Parkinson’s disease (PD) is a slowly progressive neurological condition that affects over one-million people in the United States alone. Onset usually occurs in the fifth or sixth decade of life, however up to 10% of individuals will receive a diagnosis before the age of 50 {1}.

The basic characteristics of Parkinson’s disease are motor problems including slowness of movement, rigidity and tremor.

People with Parkinson’s are also likely to experience balance and gait problems later in the course of illness. Also difficulty with fine motor movements, such as handwriting may also occur.

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There are also numerous amounts of non-motor symptoms associated with Parkinson’s. These include fatigue, anxiety, depression, and sleep disturbance. Symptoms vary significantly from person to person. (Table 1)

As I write this article there is no known cause of Parkinson’s disease.

The loss of either cells in the substantia nigra of the brain or the loss of pigmented neurons contributes to motor symptoms {1}.

Dopamine, a chemical responsible for smooth purposeful movement, is produced in several areas of the brain, including the substantia nigra and the ventral tegmental area. It is a neurohormone that is released by the hypothalamus {1, 2}.

A decrease in dopamine does not account for all symptoms experienced in PD.

There is ongoing research to better understand the pathology of Parkinson’s disease.

Currently there is no diagnostic test or biological marker that confirms a diagnosis of Parkinson’s. The confirmation of a positive diagnosis is based on medical history and physical examination performed by an experienced practitioner, most likely a movement disorder specialist (MDS) {1}.

An MDS is a neurologist with additional training in Parkinson’s disease. A person’s activity of daily living, current symptoms and age are some of the factors that go into an individualized treatment program.

This article will focus on exercise as a treatment for PD.

At this time, there are no specific recommendations on what type of exercise for Parkinson’s Disease is most beneficial{6}. However, one thing is agreed upon by most clinicians, exercise is essential for people with PD.

Individuals are encouraged to consult with a physical therapist or fitness professional familiar with PD. An exercise program should include cardiorespiratory, resistance and flexibility training.

Gait and balance training must also be involved as part of a person’s lifelong commitment to an overall comprehensive training program.

A well-planned consistent exercise program has shown to benefit people with PD by reducing stiffness and improving mobility, improving oxygen capacity and reducing depression {3}.

Exercise for Parkinson’s Disease2

One approach to treating PD with exercise is the Lee Silverman Voice Treatment (LSVT) Big program {4}.

LSVT Big uses the idea that was similarly used with the original LSVT Loud program, which is an exaggerated motion or multiple exaggerated motions.

In LSVT Big, the individual mirrors the instructor through a series of stepping, rocking and large arm movement activities.

Becky Farley, PT, PhD, the inventor of LSVT Big, says the program trains for both speed and amplitude {4}. The protocol entails many repetitions of core movements that are used in daily living.  LSVT Big works on all stages of PD, from early onset to later.

Not only are the movements incorporated beneficial for people with PD, but people with other neurological disorders, i.e. stroke, as well as people with orthopedic issues can attain gains with LSVT Big.

Robert D’Egidio PT, DPT with Atlantic Health System in New Providence, New Jersey agrees that LSVT Big has good theoretical principles and excellent activities, but states that there are limitations in the programs ability to produce enough cardiorespiratory benefits and most people are not going to commit to the required frequency of effectiveness (2x/day; 7 days/week) as well as the LSVT Big strength/flexibility component is geared to the person’s ability versus their potential {5}.

He uses LSVT Big as a complementary activity to the program he is developing; Atlantic Health – Functional Based Exercise Regimen (AH –FBER). Robert’s contention is that people with PD can be pushed well beyond their perceived exertion and stretch tolerance.

The approach, which of course depends upon a person’s ability, pain limitation, degree of symptoms and cardiorespiratory condition, begins with seven exercises to train immediately.

The Exercises

This foundational routine consists of: deep sitting, step up with opposite knee drive, lunge, alternate standing hip abduction, marching, step jacks and lunge walking {5}.

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The reason these exercises are used in the foundation routine is that they can be done utilizing bodyweight alone, they emphasize functional type exercise, they are intense enough to increase a person’s heart rate by at least 20 – 30 beats per minute and they address the component of balance {5}.

(Table 2)  After this foundation set is introduced, approximately 5-6 sessions and depending upon the person’s progress, increased progressions will be made to the exercises.

Part of a person with PD’s day to day activities will most likely include walking to some degree. Individuals with PD often have problems with abruptly halting or “freezing” when they are walking.

To try to decrease these “freezing” episodes one can try reciprocal arm swinging, high – long steps, paced walking with high stepping or loud rhythmical clapping {3}.

Physical activity has been shown to have positive influences with regards to neurodegenerative diseases with exercise showing a correlation to an improvement of motor symptoms in PD {6}.

It is possible that these benefits occur through mechanisms that reduce inflammations in the central nervous system {6}. Animal models have shown that exercise may confer a “neuroprotective” benefit in PD.

In addition to exercise being physically beneficial for people with PD, it will also have an emotional effect.

As we know, exercise, especially in groups, promotes unity and enthusiasm for individuals with a desire to continue exercising. It is also helpful for mood disorders such as anxiety and depression, which are common behavioral symptoms for people with PD {6}.

There is still work and study to be done, but exercise for Parkinson’s Disease is key to a quality of living in sufferers.

People with PD should begin an exercise program with either a physical therapist or fitness professional that has an understanding of the disease.

Individual programs can be tailored to a person’s ability as well as to how advanced the disease is.

The positive and supportive environment within the setting of a group cannot go unnoticed as common bonds are formed and a circle of support is built. In the meantime, research is ongoing as to why exercise is a valuable tool to fight this disease.

 

References:

1. http://www.apdaparkinson.org/publications-information/basic-info-about-pd/
2. http://www.news-medical.net/health/What-is-Dopamine.aspx; What is Dopamine?; By Dr Ananya Mandal, MD.
3. Exercise and Physical Therapy for Parkinson’s Disease. Parkinson’s Disease Clinic and Research Center. University of California at San Francisco. http://pdcenter.neurology.ucsf.edu.
4. http://news.todayinpt.com/apps/pbcs.dll.  Today in PT. Teresa McUsic.
5. D’Egidio, Robert PT, DPTApproach to Treating People with Parkinson’s Disease.  Atlantic Health System. Overlook Medical Center, Summit, NJ.
6. Effects of a formal exercise program on Parkinson’s Disease: A pilot study using a delayed start design.  A. Park, D.Zid, J. Russell, A. Malone, A. Rendon, A. Wehr, X. Li. Parkinsonism and Related Disorders.  www.elsevier.co/locate/parkreldis. Oct 2013.

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