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PARKINSON'S DISEASE AND EXERCISE


Parkinson's disease is a neurological disorder that results from insufficient dopamine, a brain chemical.  For reasons not completely understood, specialized nerve cells deep in the brain gradually stop producing dopamine.  The loss of dopamine causes major neurological signs of Parkinson's disease to develop:
  1. Tremor - shaking that usually begins in one hand or foot, but may progress to include all 4 limbs.  Occurs at rest but disappears during sleep and activity.
  2. Muscular rigidity - an increased resistance to joint movement.  May feel like stiffness, achiness, fatigue, or pain.  Leads to impairments in walking, breathing, facial expression, swallowing, and speaking.
  3. Bradykinesia (slowness of movement) - Slow movement; generalized fatigue; difficulty with simultaneous movements, complex activities, and starting or stopping movements.  Automatic movements, such as the arms swinging during walking, may disappear, this is the most disabling sign of Parkinson's disease.
  4. Balance problem - difficulty changing directions while walking, taking faster and faster small steps while walking, or frequent falls.
 
Common physical impairments of Parkinson's disease include:
 
• Forward stooped posture
• Decreased strength
• Cardiovascular changes
• Mask-like facial appearance
• Malnutrition
• Visual impairment
• Decreased joint range of motion
• Bowel and bladder dysfunction
• Oily skin, excessive sweating
• Difficulty chewing and swallowing
• Speech difficulties
• Shortness of breath, poor breath control
• Gait impairments - small shuffling steps, festination (rapid small steps with
   forward movement of the body), loss of automatic movements, difficulty stopping
   or startling, freezing, falling.
 
 
Exercise is an important part of treatment for the person with Parkinson's disease.  The earlier exercise begins, the better.  Activity and exercise will delay some of the effects of aging and inactivity usually seen with Parkinson's disease, and will improve the overall quality of life.  The exercises must be appropriate for each individual, so always check with your doctor before beginning any exercise program.  Some general exercise guidelines:
  • Find the right balance between activity and rest.  Too much activity increases fatigue, but too little increases disability.
  • Exercise during peak medication coverage and during times of decreased stiffness and soreness.  This may be later in the day.
  • Adjust your exercise program as needed as your conditions changes, and also from day to day, depending on your fatigue level.
  • Seek help from your doctor if your condition changes.  Your doctor may recommend that you see a rehabilitation professional for specific therapeutic exercise or for help with balance and walking.

The following types of exercises are beneficial for the person with Parkinson's disease.  Always check with your doctor before beginning any exercise program.  All exercises may not be appropriate for all individuals, and other exercises may also be appropriate to meet your individual needs:

  • Build your cardiovascular endurance.  Endurance, and aerobic exercise, designed to benefit your heart, lungs, and circulation will improve your overall endurance and minimize some of the declines associated with Parkinson's disease.  Walking or cycling on a stationary bicycle are some aerobic exercises.  Begin aerobic exercise training gradually, working at a moderate, comfortable intensity.  A goal of 30 minutes of endurance exercises most days are recommended for adults, even those with Parkinson's disease when possible.  Three 10-minute exercise sessions, spaced throughout the day, are nearly as beneficial as one 30-minute session.  Some people with Parkinson's disease may not be able to exercise aerobically because of their health status.  Your doctor can help to determine if and what type of aerobic exercise would be best for you.

  • Posture training and being aware of posture during activity and rest will help your body resist its tendency toward flexion that accompanies Parkinson's disease.  Go through your body a segment at a time to "check" your body alignment.  Good posture enhances social interactions, speech, vision, balance and fall prevention.

  • Range of motion exercises with an emphasis on fully straightening the joints are important to stay flexible.  Parkinson's disease causes a selective weakness in the muscles that straighten the joints (extensor muscles), therefore the joints tend to bend, and may even lose their ability to fully straighten.

  • Facial exercises help reduce stiffness in the muscles of the face that occurs as a result of Parkinson's disease.  Range of motion exercises for the eyes, tongue, jaw, and lips, and exaggeration of facial expressions are used to fully lengthen and shorten the facial muscles.  This type of exercise helps to delay the onset of chewing and speech difficulties, as well as the mask-like facial appearance, characteristic of Parkinson's disease.

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  • Deep breathing exercises help to keep the muscles used for breathing strong and flexible.  This is important to avoid shortness of breath and loss of the breath control necessary for speech.  Click here for more information about deep breathing.

  • Balance and standing exercises help a person with Parkinson's disease to maintain or increase leg strength and improve balance to prevent falls.  View standing exercises for balance or leg strenthening and balance for exercises to improve balance.
  • SIT AND BE FIT videos that provide the best exercises for people with Parkinson's disease include:
     
    *Tone & Stretch IV:  DVD  VHS
    (exercise band, faster)
    *All American Workout:  DVD  VHS
    (exercise band used for challenging exercises)
    *These videos are more challenging, and therefore more appropriate in the earlier stages of Parkinson's disease.
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