Resolution 2011 part 1 gave you some helpful hints to begin your exercise program. Now use
the acronym F-I-T!
to get you started on your exercise program.
Evaluate your current status. Are there daily activities that have become more difficult to perform? Perhaps it’s carrying a bag of groceries into the house. Or maybe it’s trouble walking with an uncooperative leg or shuffling. Maybe you feel off balance in certain situations or have difficulty getting up off the sofa or out of the car. Perhaps you struggle to turn over in bed or get up and down from the floor. Or you can’t walk as far as you used to and struggle with fatigue. Your golf score may be suffering.
Identify these functional limitations and write them down. Then think about what may be restricting you. It often is not just a strength issue. Also consider your Parkinson’s disease (PD) symptoms and how they relate to your challenges.
It may be a fuzzy mind/body connection since PD affects the “automatic pilot” in the brain and forces you to pay attention to movement in order to make it happen, taking more of your concentration. Doing other activities (the proverbial chewing gum!) while walking may be challenging. You could be deconditioned with poor stamina simply from being more sedentary and not regularly getting the physical activity that you once did. You could be lacking flexibility as the muscle rigidity from PD begins to get the best of you; this often affects muscles surrounding the spine and can result in postural changes and pain. Perhaps your reflexes and reaction times have slowed preventing the quickness for activities like playing catch with the dog or your grandchildren. If your balance is affected you may have had a few unexpected falls or close calls. You may experience changes in your walking that have led to one foot catching or stumbling especially on uneven ground.
After you have identified what may be contributing to these changes in your day to day function, try and set some specific functional goals for yourself based on these daily activities. Identify realistic outcomes you’d like to achieve and set a target date. Perhaps you want to be able to be able to walk across the soccer field to a grandson’s game or make it around the mall without resting on a bench. Or maybe you’d just like to get off the couch on the first try! List several functional changes that are realistic and maybe one that’s a bit of a stretch like learning a new dance step or walking a 5K. Make it relevant to your situation.
Setting goals can be motivating and can help you see progress which in turn encourages you to keep going. Exercise is also a great anti-depressant and can improve mood and attitude.
The I is for information. A well-informed person with Parkinson’s can get his or her most bang for their exercise buck
INFORMATION: research about PD and exercise
It’s important to be informed about studies pertaining to PD and exercise to reap the full benefits based on scientific evidence. Here are some recent studies:
A mini review of the literature published to date on treadmill training for the treatment of gait disturbances in people with PD was performed and published in The Journal of Neural Transmission in March 2009. 11 long-term trials reported positive benefits in gait speed, stride length and health related quality of life. Long-term carryover effects suggest there may be a neuroprotective effect, meaning that it may actually slow down the progression of PD in the brain. Additional studies need to be done to further study this. However, evidence points to the fact that using a treadmill has a positive effect on walking in a person in PD and would be a good choice for an exercise program. Some of the studies followed a routine of 3 days a week for approximately 45 minutes working at a training heart rate. To view some interesting research on primates involving treadmill training and neuroprotection check out an episode of the news program Frontline titled “Parkinson’s: Is exercise the answer?” on www.youtube.com.
Dr. Jay Alberts of Cleveland Clinic noted improvements in a person with PD after tandem cycling and keeping up to an rpm rate of 80-90 rpm, which was driven by the person in front. This is a higher pedaling rate than the person would have generated on their own. He conducted a small study using stationary tandem cycles to employ this “forced exercise” phenomenon and found up to a 30% symptoms improvement in persons with PD with gains lasting 2 weeks later. He is in the process of conducting a larger-scale study on this effect and looking at motorized stationary bikes such as the Theracycle. Watch an episode of Good Morning America called “Can Exercise Treat Parkinson’s?” for more details at www.youtube.com
A recent article in the April 2009 PT Journal by researcher and PT Dr. Fay Horak proposed a program of “sensorimotor agility” based on her earlier research on Parkinson’s following a strong scientific framework. It incorporates principles from boxing, kayaking, Tai Chi and Pilates as well as coordination drills (think football practice!) or lunges.
Numerous other studies have shown stretching exercises, especially for the spine (axial mobility) can improve function in persons with PD. Other research has looked at the benefits of strength training which can improve ability to get up from a chair and contribute to better balance. Many more studies are currently underway. Expect to hear much more about the neuroprotective effects of exercise.
T is the last letter to help get a program underway:
TRAINING: decide what you will do and how often
Some considerations: Incorporate components of exercise that address the limitations from PD such as a walking program to address gait changes or strengthening the legs to improve balance and daily activities such as getting up from a chair. Add stretching or yoga if flexibility is an issue. Consider mind-body practices such as Tai Chi to improve your awareness and posture.
Look at recent research and decide if treadmill training, tandem or motorized cycling is something that is accessible or appealing to you. If not, select a related activity like outdoor walking, hiking or stationary biking instead. If you are a more advanced exerciser consider some boxing moves, coordination drills (grapevine?) or dynamic lunges.
Start with a small step approach and aim for 10-15 minutes most days of the week. Try not to let more than 2 days go by without doing some form of exercise.
If you lack endurance, try breaking exercise into more manageable segments such as three 10 minute walks. If possible, work up to 30 minutes or more at least 3-4 days a week.
Studies have shown that people who participate in group exercise tend to stick with it longer than going solo and socialization and camaraderie are great benefits too. Look at your local senior or community center for offerings or check with your local Parkinson’s Association.
If you feel you need further instruction on technique, progression of exercises or a change in routine consult a physical therapist, reputable personal trainer or exercise physiologist for advice. Ask your doctor to advise you as well.
Have a happy, healthy 2011 and remember: You can’t make footprints in the sands of time by sitting on your butt and who wants to make butt prints in the sands of time?
Author: Maria Walde-Douglas, PT has been a physical therapist for 20 years. She works at The Struthers Parkinson’s Center in Golden Valley, MN, a National Parkinson Foundation Center of Excellence. She teaches a yoga class for persons with PD and is certified in the LSVT BIG method of exercise for Parkinson’s. Her treatment philosophy is a holistic team approach to the management of PD and that fun, laughter and exercise are not mutually exclusive!