Exercise for Parkinson's Disease: Principles

H. Paul Zeiger, Ph.D. and Carolyn A. Zeiger, Ph.D.

Introduction

Ten years ago exercise programs for PD were very little known. (An exception is the work of John Argue ) Today exercise is recognized by experts in the field as an essential constituent of best-practice therapy -- right from the start. (See web site for Professor Fay Horak )And programs are becoming more and more widely available.Instructors in a variety of classical disciplines: personal training, dance, Tai Chi, and yoga, to name a few, are adapting their instruction for use with PD. Research work by professional scientists from the academic world of physical therapy are measuring results and coming up with recommendations.Principles are emerging that apply across the board to whatever form of physical activity is under discussion, and such principles can be very helpful in designing your own practice. Here is an interim report on those principles. It is aimed at those recently diagnosed with PD, and their care partners and exercise professionals.

1. Start now and keep at it (several times a week)!

Exercise is like brushing your teeth -- a regular component of hygiene necessary for maintaining as much functionality as possible. It is OK to use self-discipline to get started, but in the long run it has to be fun enough and feel natural enough to continue without a stern internal overseer.That will probably mean taking advantage of a number of available resources, including doctors' prescriptions for physical therapy, specialized classes, support from friends with and without PD, books, and DVDs, and a commitment to ongoing learning.

2. Make it support the activities that you care about (which may change over time).

That means paying close attention to your activities of daily living, as well as recreation and hobbies, and observing where the PD is getting in your way. Your care partner can also be a valuable source for this information.

Lost abilities can often be relearned, frequently by doing consciously what was formerly done unconsciously. This has been shown over and over again in the areas of posture and walking. Persons shuffling along, bent over, without arm swing have regained a normal posture and gait.The price is lots of attention, lots of practice, lots of repetition.

Ask for help.Doing any kind of training solo is hard, even if you don't have a condition like PD that saps your enthusiasm and resolve. Use whatever you can find: support groups, knowledgeable physicians, physical therapists, etc.Your physician(s) may be able to help with appropriate prescription drugs to reduce not only the disorders of motion but anxiety and depression as well.Make sure that at least one of your physicians is experienced in evaluating the combined effects of everything you are prescribed.Note: Apathy is a very common early symptom.

Do not assume that anything is either possible or impossible without designing (safe) experiments for finding out. The literature is full of surprises about what people with PD can do. Your body is unique; find out for yourself (and do not consider it failure when you find things that are beyond you, that too is useful data).

3. Evolve your practice.

Regardless of what physical activities you engage in, as you improve at them, there will be opportunities to enhance them in the directions of bigger, stronger, and faster motions. Professor Becky Farley (see references) has conducted numerous experiments to demonstrate both the importance and the feasibility of making such enhancements when working against PD.Of course, balance and safety will need to be preserved.It's an important skill for exercise professionals working with PD to know how to push the envelope while preserving safety.

4. Keep an eye on (and have your care partner keep an eye on) abilities that are most frequently compromised:

Multitasking: as when in daily activities you are interrupted by a phone call and lose track of the fact that you had taken out half of the garbage.Challenge your multitasking by, for example, spelling or doing mental arithmetic while walking an obstacle course.

Balancing on one leg while moving the other to a new position If you are shuffling, this skill may need work.Tai Chi and dance have exercises for this (dancer's ronde de jambe on the floor, for example).

Keeping your center of gravity over your base of support, especially front to back: For example, if you are standing up straight, your base of support is the four-sided figure on the ground marked by the outside edges of your feet and two straight lines, one between where your two heels rest on the ground, and the other between where the two balls of your feet rest on the ground. Your center of gravity lies roughly at the core of the pelvis, and if you lean in any direction until that center gets to a point outside the base of support, you will start to topple over. Normally a reflex action sets in before the point of toppling, but that may not always be guaranteed in the presence of PD.If this reflex is weak or lacking, that is ample justification for a prescription of physical therapy.

Shifting weight from foot to foot: Exercises include shifting from side to side, front to back, around in a circle, and along the boundary of your base of support.If this skill is lacking, it will be harder to recover from freezing, because a frequently effective way of breaking a freeze is to start by rocking from side to side until one foot gets entirely unweighted, and thereby movable.

Breathing deeply: This one tends to sneak up. Yoga breathing exercises or any kind of cardiovascular challenge are important tools.Possibilities include cycling on bike, trike, or stationary cycle, running, walking uphill, walking with poles or a walker, and turning a crank with the arms.

Opening the upper chest, both side to side and bottom to top:Notice the hunched forward posture of many with PD (and many without).This can be prevented and even undone by persistent exercise over a long time.Many yoga poses (starting with Bridge) work this issue.Renee Le Verrier's text and DVD are good references.

Ability to deliver force and speed simultaneously, as when shooting a basket or jumping over an obstacle: This is a huge issue, recently isolated by Becky Farley and addressed in her PWRGYM activities.

Swinging your hips (and hence your arms) when walking: Many a case of PD has been diagnosed by observing a walk that lacked swing of the hips and arms.These tendencies can be attacked directly by conscious practice.For some, music helps.

Engaging in a practice along the lines outlined here works!To cite just three modest examples, we have seen one person double the distance from which he could sink a basketball shot,another enhance his golf drive by 30 yards, and another learn to rise smoothly and easily out of a chair, something that, before practicing, he had lost the ability to do at all, let alone do it smoothly and easily.

For additonal reading on this subject, see Terry Ellis and Renee Le Verrier .