Benefits of Exercise in Parkinson's Treatment

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Physical therapy can be extremely beneficial to older adults with Parkinson's disease. Effective therapy can slow the functional decline associated with the disease. Because exercise reduces stiffness and improves mobility, posture, balance and gait, it is extremely important to include in PD patients' regular routines. Family members and caregivers should encourage and assist exercise and regular activity as much as possible. The overall value this has on their quality of life is undeniable. Outside of the obvious support it provides with mobility, the confidence produced has a well-rounded positive effect. When in a group environment, it helps patients remain social, which is of great value.

If a patient is not already an active person in their daily life, it is never too early to initiate activity. Everyone is different, and PD-related mobility impairments happen in different stages for every patient. Establishing such a routine has early rewards, but it is a little easier to incorporate the use of physical therapy when the time arrives.

Primary physical symptoms like rigidity, resting tremor, bradykinesia (slowness of movement), akinesia (hesitancy), and balance problems can increase fall risk and cause difficulties with daily activities, including walking, rising from sitting, and getting in and out of bed.

Let’s look at some available exercise options and their benefits.

A skilled physical therapist (PT) can develop exercises and activities to help a patient overcome these symptoms. Physical therapists also are knowledgeable on how medication and exercise can work together. They can recommend activities and training to help patients get the most from their drug treatments. A physician may order physical therapy as needed and private clinics that offer specific programs are becoming more common.

A physical therapist can create a program that improves strength, range of motion, and balance, as well as perform a home safety check to make sure that the environment is organized to allow safe and maximal function. This can include simple things such as removing small obstacles from pathways. PTs are the experts in gait training (improving walking), which can be one of the most impacted activities for Parkinson's patients.

When confidence in mobility is lessened, the patients will choose to become still, avoiding getting out or even ceasing to care for themselves. This behavior is a direct path to more severe stiffness, rigidity and depression; it will only aggravate their symptoms and lessen their quality of life.

The simple task of initiating walking can be a big challenge for those with Parkinson's. PTs can use visual and auditory cues that overcome the "freezing" that patients experience and provide training on using these techniques independently. For example, sometimes the rhythmic sound of a metronome can cue steps during walking. A shuffling gait pattern can also develop and visual cues such as tape lines on the floor may encourage increased step height and stride length and decrease the risk of trips and falls.

Incorporating elements of yoga, Pilates, tai chi, dancing or boxing to exercise programs can improve core strength and balance and facilitate rotational movement to combat rigidity. Physical therapists can help determine if an assistive device, such as a cane or Rollator, is needed, and train patients on how to use these devices. The PT can also recommend simple home modifications, such as adding grab bars or removing throw rugs, to increase safety and function. A custom home exercise program can augment the work done in therapy sessions and after discharge from therapy.

Some physical therapists have attended continuing education courses to become certified as BIG therapists, providing the LSVT BIG protocol of care to patients with Parkinson's. This is an exercise treatment program for people with PD based on the principle that the brain can learn and change (neuroplasticity). It has been formulated from an existing program to help with speech for people with PD called the Lee Silverman Voice Treatment. This treatment focuses on the limb motor systems, helping participants use self-cuing and attention to their actions to make bigger movements. By focusing on the core movements used in daily living, LSVT BIG helps overcome movement impairments.

Patients simply focus on a single goal to THINK BIG! The program trains patients to utilize this bigger effort in all aspects of daily life. It targets bradykinesia, which causes PD patients to move slowly and ultimately underestimate the amount of effort required to produce a normal movement.

With repeated practice, LSVT BIG teaches patients the amount of effort required to produce normal movement. This normal movement is significantly impaired for PD patients and the increased effort translates those bigger movements into everyday activities. It is a standardized protocol delivered in a one on one session by a certified Physical or Occupational Therapist. Usually patients are treated four days a week for four weeks. During that time they are encouraged to make big efforts, big steps, and big gestures through a series of maximum daily exercises. Patients learn this recalibration of movement, if they do not feel like they are not moving too big, then they are not moving big enough. During the training period, patients also complete goal-oriented activities, which includes a program of high amplitude movements and motivation feedback that is necessary to produce maximal neuroplasticity.

Furthermore, exercise increases oxygen delivery within the body, reduces stress, and improves mood and sleep. More importantly, patients with Parkinson’s disease benefit from exercise as a neuroprotective measure. Specifically, exercise can help protect the remaining viable dopamine neurons and help slow the progression of the disease.

It is important to make physical therapy part of the treatment regimen for Parkinson's disease upon diagnosis. In the past, PT intervention would often be delayed until later stages of the disease, usually after a damaging fall. Now it is thought that earlier intervention may potentially contribute to the slowing of symptom progression. Help your loved one start moving and create a routine they enjoy as early as possible.

If your loved one has Parkinson's and is not receiving physical therapy, find out what you can do to add it to their normal activities.

There are many avenues and options available. Senior Centers often have tai chi and yoga classes available for nominal costs and sometimes free of charge. Many churches and community centers also offer these special and fun low-impact classes. It is well worth the positive results to perform a little research and find a comfortable place for exercise. The social interaction as well as the benefits of movement can be invaluable in our quality of life. There are so many options available to us, whether ordered by a physician, private clinic or community center, that it is an easy goal to choose and begin. Help your loved one make the decision to move better.

Melanie Sponholz is a Physical Therapist with a Board Certification in Geriatrics (GCS). Melanie is the Director of Quality Assurance and Professional Development at Fox Rehabilitation. She is an alumnus of Columbia University where she received a Master of Science Degree in Physical Therapy.

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4 Comments

My mom has PD and gets PT with the "think big" program as often as her Medicare will allow (usually 2X a year for @ 4 wks each time). I try to do some of the exercises w/her esp. walking everyday. However she is Stage 4 of PD and cannot get up or walk w/o assistance (me holding the gait belt and her using a walker designed for PD patients). Mom can only do this for @ 90 seconds maybe 2X a day The therapists are wonderul and optimistic and mom looks forward to it although it's become more of a social visit than real PT as far as I'm concerned.Not that it's anyone's fault. Mom's limited so the PT does what she can. She does the 'think big' program and I'm sure it works with other PD patients who are in maybe Stage 2 or 3 PD. But all the" retraining of the brain" to make bigger movements does not work so well in someone whose physical and mental capablitiies are just too compromised to allow for that.
2 things:
1. Make sure the symptoms are not a side effect of a drug they are taking. My loved one was on an antidepressant (Paxil) and once they were taken off it, the problem went away.
2. People with Parkinson's Disease can ride bikes (no joke) One gentleman who struggled to just stand could ride a bike around a parking lot. Regular bike riding can stop symptoms.
Another cycling success story - "Where did my tremor go?"