Exercise for Parkinson’s OverviewExercise is important for maintaining health for everyone. For people with Parkinson’s, exercise can improve quality and may help alleviate some of the most difficult motor and non-motor symptoms of the disease. Overall, exercise can benefit people with Parkinson’s in the following important ways:
Motor Symptom Management:Research has shown that exercise can improve flexibility, balance, coordination, agility, gait, and strength.
Non-Motor Symptom Management:Exercise may positively impact depression, apathy, cognition, and sleep difficulties.
Delay Mobility Decline:Studies suggest that exercise may help delay some of the common symptoms of the disease.
A Word on Parkinson’s Exercise ResearchMany studies suggest that exercise may improve how the brain uses and protects dopamine. Researchers are also looking at how specific types of movements may help counteract some of the motor symptoms that are common in Parkinson’s. For example, tai chi is a great activity for improving balance whereas boxing can help with quickness, planning and sequencing. Though many leading organizations are studying the effects of exercise on Parkinson’s, the Brian Grant Foundation works closely with the researchers at the Balance Disorders Laboratory at OHSU to develop programs and classes that are evidence-based.
A Word on SafetyExercise is essential for people with Parkinson’s, just like medicine. But balance problems and other motor symptoms can increase the risk of falling. Here are some things to consider when starting or engaging in an exercise routine:
Talk To Your Health Care ProviderWhether it’s your neurologist, physician or physical therapist, make sure you’ve talked to a health care provider about your exercise program, especially if you’re considering a new physical activity. Also, if you’re experiencing new symptoms or worsening symptoms, talk to your health care provider to make sure you’re exercise routine is safe.
Time Your MedicationsMany people with Parkinson’s have “on times” when their medications are most effective at alleviating symptoms. Exercising during on times can be more effective and can help reduce the risk of falling and other problems associated with Parkinson’s. Talk to your health care provider about medication timing for optimal exercise times.
Stay HydratedStaying hydrated with water or sports drinks is an important part of an exercise program. For people with Parkinson’s, staying hydrated can also help with low blood pressure and dizziness and may help reduce the risk of falling.
Be Mindful Of SymptomsBoth motor and non-motor symptoms can increase fall risk. Motor symptoms that are associated with a greater fall risk include slowness, rigidity, stooped posture, freezing, shuffling gait, dyskinesias, falling backwards and a narrow base of support. Non-motor symptoms, such as sleep problems that cause fatigue and cognitive impairment, can also increase the risk of injury. Be mindful of your symptoms and check in with your health care provider if you’re experiencing new or worsening symptoms.
Recommendations for Exercise for Parkinson’s
Recommendations for Exercise Intensity and DurationAny exercise is better than none. Parkinson’s patients enrolled in exercise programs for longer than six months, regardless of intensity, have shown significant gains in function. However, greater intensity reaps greater benefits for people with Parkinson’s. That’s why experts recommend that people with Parkinson’s exercise with as much intensity as is safely possible for as long as possible. The exercise sessions should be challenging, requiring focus, effort and full attention. For example, walking on a treadmill is good, but also try walking quickly outside with distractions, obstacles and changes in terrain. People with Parkinson’s should aim for the following for how much and when to exercise:
- Begin training in the early stages of Parkinson’s
- Train most days of the week, for at least one hour
- Add mental and physical challenges when appropriate and safe
- Train at higher intensity levels, meaning you can still talk while training but in short bursts
Recommendations for Types of ExercisesAbove all, do what you enjoy! Remember any exercise is beneficial. When you engage in activities that make you feel safe and confident, exercise can be fun as well as healthy. For people with Parkinson’s, aerobic activities combined with movements that address specific symptoms can help you practice and maintain everyday motor functions that directly impact quality of life. Researchers and exercise therapists often focus on the following types of movements:
- Big movements
- Full, functional, sequential movements
- Self-initiated/self-paced exercises
- Planning and decision-making movements
- Reciprocal arm and leg movements
- Torso rotations
- Erect posture exercises
- Controlled slow and quick movements
- Balance and stability exercises
- Strengthening of extensor muscles and stretching of flexor muscles
- Cardiovascular conditioning
- Dual task exercises (performing multiple tasks simultaneously) that include both physical and cognitive tasks
- Exercises that improve sensorimotor awareness
- Exercises that involve the whole body
- Loud voices
- Progressively increasing the complexity of movements by varying contexts
|Symptom||Movement Principles||Suggested Activities|
|Rigidity: Stooped posture and decreased range of motion in the neck, trunk, and hips||• Rotation • Reciprocal movement • Rhythmic movement • Extension exercises • Tall, “charge up” posture||Torso rotation exercises: • Kayaking • Golfing • Elbow to opposite knee • Side bends • Bow and arrowUpper back strengthening exercises: • Rowing • Lat pull downPilates and yoga Chest stretches|
|Bradykinesia: Slow movementsHypokinesia: Small movements and narrow base||• High effort, whole body movement • Wide base of support • Extensor muscle strengthening • BIG, fast steps • BIG, large arm swings||• Walking and agility exercises • Lunging in all directions • Boxing •Kettlebell swings|
|Akinesia: Impaired sequential coordination (includes freezing)||• Preplanning tasks • Quick change movements • Practice moving in small spaces • Understand and use external cues • Dual tasks • Sequential movements||• Walking and agility exercises • Obstacle courses • Quick turns in corners • Lunging in all directions • Boxing • Kettlebell swings|
|Impaired Sensory Integration: Problems processing sensory information||• Practice balance on different surfaces • Reduce reliance on vision and external cues||• Stability ball exercises • BOSU ball exercises • Exercises with eyes closed • Exercises with head turns • Stand on a foam pad|
|Impaired Balance||• Balance specific exercises adding visual and surface changes • Weight shifting • Strengthening hips and legs||• Stability ball exercises • BOSU ball exercises • Kettlebell exercises • Lunging • Tai Chi • Boxing|