Exercise in Parkinson's disease: What kind, how often and how intense?
How to Navigate Exercise with Parkinson Disease
From the time you are diagnosed, your neurologist tells you that you need to start exercising, as it is going to help you fight Parkinson disease. The problem is, what does that mean? Should you instantly join a boxing group? Do you need to start doing yoga? Is walking the dog enough? How do you know where to put your energy, and what will give you the most “bang for your buck?” We are going to take some time to interview Dr. Alison Kraus on the different kinds of exercise and how you can incorporate them into your weekly routine. Remember, it is not a one size fits all, and your goals may change. This means your exercise routine should change to meet your current impairments and goals at all points in your fight against Parkinson disease.
Who is Alison Kraus PT, DPT, NCS?
Alison Kraus graduated with a doctorate in physical therapy in 2013 from Ithaca College and a B.S. in Clinical Health Studies from Ithaca College in 2011. Currently, Alison works at UF Health Rehab at the Norman Fixel Institute for Neurological Diseases. She is responsible for evaluating and treating patients with movement disorders and she is dedicated to improving their quality of life. She works to coordinate care with local and non-local physical therapists and to promote wellness in patients with Parkinson’s disease, Multiple Sclerosis, Vestibular Disorders and Traumatic Brain Injury. Since 2015, Alison has lectured and assisted in clinical labs for Neurological Rehabilitation courses. She also coordinates clinical internships for undergraduate and graduate students from various universities to allow students to have the opportunity to observe and work at the Norman Fixel Institute. She strives to connect the educational material learned in the classroom to clinical aspect of neurological rehab.
What is exercise?
Exercise is a repetitive movement with the goal of improving fitness and wellness. This means housework and yard-work are activities that people participate in to keep them active. Exercise is a subcategory of activities that provides specific benefits for your mood, cognition and motor symptoms with Parkinson disease. Exercise needs to be carried out over a long period of time to sustain the benefits, but it can promote neuroplasticity, and can improve how efficient the brain uses dopamine with Parkinson disease. This blog will be a good start to describe various forms of exercise and how to incorporate them into your routine. For additional information, or a more personalized program for you and your capabilities, ask your neurologist for a referral to a physical therapist. You can see a physical therapist from the time of diagnosis to discuss exercise and to adapt a plan specific to you along the way.
There are so many types of exercise, which you can focus on— and your focus should include how often do you have to do these exercises?
Do I need to do Aerobic exercise?
Aerobic exercise or cardiovascular exercise is performing a repetitive movement with the goal of increasing your heart rate. This can vary in intensity from low (i.e. an easy walk), moderate (i.e. fast walk, jogging, swimming) to high (boxing, circuit training, jumping jacks). In a patient with Parkinson disease, no one form of aerobic exercise appears to be superior to another, HOWEVER in order to achieve therapeutic benefit moderate or high intensity exercise is needed.
Mode: fast walking, cycling, elliptical, interval walk-jogging, swimming, boxing or circuit training
How often: 3-4x/week
How long: 30 minutes (a 5-minute warm up and cool down is also recommended). If this is too much to start, you can start at 10-minute bouts and increase overtime.
How intense: working to achieve 60-85% of your HR Max
This may sound like a lot, but with aerobic exercise, the potential benefit is worth it! It can in some expert’s opinions have potential disease modifying effects, increase neurogenesis and neuroplasticity, improving fitness levels and even improving cognition. One thing to consider is choosing a mode of aerobic exercise that fits your goals. If your goal is to improve your walking, then walking for aerobic exercise is a great choice for you. If your goal is to increase activity tolerance or to help rigidity, maybe cycling is a better choice.
Do I need to do strength training?
Strength training, or resistance training involves the use of weights and focuses more on isolated muscle control for upper and lower extremities as well as core and back muscles. Parkinson Disease can affect force production in major muscle groups therefore affecting functional movement (i.e. sitting to stand, walking, posture, lifting objects). This can also lead to people with Parkinson Disease becoming fatigued quicker than their age matched peers. Strength training has the potential to have disease modifying effects for motor symptoms as it can decrease bradykinesia or slowness in movement and improve overall mobility
Mode: strengthening machines for the major muscle groups for arms, legs, core/back. Free weights can also work for a home program
How Often: 2-3x/week
How long: 2-3 sets of 8-12 repetitions. You should feel fatigued by the 12th repetition, if it is too easy, increase the weight you are using for that exercise.
How intense: Must be progressive in nature. Track your weights and repetitions of to work to add from week to week.
Strength training can be a great way to improve your mobility with Parkinson disease. This is again an area to think about task specific exercises. For example, if you’re having trouble getting up from a chair; strength training for your legs (squats with weights) can be helpful. If you are having trouble with worsening posture, a progressive strength training program focused on back muscles can increase your ability to stand erect. Work with a physical therapist to ensure you have a well-rounded strength training program to maintain your mobility.
Do I need to stretch too?
Stretching is a prolonged hold on a muscle where you are feeling the “pulling” sensation. Stretching is very important to manage muscle rigidity and that is one of the main motor symptoms of Parkinson disease. Stretching should focus on muscles in your hips, legs, low back, chest, shoulders and even your hands.
Mode: whole-body flexibility exercises, yoga
How Often: Daily, but even 2x/week can help
How long: Maybe spending 10 minutes in the morning or spaced throughout your day to help manage rigidity. Warm up with a stretch before your aerobic or strength exercises to prevent injury
How intense: Hold each position for 20-30 seconds and repeat 2-3x. Some stretches can be more of an active stretch where you hold them for less time (5-10 seconds) and perform more repetition (10-15x).
Stretching 2x per week or more has been shown to manifest improvements in the severity of motor symptoms with Parkinson disease. There are many general warm up routines and flexibility programs you can start with on YouTube or through the Parkinson’s Foundation Fitness Friday video series. Remember, with stretching and all exercise routines, the effects of the exercise are short term (unfortunately). Therefore, trying to incorporate a continual stretching program part of your weekly routine is important.
What about incorporating Tai Chi or balance exercise, do I have to do that too?
Postural instability is another symptom that is common and usually occurs as the disease progresses. Incorporating balance exercises into your weekly routine can help to maintain your balance and decrease your risk for falls. This may be an exercise domain that consulting with a physical therapist can assist you to determine an appropriate and safe place to start, and how to progress through a program.
Mode: Tai Chi, Yoga, Aquatic Exercise with focus on balance, dance,
How often: 2x/week
How long: 20-30 minutes
How intense: Intensity should be challenging for your balance. If you don’t feel that the balance exercises are hard, then you may need to search for a way to make it harder (uneven surface, arm movements, dual tasking). Make sure you remain safe when challenging your balance, you can have a chair or wall nearby to maintain safety.
Tai chi, balance and dance have been studied in people with mild to moderate Parkinson disease so starting early, before your balance becomes an issue can be a critical step in your plan. You are not alone, join an exercise group, for added benefit to motor and non-motor symptoms of Parkinson disease as well as increase accountability for your weekly routine. Finding a well-rounded exercise program will be important, so start early, and consult with a neurologic physical therapist to help to develop an individualized exercise program to address your impairments and to help you to best achieve your goals.
To read more books and articles by Michael S. Okun MD check on Twitter @MichaelOkun and these websites with blogs and information on his books and http://parkinsonsecrets.com/ #Livingwith Parkinson’s #EndingPD #Parkinsonsecrets #LessonsFromTheBedside
He also serves as the Medical Advisor for the Parkinson’s Foundation.
To see more on Dr. Indu Subramanian she does live interviews of experts in Parkinson’s for the PMD Alliance.
The blog artist is Jonny Acheson.