Exercise

Recently I met a women with Young Onset PD (YOPD). We were sitting next to each other in a class. She introduced herself and casually mentioned she has PD. She mentioned it so casually that I thought I misunderstood her because she didn’t exhibit any symptoms. Later she informed me that she had symptoms since 2003 (7 years ago). Was treated for a “frozen shoulder” initially. Five years later was diagnosed with YOPD and clinically presented with right sided bradykinesia, rigidity and tremor at that time. She started to exercise very regularly and is asymptomatic! She admits to getting stiff after sitting for more than 45 minutes and therefore attempts to limit her sitting within this time interval. With more research demonstrating how higher intensity exercise can reduce bradykinesia and rigidity, I asked what she did for her exercise regimen. I was amazed at how much work she put into her exercise program and wondered how many people could maintain this level of motivation. I was equally impressed by the variety of activities she incorporated which most likely helped keep her motivated. Here is the exercise regimen she outlined:

• 20 minutes of ping pong in the early morning to get started
• she converted a room in her house to an exercise room with mirrors and treadmill – spends an hour daily primarily practicing various dance moves Zumba, latin dance, hip hop, jive and swing. She may substitute her dancing with Yoga stretches or floor exercises.
• Zumba classes 3 times a week
• Tennis 3 times a week (not official games)
• She has enrolled at a university for a PD pilot study on exercise which consists of floor and balance exercises, weight training, treadmill
• Instead of watching TV in the evening she has become a “Wii addict” playing: tennis, golf, bowling and Wii balance/fit

For many of you this schedule may seem or would be overwhelming. Simply having the time for this routine is a separate problem. For this individual it is doable. Looking at her program critically may help others make choices to improve their activity. I think a key component for these activities is that she has chosen ways to exercise which are fun for her. She has a back up system in place that if she doesn’t want to go out of her home to exercise – she has a room dedicated to exercise. The mirrors in her room are a great idea since people with PD may think they are moving well but when they actually see themselves move they are often surprised how underscaled their movements are.  The mirrors offer additional feedback to optimize amplitude of movement and form. The Wii games are great because you can compete against yourself and monitor your progress for added incentive. Dancing challanges balance and strength and is typically an aerobic activity. Any activity performed with music improves drive and motivation to keep going when otherwise you may have stopped much sooner.  So adding music to any kind of exercise may help keep you going as long as it doesn’t distract or interfere with the activity.  Enrolling in an exercise research study is another great idea not only to exercise but meet different people and learn other things to do to help yourself after the study has finished. Yoga stretching typically stretches more than one area at a time AND can help strengthen your muscles by attempting to hold the position (bonus).

Current research is indicating that exercise may be neuroprotective. Exercise offers hope to control the progression of PD. The opposite also seems to hold true. Being sedentary may actually accelerate the progression of PD. Research is indicating that higher intensity exercise is needed to improve or reverse symptoms of PD.

Recently I received emails asking for balance exercises. This seems like a simple question but the answer is not always straight forward. Exercises which would enhance the balance of a person with young onset PD will look quite different from exercises to enhance the balance of an elderly person with PD who also has arthritis. Generally speaking the muscles in our legs are the main guide wires for balance. Fortunately there are many avenues to strengthen these guide wires. Performing exercises in a standing position offers the greatest return on your investment. These types of exercises or activities would be: Tai Chi, Dance (becoming more popular and definitely more fun), Rock Steady boxing, Delay the Disease program,  playing Wii games/balance activities, LSVT BIG or Parkinson’s wellness recovery program or simply performing conditioning exercises. Yoga, another form of strengthening which isn’t necessarily performed in the standing position, offers both strength and flexibility benefits. The level of difficulty can be adjusted with all of these activities. Balance exercises should be performed in a safe environment so that proper support is available to prevent a fall and at an intensity to achieve strength gains.