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I have Parkinson’s disease, what type of exercise should I do?

Whether our patient’s are newly diagnosed with Parkinson’s disease or were diagnosed years ago, they often have been told by their neurologist (hopefully) that exercise is now considered medicine when treating Parkinson’s disease. The intent of this blog is not to explain why, physiologically, exercise is beneficial, but to help you in selecting what type of and how much exercise is best for you.

Our basic and guaranteed response to the above question is to find an exercise modality that you enjoy and will stick with. The key to gaining benefit from an exercise program is consistent participation. If you don’t like the type of exercise you’re doing, you will have a hard time making it a part of your lifestyle.

Focus on the “components” of fitness

A well-balanced exercise program should include the following components. The first four are often reinforced by the exercise industry. I have added in my own components of fitness that are specific to Parkinson’s disease.

Muscular strength – muscles strength is a critical component for movement. You can focus on doing strength training of major muscle groups as part of your routine. The American College of Sports Medicine (ACSM) recommendation for adults with neurologic conditions is progressive strength training of major muscle groups at least 2 days/week. Strength training can entail the use of free weights, resistance bands, or use of your own body weight (such as squats, push-ups, or planks).

Muscular endurance – the ability of our muscles to perform a task for a long period of time (or even performing that task repeatedly) can be trained or improved through exercise. Think about picking up your child/grandchild versus holding them for 10 minutes. This can be achieved by using a higher number of repetitions while strength training, or by holding poses for longer. For example, gradually increasing how long you hold a plank or bridge.

Aerobic endurance – this is your ability to sustain an activity like jogging or bicycle riding for a length of time. Your body adapts with practice to an improved response from your heart, lungs, and circulatory system. The ACSM recommends 150 minutes/week of moderate intensity aerobic exercise (like cycling or treadmill walking). Moderate intensity is working at 60-80% of your maximum heart rate (220 heart beats/minute – your age). 150 minutes/week sounds like it is hard to do, but this goal can be achieved in 10 minutes increments. You can also sneak aerobic exercise in by making small changes such as taking the stairs instead of the elevator or parking farther away from the entrance to the grocery store.
Flexibility and posture – muscle rigidity is a common symptom of Parkinson’s disease, making regular flexibility training a critical component to moving better without pain or stiffness. Keeping your trunk muscles flexible helps prevent the flexed, stooped posture associated with Parkinson’s disease.

Balance – postural instability is common symptom of Parkinson’s disease. Balance problems can lead to falls and all of the other nasty complications that come with ending up on the floor. Balance exercises can be easily added into your routine. If you are experiencing falls, I may be a good idea to get a physical therapy evaluation to fully evaluate what component of your balance needs improvement.

Amplitude and speed of movement – People with Parkinson’s tend to move slower (bradykinesia) and smaller (hypokinesia) than people without Parkinson’s disease. You can purposefully move faster and bigger, getting more “bang for your buck” by having an outside source pushing you. Have your partner set the pace of your daily walk faster than your self-selected pace. Walk using nordic walking poles to push your arms through a bigger range of motion (this also increases your stride length). Many popular Parkinson’s specific exercise programs use this concept. Dr. Jay Alberts from the Cleveland Clinic and with Pedaling for Parkinson’s found that “forced exercise” on a tandem bike helped reduce motor symptoms of Parkinson’s disease. “Forced exercise” is a term to describe working at a rate beyond your self-selected speed, so pedaling at 85 rpm vs 60 rpm. PWR! Parkinson Wellness Recovery, created by Becky Farley, PT, MS, PhD emphasizes exercising and moving with a high level of physical effort to create more benefit from your daily exercise routine.

To Summarize:
Working beyond your self-selected rate, intensity, and with effort is a major key to gaining more benefit from exercise. Taking these concepts and generalizing, I feel comfortable recommending finding a type of exercise that your enjoy, that is challenging, and where the pace or intensity is set by an outside source. Examples of this would be taking a class where the instructor is setting your pace, exercising with a partner, and by learning a new skill. Variety is the spice of life. Aim for more benefit with all of your exercise modalities, push yourself beyond your comfort level, and strive to add in the above listed component of fitness.

mydenverpt

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04 Nov, 2015

Physical Therapy

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