By Patrick LoSasso, Certified Personal Trainer, CSCS.*D

Patrick is on the board of directors of The American Parkinson’s Disease Association Los Angeles Chapter and is a contributing writer to this website. Patrick has developed a specialization in working with individuals with Parkinson’s Disease called ReGenerations-PD (Rejuvinating Exercises for the Generations Living with PD). Below is an excerpt from his exercise manual The BrainBall-FX. If you have an exercise related questions may email him at Patrick@PreventionThruFitness.com.

Parkinson’s is a disease that, in addition to causing neurological challenges, can affect your physiological ability as well as your neuromuscular and skeletal system. So regardless of your stage of the disease, it’s important that you understand it’s potential effects and where the challenges may manifest themselves. If you’re experiencing some of the symptoms below, it would be helpful for your exercise program to incorporate exercises that will address these conditions.  If you’re primarily symptom free, a comprehensive and intensive exercise program  will help you prepare for their possible eventuality and postpone or minimize their effects.

Back Pain: Back pain is common in the unaffected population as well as those with PD. I have found much success in both communities with a systematic treatment which combines heat, exercise, stretching, massage, and ice. Consult your doctor and ask if any of these techniques are appropriate for you. Finding the right combination can be extremely pain-relieving as well as physiologically beneficial.

Degradation of posture: Left alone, the individual with PD may begin to approach what is called the Parkinson’s posture, which is a slumped forward position with protracted shoulders and forward turned hands. This is very difficult on the spine and can cause tightness of muscles in the chest and shoulders as well as tightness in the hip flexors and neck, shoulder and low back problems. Here, strengthening the muscles of the upper back and the postural muscles of the spine is key to preventing and correcting this condition. You will also want to stretch the anterior (front) muscles of the upper body: the chest and shoulder musculature (the doorway stretch is excellent for this). You will also want to improve the strength of the posterior muscles of the upper back: rhomboids, scapular stabilizers, trapezius, etc. The stretching of the chest and the strengthening of the back muscles will help pull the shoulders back, the head up and the body into a more proper posture position.

Tremor: Dyskenesia, or involuntary movement can occur in the PD individual. This can be as subtle as a quiver of the lip to an extremely disrupting and frustrating shaking of a limb. Studies have shown that intense cardiovascular exercise performed on a consistent schedule can reduce the intensity of the symptom. The stationary bike is a wonderful and safe option, as is swimming, jogging, power walking, boxing, elliptical, water aerobics, and others. So dedicate yourself to 30-50 minutes of this exercise 3 to 5 times a week.

Muscle stiffness: You may experience muscle stiffness with PD. You need to focus on getting oxygen to the muscles through exercise and implementing stretch and massage as much as possible. Dedicating 20-30 minutes a few times a week just to stretching and massage will make a difference. But always, always, always, begin this with a 10 minute warm up. There is no point in stretching a cold muscle. This puts undue stress not only on the muscle, but on the tendon that attaches the muscle to the bone. The type of stretch most of us have been taught is what is called a static stretch. This involves holding a stretch of the muscle from attachment point to insertion point. Another very useful type of stretching called myo facial release. Myo facial release stretching involves applying pressure to the belly of a muscle, while it is being stretched statically, or from end to end. This can be a great way of loosening up the soft tissues.

Reduction in range of motion: Joint stiffness and reduced activity will cause losses in functionality and reduction in range of motion. The best approach to improve this is through a combination of strength training, flexibility and movement. You’ll want to improve the suppleness of the joints by keeping the ligaments, tendons and muscles soft and pliable.  And you’ll want to improve the strength of the musculature around the joint so that the limbs can lift and rotate through the proper ranges of motion. Muscle stiffness and reduction in oxygen to the muscles of the core and postural musculature can create difficulty in trunk or torso rotation and contribute to poor posture. Chair rotation exercises involving hip stabilization and trunk rotations while attempting to maintain proper spinal alignment can be a wonderful way to open up the body and drive nutrients and oxygen to the muscles and soft tissues.

Balance challenges: The ability to maintain balance requires muscle strength and proprioceptive awareness. When balance is lost, the individual must be able to react, correct, and stabilize. The components to work on to improve balance are muscle strength, proprioceptive awareness, and stepping drills that imitate common lower extremity movement patterns that will help correct and improve stability. PD can cause slowness of movement or problems with initiation of movement. Speed drills and exercises involving exaggerated movement can help. If you’re taking small and slow steps, push yourself to both exaggerate your movements and move quicker than you feel you’re able. You may be uncomfortable at first, but most likely, you’ll be moving at a more safe and appropriate speed.

Freezing: Freezing often is a symptom that can affect an individual with PD. There are tricks you can find that will get you beyond this point. Everyone is different and you must find the technique that works best for you. The first thing you should do, regardless of your trick for moving forward is to stop, and reset. Take a moment to reset your posture, take a deep breath and get a clean slate. Your feet may feel glued to the ground. If this is the case, one of the tricks is to focus your sight on a point beyond your destination and make that your target destination. Then begin shifting your weight to from side to side, back and forth, as you gradually begin to lift your feet. When you feel you’re ready, take a big step forward and initiate your walk. Make it a BIG first step and stride forward with exaggerated movements. But always move with a focus on balance and safety.

Loss of proprioceptive awareness: As PD progresses there is a tendency to lose your awareness of where your limbs and body are positioned (2). In studies, the medications associated with PD such as levodopa have shown to also interfere with this sense. Exercises such as open and closed eye balancing exercises have been shown to improve this awareness. A useful tool for improving this is the balance board or the Bosu ball or a foam pad. Always practice balance with a stabilizing object near by as to improve this awareness, you must encounter moments of instability.

Difficulty with eye tracking: Testing of PD individuals has shown that there is a progressive difficulty of hand eye coordination as well as a loss of the ability to track an object with the ocular muscles(the muscles that control the eyes). Training ocular muscles can be as simple as holding a thumb up and following it from left to right. Incorporate activities that involve hand eye coordination challenges into your exercise program. This can be both effective and fun.

(1) Sponsor of study: Department of Veteran Affairs, Collaborator University of Iowa. Title: Effects of Aerobic Exercise in Parkinson’s Disease.

(2) J Neurol Neurosurg Psychiatry 2001; 71:607-610

Journal of Neurology, Neurosurgery & Psychiatry “Proprioception in Parkinson’s disease is acutely depressed by dopaminergic medications.

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©2009 Patrick LoSasso, Certified Personal Trainer, CSCS,*D (Patrick@PreventionThruFitness.com)

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