Exercise and Parkinson's Disease
by R. Malcolm Stewart, MD,
Director of APDA I&R Center, Dallas, TX
Parkinson's disease (PD) is a neurodegenerative disorder recognized by four major symptoms including stiffness, slowness and difficulty with gait and balance. In addition to these cardinal symptoms, many PD patients are deconditioned and have decreased body mass, fatigue, decreased endurance,
depression and cognitive impairment. Exercise of various types can be useful in improving many of these symptoms as well as therapeutic for depression and prevention of cognitive decline. Therefore, exercise is important for more than just the muscles and should be part of the medical program from the earliest to the most advanced stages of PD.
Stiffness: Rigidity or stiffness is one of the major symptoms of PD. This increase in tone may be on one side of the body or both, or predominantly a lower body problem. This stiffness is manifested by a lead pipe-like feeling of tightness in the muscles. This tightness also may produce cramps, spasms and pain. The stiffness may aggravate other pain syndromes such as lower back pain, sometimes periodically such as with the wearing-off phenomenon. An additional problem which can develop from under use of the muscles is the frozen shoulder (adhesive capsulitis). Treatment and prevention requires twice daily-stretching exercises.
While anti-Parkinson medications are able to alleviate some of the spasm, the key therapy for rigidity is regular and sustained exercise, particularly stretching types of exercise. One must be careful not to do weightlifting more than 10 pounds since this type of exercise can actually increase muscle tightness.
In doing the exercises, one starts at a low level and increases the number of repetitions over time. While muscle building exercises are generally done on an every other day basis, stretching exercises can be done on a daily basis.
Over a period of a few weeks, one will begin to see
the benefit in terms of mobility and reduction of discomfort. If one stops the exercises, the benefit may dissipate over a period of three weeks. This fact makes it important to keep up the exercises on a regular basis. Even when traveling, one does not need any special equipment, but can do the exercise on a bed, a chair or the floor if necessary. Depending on the location of the symptoms, one can concentrate on the part of the body that is most affected.
Slowness: Slowness or bradykinesia is a cardinal feature of PD. In some instances, practicing exercises can help in making the movement occur faster. Unfortunately, if one stops the exercises, the speed of movement can slow down again fairly rapidly.
Gait and Balance: Tai Chi is a form of exercise which promotes balance and is recommended for PD patients. Some forms can actually be performed in a chair. Tai Chi is very useful in helping prevent falls. This prevention is one of the important programs for PD since fractured hips, head trauma and shoulder injuries are common in patients with balance problems. Exercise in walking is also useful for freezing of gait.
If someone becomes wheelchair bound, this is not an excuse for stopping exercises since stretching exercises can help prevent contractures and skin breakdown from pressure points.
Non Motor Symptoms: Depression can also benefit from exercise. Since about 50 per cent of PD patients suffer from depression at some time, exercise can be a useful therapy. One cannot be depressed and exercise at the same time. This non-pharmacological modality can be an adjunct to the regular medical treatment of depression. It is common knowledge that exercise can give a high, presumably due to the release of endorphins.
Exercise is important in the prevention of dementia. In trying to prevent dementia and
Alzheimer's disease, one should remain mentally active and physically active, reduce stress and keep body weight down. The brain reinvents itself each day and the exercises contribute to the stimulation necessary to keep the brain vital. It's like exercising the muscles in the head. There have also been some basic animal studies which demonstrate that there may be some protective effects to the basal ganglia to resist damage from neurotoxins when the animal was exercised before treatment.
Cardiovascular Fitness: By the very nature of deconditioning due to problems in the neuromuscular system, PD patients also suffer from cardiovascular deconditioning. Walking and swimming are very important exercises which can be useful for both rigidity as well as improving cardiovascular tone.
Fatigue: This symptom is often seen in PD. This can be a result of the PD itself, medications, depression or deconditioning. An exercise program can be useful in increasing the stamina and endurance of the PD patient. If one has a tendency to excessive daytime sleepiness, an exercise program can be helpful in stimulating wakefulness.
Available Resources: There are many opportunities for the Parkinsonian to participate in an exercise program, all the way from a formal physical therapy program, to a home exercise program, a support group exercise program, a physical trainer and so on. The important thing is to get started. Some patients suffer from a motivational syndrome as part of their illness and need encouragement to perform the exercises. Don't ask if they want to exercise or give them the opportunity to say no. Just say that it is now time to exercise. The benefits are clearly evident. Time is a wasting, so get yourself in gear and go for it. If you don't use it, you lose it!
Exercise instructions at a monthly meeting
