Aging and Body Changes
Aging and Physical Change
To do well with Parkinson’s one must age well.
Some Parkinson’s symptoms can aggravate changes with age such as slowness in movement and thinking, flexed posture, stiffness, joint and muscle and back pain. Understanding how the body changes, what is preventable and what it means to us and our activities with age is important to our health with Parkinson’s. This article is part of a two part series- Aging and Our Senses and Aging and Our Body.
Your bones can become less dense and more brittle (osteoporosis- see Bone Health) leading to increase risk of fractures from falls and injury. Your spine can compress causing your posture (see accompanying article, Posture) to change, shoulders to slouch or even height to shorten. This is caused by a combination of density loss in vertebral bones and a los in height of the disks that serve to cushion the vertebrae. More information about osteoporosis and what you can do about it is available in the article Bone Health.
· See your doctor for a bone density screen especially if you are postmenopausal women, or have a risk of falling and injury regardless of gender.
· Be sure you get the required amount of calcium and magnesium in your diet.
· Get your vitamin D level checked as it has been found to be lower in people with Parkinson’s.
· Exercise, outside if you can. Your bones get stronger with weight bearing.
There are of course many causes of joint problems causing pain or limitation in movement as we age. Our joints become stiffer and less flexible with age. The synovial fluid that bathes are joints can decrease and cartilage that cushions the joint can wear down; both leading to pain and bone degeneration. Calcium can deposit in our joints.
Hips, knees, shoulders, and fingers show more change than other joints such as elbow or ankle.
Degenerative joint disease otherwise known as osteoarthritis or wear and tear arthritis is a common cause of joint pain in older people. It is caused by a breakdown in cartilage at the joint. Cartilage is necessary to cushion and lubricate the joint. The hands, feet, spine, hips and knees are the most common joints affected. This type of arthritis can run in families and is more common in med under the age of 45 years and women over the age of 55 years. More information on arthritis will be posted in a future article.
Pain from arthritis is often a combination of true joint pain and pain that results from inactivity. Inactivity leads to muscle atrophy, decreased strength in muscles, ligaments and tendons, mood problems all further worsening pain. A medically supervised, slow and gradual exercise and strengthening program can improve this pain!
Morning stiffness can be a sign of your Parkinson’s and arthritis. Stiffness from arthritis is located in the joint area and is usually present for 30 minutes but then improves. Stiffness from Parkinson’s rigidity can be present in the morning especially before your medicine is due but typically is felt more in the muscle and less in the joint. You can of course have stiffness from both causes.
· Talk to your healthcare provider about treatment.
· Ask for a physical therapy referral.
· Take an honest look at your diet if you are overweight. Even five pounds of weight loss will reduce the pain from a joint that is required to work with the extra weight.
· Get exercise. You might first consider gentle exercise- such as gentle stretching, yoga (look for gentle, therapeutic or restorative yoga), or water therapy. Overtime added strengthening; flexibility and aerobic activity will increase stamina, joint mobility and reduce pain.
Muscles atrophy or become smaller due to changes in neurologic control, reduced activity and change in muscle itself. Muscles fibers become smaller with fat deposited in the muscle. Muscles change before the age of 40 and to some degree this is genetically determined. It is interesting to note that although these changes reduce the ability to sprint or perform fast quick movements, endurance is actually improved. This is why many endurance athletes such as marathon runners can perform well even in older years.
· Add muscle strengthening and stretching exercise to your daily routine.
· See a physical therapist or personal trainer to help you design and maintain an exercise routine, respectively.
· Be sure you get the protein you need (0.36g/weight in pounds for people without other medical conditions). People with Parkinson’s sometimes skimp on their protein due to concerns of interference with levodopa (see article on protein and levodopa).
Change in stamina and endurance is caused by many factors. The joint and muscle changes described above can play a role. Changes in movement control due to conditions such as Parkinson’s not only make your movement slower but also increase the work or energy that is exerted to move. Inactivity is a significant cause of reduced endurance. Other medical conditions such as heart disease, lung disease, blood pressure control problems, cancer, obesity, thyroid conditions, and diabetes to name a few are medical conditions that affect stamina.
· See your primary physician to be sure your medical problems are well treated.
· Talk to your provider about a heart healthy lifestyle.
· Drink plenty of fluids to avoid dehydration or low blood pressure.
· Avoid rapid swings in blood glucose by eating a diet high in fruits, vegetables and whole foods and low in processed, high fat foods.
· Ask for a nutrition consult if you are a diabetic. Also be sure you know how to manage your blood glucose levels and know your hemoglobin A1C, a long range marker for glucose control, and what your target range should be.
· Talk to your healthcare provider about weight loss if you are overweight.
· Ask your Physical therapist to design an exercise program with stamina and endurance in mind.
Walking and Balance
As we age, changes in walking and balance have many causes include change in muscle strength, joint, coordination, stamina and neurologic changes such as that seen in Parkinson’s disease, peripheral neuropathy or stroke like conditions (all conditions that increase in frequency as we age). There is debate in the scientific literature as to whether there is truly a senile gait, that is does our walking have to change with age and some researchers believe that the answer is no- that is, not everyone is destined to experience change in walking simply due to aging. Work on your balance now whether you have a problem or not.
· Perform balance exercises every day. These exercises often take little time and energy so can be done easily if you make the habit.
· See a physical therapist to get started to tailor these exercises to your needs and to keep you safe while exercising. The therapist will focus on:
o Safe exercise and avoiding injury
o Developing a program that meets your needs today and can grow with your needs
o Core strengthening for posture, balance, and prevent back injury/pain
o Posture and spine.
o Strengthening, flexibility and balance/coordination
o Routine that is fun
o Tips and follow-up to insure motivation and follow through is strong.
· Think general health and be sure you get the sleep you need, eat the right foods, and
· Take a walk everyday if you are able.
Author: Monique Giroux, MD
Copyright 2011 Northwest Parkinson's Foundation Wellness Center