 2009)
   2. “In our experience implementing community exercise programs for people with PD, it is often easier for those with apathy or depression to ‘show up’ at an appointment to exercise compared to exercising independently.” – Exercise Adherence in Persons with PD (Ellis, 2009 – pdonlineresearch.org)
8. Stick with it.If you stop exercising, the positive effects you’ve worked so hard to achieve through exercise will decline and disappear. People with PD who exercise do better than those who don’t.
   1. “Discontinuation of exercise in advance of brain injury may…leave the brain more vulnerable to degeneration.” ). – Motor Enrichment and the Induction of Plasticity Before or After Brain Injury (Kleim et al, 2004)
9. Exercise for your whole being.Exercise isn’t just good for your body. Other issues related to Parkinson’s disease – like depression, sleep and constipation could also be positively affected by exercise and activity.
   1. “…Exercise may be conceptualized as a non-pharmacological equivalent of antidepressant medication, which is presumed to exert its effects by modifying brain chemical systems.” – Exercise for Mood and Anxiety Disorders (Smits & Otto, 2009)
10. Use exercise to take control of your PD.People with Parkinson’s are robbed of so much control in their lives, but exercise is one thing you can control and in the process, create a better quality of life for yourself.
    1. “Exercise can be fun and is good for you. It can give you more 
confidence and more energy. More importantly, exercise is something that you can do to help manage your disease and improve your quality of life.” – Be Active! An Exercise Program for People with Parkinson’s Disease (Ellis, Rork & Dalton et al, 2008

http://www.davisphinneyfoundation.org/living-pd/10tools/