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Parkinson’s Disease Exercise Guidelines

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 (Rejuvenating Exercises for the Generations Living with PD). Below is an excerpt from his exercise manual The BrainBall-FX. If you have any questions you may email him at Patrick@PreventionThruFitness.com.
I’m often asked about what kinds or modes of exercise are both appropriate and effective for those wanting to empower themselves and do what they can to improve their condition. There are many exercise disciplines that can help, but essentially an exercise program for individuals with Parkinson’s should be both enjoyable and customized to the individual’s current status. The  primary objective is to improve or maintain function by addressing the following physiological aspects through exercise:
1. Posture
2. Balance
3. Flexibility
4. Strength
5. Power
6. Endurance
7. Proprioception*
8. Hand-eye coordination
9. Movement initiation
10. Coordination of body and limb movement
11. Multitasking

Parkinson’s Disease & Exercise: Fighting Back

There is much you can do to make life better, and the process can be enjoyable and fun. Pursuing a coordinated fitness program has proven to be extremely effective in empowering individuals living with Parkinson’s Disease to fight back and improve their quality of life. There is currently no cure for Parkinson’s, but a properly designed exercise program has been shown to significantly delay, slow, and even reverse the onset of some Parkinson’s symptoms.
There will be good days and bad days but be courageous and be heartened by the fact that you can improve your quality of life, no matter what your age or level of PD involvement. Every time you complete a workout, you’ve won a battle. So get going and take charge. Medications administered for this disease have made great strides, but daily exercise and physical activity are essential in maximizing their benefits. It can be wonderfully motivating to know that with a comprehensive approach to fitness, you can exercise your right to live life to its fullest!
There are four major components of a properly designed exercise program that you should be aware of to competently address the above physiological aspects:
1.     Muscle Strength
2.     Cardiovascular Fitness
3.     Posture & Flexibility
4.     Balance & Coordination

Muscle Strength

Increasing the strength of your muscles is the foundation of your fitness program. This will improve your stability and confidence. Strength training with weight bearing exercises or resistance bands is a wonderful, safe way to build muscle and increase strength. But there are other important adaptations that occur in your body through a progressive strength training program. The connective tissues of our bodies, ligaments and tendons, also adapt and are strengthened as a result of a resistance training program. Bone density is another vitally important element to address as we age. Weight bearing exercises help us avoid conditions such as osteoarthritis, osteopenia or osteoporosis by building strong joints and sturdy bones.

Cardiovascular Fitness

Walking, swimming, running, biking, boxing, dance and movement disciplines such as tai chi are great and safe ways of conditioning the aerobic system. The function of the cardiovascular system is important in improving circulation, respiration, heart function, muscular endurance and alertness. The best way to train this energy system is through concentrated, repeated movement that tasks your aerobic system for a specific duration of time. In other words, focus your exercise, get your heart rate up and keep it up for the length of your workout. Then, the next week, try a small increase to the level of exertion, or the duration. People often ask me what the best activity for aerobic exercise is. The specific activity you choose is not that important, but it should be one that safely raises your heart rate above to which it is accustomed, and an exercise activity that you enjoy. Walking or running, and the stationary bike are wonderful modes of exercise for those with PD. If balance makes walking or running difficult, the bike or elliptical machine are great and safe ways to cause cardiovascular improvement.
Your Central Nervous System (CNS) will also benefit from exploring other, unfamiliar modes of aerobic exercise. Forcing the CNS to adapt to a different, repetitive activity is powerful therapy for the individual with Parkinson’s. Anytime you can challenge your brain to reach out to the body through the CNS and perform a new movement, it’s a wonderful, therapeutic reinforcement of the mind-body connection.
You could start with a simple 20 minute brisk walk, 3 times a week. The following week, add a fourth walk. The following week, add 2 minutes to each walk, etc.

Posture & Flexibility

Parkinson’s can create stiffness of movement and muscle tone as well as bradykenesia or slowness of movement. A great way to combat this symptom, and even reverse some of its effects, is a comprehensive flexibility program. Range of motion exercises can also help minimize muscle stiffness. Understanding proper posture and practicing good posture every day, is extremely beneficial. Knowing how we maintain correct spinal position, and the mechanics of how we should stand, how we should sit, how we should move, and how we should lift objects, is critical to preserving and restoring spinal health. This will also reduce the chance of a dangerous fall. Exercises that create muscle memory or a muscular imprint of proper posture should be practiced every day. Every time you move, change position, or bend down and lift a gallon of milk is an opportunity to reset and practice good posture. Get into the habit!

Balance and Coordination

As Parkinson’s progresses it makes things that were once automatic and easy, challenging. Thus, we must begin to understand the methodology of movement, and practice techniques for everyday mobility. So, we must first intellectually understand what our body must do in order to achieve an action. We must know all of the specific steps that must be executed, and in which order. Being mindful of our movement throughout the day is now important. Strategies such as getting out of a chair, descending a flight of stairs, getting in and out of a car, now have a method and need to be intellectualized, memorized, and practiced. Exercises requiring a proprioceptive skill and stabilization reinforce the brain’s ability to activate muscles and maintain your balance.

How much should I exercise?

That’s easy to remember. You should do something every day! You don’t need to perform a full workout each day, but you should incorporate at least two of the four major components of exercise every day of the week. It’s important to stay active and engaged with life, so empower yourself, challenge yourself, and get up and exercise your right to have a healthy and happy life.
Take charge of your own wellbeing. Empower yourself and improve your quality of life by finding activities you enjoy. Exercise should now be a part of your daily life. It’s never too late to join the fight and see tangible results that make things just a bit better. That’s a battle that you can win.
*Proprioception: The sense of the relative positioning of your body and limbs in space.
© Copyright Patrick LoSasso, Certified Personal Trainer, CSCS.*D, 2011


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