The Multiple Benefits of Exercise in Parkinson’s Disease
Parkinson’s disease (PD) is a neurodegenerative disorder recognized by four major symptoms, including tremors, 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 and lack of endurance, depression, and cognitive impairment. Exercise can be useful in improving many of these symptoms, as well as therapeutic for depression and prevention of cognitive decline. Incorporating a variety of exercises should be part of the medical program from the earliest to the advanced stages of PD.
RIGIDITY: Rigidity or stiffness is one of the major symptoms of PD. This increase in tone may be on one or both sides of the body, or predominantly a lower body problem. This stiffness is manifested by a lead pipe-like feeling of tightness in the muscles and may produce cramps, spasms or pain. Additionally, rigidity may aggravate other pain syndromes, such as low back pain, sometimes on a periodic basis. An additional problem that can develop from under use of the muscles is the frozen shoulder (adhesive capsulitis). Treatment and prevention of recurrence of the frozen shoulder requires twice daily stretching exercises.
While anti-Parkinson medicine is 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 weight lifting of more than 10 pounds since this can actually increase the tightness of the muscles.
In doing the exercises, start at a lower level and increase 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, those suffering with PD will begin to see the benefit in terms of mobility and reduction of discomfort. However, if they stop 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, do the exercises on a bed, a chair or the floor if necessary. Depending on the location of the symptoms, concentrate on the part of 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 make movements occur faster. Unfortunately, if you stop the exercises, the speed of movement can slow down again fairly rapidly.
GAIT AND BALANCE: Tai Chi is a form of exercise that promotes balance and is recommended for PD patients, as it is very useful in helping prevent falls. Fall prevention is one of the most important programs for PD since fractured hips, head trauma and shoulder injuries are common in patients with balance problems. Walking is also useful for freezing gait. If someone becomes wheelchair bound, this is not an excuse to stop exercising, as stretching exercises can help prevent contractures and skin breakdown from pressure points.
NON-MOTOR SYMPTOMS: Depression can benefit greatly from exercise. Since about 50 percent of PD patients suffer from depression at some point, exercise can be a useful therapy for this condition. This non-pharmacological modality can be an adjunct to the regular medical treatment of depression, as exercising can give a high and release endorphins.
Exercise is also important in the prevention of dementia. In trying to prevent dementia and Alzheimer’s disease, remain mentally and physically active, reduce stress and keep weight done. 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.
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: As a result of the disease itself, medications, depression or deconditioning, fatigue is often seen in PD patients. An exercise program can be useful in increasing the stamina and endurance, as well as stimulating wakefulness.
There are many opportunities for those with PD to participate in an exercise program, from formal physical therapy, home exercise, support group programs or a physical trainer. The important thing is to get started. Some PD patients suffer from an amotivational syndrome, which is a psychological condition associated with diminished inspiration to participate in social situations and activities, as part of their illness and need encouragement to perform the exercises. Don’t ask if they want to exercise and give them the opportunity to say no. Just say it’s now time for the exercises. The benefits are clearly evident. Time is wasting so get yourself in gear and go for it. If you don’t use it, you lose it!
By: R. Malcolm Stewart, M.D.