March 10, 2016
Research demonstrates the
importance of maintaining an active lifestyle for people who live with
Parkinson’s disease (PD). We know, for example, that certain exercise programs
can improve strength, balance, flexibility and aerobic capacity — all of which
are important in PD. We also have early, though not conclusive evidence from
animal studies that vigorous exercise may actually protect against the death of
brain cells that underlies PD.
But which type of exercise is best,
and how intensive and frequent should it be? There’s no standard “exercise
prescription” for PD; the right program may be different for each person, and
should be adjusted as PD progresses. The good news is that many types of
activity are beneficial, so people with PD can choose the ones they enjoy and
that best meet their needs. The single most important piece of advice is to get
active, and stay active!
What Changes as PD Progresses?
People who are in the early
stages of PD tend to be just as strong and physically fit as healthy
individuals of the same age. But as PD progresses, so do the physical
challenges. In addition to the movement symptoms of the disease — tremor,
slowness, freezing of gait — people with PD commonly lose some of their range
of motion, especially in the neck and back. This can interfere with their
ability to twist and look over the shoulder (when driving, for example), and
can affect balance.
It is also common for muscle
strength to decrease in the course of PD. In one study, people with moderate PD
symptoms — that is, those who scored higher than 30 on the standard Unified
Parkinson’s Disease Rating Scale — exhibited just one-half of the strength
exhibited by a group of healthy individuals in their quadriceps (the thigh
muscles that are important to walking and to standing up).
Other common consequences of PD
are declines in cardiovascular conditioning, which supports a person’s physical
endurance, and in the ability of the nervous system to get the body going. This
can mean that even in the early stages of Parkinson’s disease, a person may
need to breathe more oxygen when walking — that is, he or she may need to put
in more effort than the average person to go for a walk. One question is
whether this inefficiency in oxygen use contributes to the fatigue that is so
common in Parkinson’s disease.
The good news is that exercise
can help to lessen the impact of these changes. People with PD who stay active
and exercise feel better, and do better, over time.
Organized Exercise vs. Physical
Activity
When it comes to physical
activity in PD, we are really talking about two things — structured exercise,
and general physical activity. Each provides its own benefits, and people with
PD need both. What’s the difference?
One difference is that structured
exercise programs, such as cardio or strength training regimens, are often
carried out under the supervision of a physical therapist or other health
professional. General physical activity, on the other hand, is a matter of how
we move around throughout the day, whether walking, gardening or dancing,
typically without supervision. Recent studies indicate that everyday activity
is just as important to living well with PD as are structured exercise
regimens!
The Benefits of Structured
Exercise
Exercise is still a fairly new
area of research in PD, and we are only now beginning to understand its
effects.
Structured exercise, research
shows, can ease the movement symptoms of PD that put people at risk of falls.
For example, programs focused on improving flexibility, aerobic endurance and
strength, can help with balance; some studies also show benefits for fall
prevention. Additionally, programs involving physical therapy, treadmill
exercise, dance and martial arts can help a person with PD to take bigger
steps, walk more quickly, extend the arms farther, rise more easily from a
chair and improve balance. In addition, exercise in general can lessen the
severity of nonmotor symptoms such as depression, cognitive changes and sleep
difficulties.
Even when the benefit is small,
exercise can improve the daily life of a person who lives with PD. Considering
that PD is progressive, such improvements are even more remarkable; simply
maintaining the same level of strength requires making gains against the advancing
disease.
Based on these findings, how can
a person with PD find the right exercise program? The right type of structured
exercise for a person with PD will depend on his or her goals and symptoms. A
key component is finding a physical therapist who can tailor a program to meet
your needs. If you struggle with balance, for example, a therapist might
develop a program aimed at improving it, through flexibility and strength
training as well as activities to challenge balance such as dance, boxing and/or
postural control exercises. But if your balance is steady, other types of
exercise — such as aerobic conditioning and lower extremity strengthening —
might be more useful in improving overall cardiovascular and strength fitness.
Activities such as boxing, martial
arts, tai chi, challenging hiking and vigorous dance can provide a combination
of improvements in balance, strength, flexibility and cardiovascular fitness.
Yoga can be helpful for improving range of motion and flexibility of certain
muscle groups.
One important note: in order to
maintain the gains made from exercise, a person with PD needs an ongoing,
long-term program. Just as you lose the benefits of a PD medication if you stop
taking it, you lose the effects of exercise if you stop the regimen.
The Benefits of Staying Active
Research shows that people with
PD become more sedentary as the disease progresses. According to one study,
people with PD were one-third less active than older adults generally. Yet
studies also suggest that staying active is critical as we age, whether or not
we live with PD. Sitting less, doing household chores, or taking a stroll in
the neighborhood might all significantly improve life with PD. Staying active
can also help people with PD maintain the gains they achieve through organized
exercise. So how can people with PD change their habits?
In addition to physical therapy,
researchers have found that setting goals can be helpful. What is your current
level of activity? Can you set a goal to walk a bit more, or move more during
the day? Even modest goals — for example, getting up to take a pill rather than
asking someone to bring it to you, or taking a stroll around the neighborhood
after dinner — can improve well-being.
It also helps to get
encouragement. You might want to ask family and friends to join you in an
activity or to support you by asking about your progress.
Lastly, be sure to monitor your
activity levels. There are many tools available to measure activity, including
how many steps you take each day. When I started wearing a simple pedometer, I
was amazed to find that I had increased my own steps per day from 3,000 to
10,000! Many of these tools also offer apps for mobile devices, which allow you
to share your progress with friends and family, providing a social aspect to
the experience that can keep you motivated.
The Big Question: Can Vigorous
Exercise Slow PD?
We all would like nothing better
than to find a way to slow or reverse the progression of PD. Recent research
suggests that vigorous exercise may be one of these ways. In one small study,
overall PD symptoms improved remarkably among participants who were pushed to
bicycle 30 percent more intensely than usual. Animal studies suggest that
intensive exercise can protect the brain. And we know that regular exercise
reduces cognitive difficulties among older people.
The jury is still out, however,
on whether exercise can protect the brain cells that are lost in PD. Studies
are under way to determine the best “dose” of exercise, and how effective it
can be early in PD. It may be, for example, that in early-stage PD, certain
types of exercise can be as effective as medications in reducing symptoms.
Conclusion: Keep Moving!
Getting into the habit of
exercising and being active, and cultivating those habits over the long term,
are important for anyone, but are especially important for someone who has PD.
We are still learning about the effects of exercise on PD, and we know that
there is no “one-size-fits-all” prescription. For sedentary people, just
getting up and moving is beneficial. More active people can build up to
regular, vigorous activity. But there is no doubt that many approaches to
exercise work well. So choose ones that you enjoy, and keep moving!
Dr. Schenkman is Associate Dean for Physical Therapy Education,
and Director, Physical Therapy Program, University of Colorado School of
Medicine.
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| By Margaret Schenkman, P.T., Ph.D., F.A.P.T.A. |
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