Parkinson's Lifestyle Medicine - Fitness Strategies
Introduction[edit | edit source]
Approximately 10 million people around the world are currently living with Parkinson’s. Meta-analysis of worldwide data reveals that the prevalence of Parkinson’s increases with age, quadrupling from a level of almost 0.5% in the seventh decade of life to approximately 2% for those over the age of 80. Other sources report that Parkinson's affects 1.5-2% of the population over the age of 60.
Parkinson’s is associated with the loss of dopamine-producing neurons in the substantia nigra of the midbrain, and it is typified clinically by resting tremor, rigidity, and bradykinesia, as well as a number of non-motor features such as anosmia, sleep behaviour disorder, depression, autonomic dysfunction, and cognitive dysfunction. The aetiology of this disease is not fully understood, but some combination of environmental and genetic factors are believed to be involved. Among these are various lifestyle factors such as tobacco use, dietary intake, and physical activity.
According to the Lifestyle Medicine Handbook, Lifestyle Medicine involves the use of evidence-based lifestyle therapeutic approaches to treat, reverse, and prevent lifestyle-related chronic disease. These include:
- A predominantly whole food, plant-based diet
- Regular physical activity
- Adequate sleep
- Stress management
- Social connections
- Avoidance of risky substance abuse
The aim of Lifestyle Medicine is to treat the underlying causes of disease rather than just addressing the symptoms. This involves helping patients learn and adopt healthy behaviours. Lifestyle interventions have the potential to impact the prognosis of many chronic diseases, leading not only to a better quality of life, but also potentially reducing their costs to the healthcare system. While there may be a tendency to think of Lifestyle Medicine as being the domain of the physician, other providers such as dietitians, social workers, behavioural therapists, and lifestyle coaches are also integral. It is also well within the scope of the physiotherapist for the following reasons:
- Diet and nutrition are key elements in many of the conditions managed by physiotherapists
- Physiotherapists are considered experts in exercise and movement
- Prevention, health promotion, fitness and wellness are crucial aspects of physiotherapy care
The focus of this page is on discussing fitness strategies for persons with Parkinson's, including mind-body, aerobic, strength, flexibility, neuromotor, task-specific, and leisure fitness.
Mind-Body Fitness[edit | edit source]
A mind-body fitness regimen can include a variety of activities that combine body movement with mental focus. The practice of controlled breathing is often a feature.
- Yoga is one such practice. It involves assuming and holding various physical postures while performing coordinated, diaphragmatic breathing. There is evidence that yoga may help manage depression, reduce falls risk, and improve motor function in persons with Parkinson's.
- Traditional martial arts such as tai chi and karate may improve balance, falls prevention and quality of life. Tai chi, also known as shadow boxing, involves gentle, slow movements and stretching combined with controlled breathing and meditation. Karate, Japanese for "empty hand", involves the practice of specific stances along with kicking, striking, and defensive blocking movements using the extremities. Qigong is another Chinese martial art form which combines gentle flowing exercises with mindfulness. A particular form of qigong is Ba Duan Jin, meaning the "Eight Section Brocades". Ba duan jin uses a combination of eight movements with deep, slow breathing. It is considered a form of medical qigong intended to improve health. There is evidence that qigong and ba duan jin qigong may improve gait and sleep quality in persons with Parkinson's.
- Pilates, initially developed for dancers, is an exercise method that emphasises abdominal and low back / hip muscle tone. It can improve balance and physical function in a person with Parkinson's.
- The Feldenkrais Method is another mindful movement practice. It has an emphasis on the quality of movement and it may may result in improved quality of life for persons with Parkinson's. A similar method is the Alexander technique. This technique puts more focus on dynamic posture. There is some evidence that persons with Parkinson's may experience improvements in self-rated disability after practising the Alexander technique.
-  This activity can be as simple as walking outdoors while focusing on the sights, sounds and smells of nature, of feeling the wind in your face or the sensations through the feet. Use of a labyrinth walking path is a novel way to participate in reflective walking.
Aerobic Fitness[edit | edit source]
Aerobic exercise can be performed a variety of ways, including treadmill or overground walking, stationary cycling, elliptical rowers, seated reciprocal stepping, upper limb cycling, swimming, and even dancing. There is evidence that high intensity exercise can result in significant improvements in functional mobility. A programme of brisk walking and balance training can improve motor function and gait ability in persons with Parkinson's. Aerobic exercise may also be beneficial in terms of having protective effects against depression and enhancing motor memory consolidation.
American College of Sports Medicine (ACSM) aerobic exercise guidelines:
- Exercise frequency - 3 to 4 days per week
- Exercise duration - 30 minutes of continuous or accumulated exercise
- Exercise intensity - to be determined by the healthcare or fitness professional
Strength[edit | edit source]
Strength exercise, including resistance training on weight machines, elastic resistance exercise, free weight (eg dumbbells) and bodyweight exercise, can lead to improvements in strength, enhanced physical function, reduced depression, and improved overall quality of life in persons with Parkinson's.
American College of Sports Medicine (ACSM) strength exercise guidelines:
- Exercise frequency - 2 to 3 days per week
- Exercise duration/repetition - 1 to 3 sets of 8 to 12 repetitions, beginning with 1 set and building to 3 sets
- Exercise intensity - to be determined by the healthcare or fitness professional
Flexibility[edit | edit source]
A flexibility programme for a person with Parkinson's can include slow static stretches for all major muscle groups. Flexibility exercises can improve functional performance and activities of daily living in persons with Parkinson's, enhancing capability for bending to tie shoes, donning and doffing clothing, and reaching for items either overhead or on the floor.
American College of Sports Medicine (ACSM) flexibility exercise guidelines:
- Exercise frequency - 2 to 3 days per week
- Exercise duration/repetition - 10 to 30 second holds with 2 to 4 repetitions of each stretch
- Exercise intensity - stretch to the point of slight discomfort
Neuromotor Function[edit | edit source]
Exercise to improve neuromotor function may include balance training (eg Otago balance program), agility work, coordination practice, gait training, and dual task training (e.g. walking while throwing a ball). Balance training could include activities such as multidirectional stepping, and anticipatory and reactive postural adjustment training, for example. Specific balance training is effective at improving postural control for persons with Parkinson's. Other exercise programmes already mentioned above, such as tai chi, yoga, boxing, and dancing, also fit within this category. There is evidence that ai chi, a form of tai chi that is water-based, is effective at improving balance, mobility, motor function, and quality of life for persons with Parkinson's.
Video demonstration of balance training (see dual task training starting at 6:51):
Task-Specific Circuit Training[edit | edit source]
Circuit training can be an effective approach to engaging the person with Parkinson's in a variety of exercise activities, potentially contributing to enhanced motor learning. This approach involves moving between multiple activities with varying amounts of rest or stretching between. Using variable practice and performance in a distributed versus blocked practice manner may be beneficial in terms of motor learning. Evidence supports that task-oriented circuit training can improve balance and gait performance, and, by extension, balance confidence and quality of life for persons with Parkinson's.
Sample Circuit Training Programme:
- Start with a 5-minute warm-up on a stationary bike or treadmill
- Perform sit to stand x 10 repetitions
- Perform sit to stand and walk 6 metres
- Walk up and down incline surfaces
- Step up and down from varied-height surfaces
- Walk while weaving back and forth between cones for 6 metres
- Walk up and down stairs
- Reach in multiple directions in sitting and standing
- Step in multiple directions in standing
- Perform boxing movements
- Finish with a 5-minute cool-down on a stationary bike or treadmill
Leisure Fitness[edit | edit source]
Activities that could be considered leisure fitness activities include Nordic walking, dancing, table tennis, and video exergames. Nordic walking employs the use of trekking poles for a total-body version of walking that encourages greater use of the upper and lower extremities while facilitating trunk rotation. It is effective at improving motor function, as well as some of the non-motor symptoms associated with Parkinson's such as apathy, depression, and fatigue. Dancing also has the potential to improve gait, cognition, balance, functional mobility, and fatigue. Participation in table tennis has the potential to improve motor function and activities of daily living in persons with Parkinson's. Participation in video exergames that involve various physical components of activity beyond just playing the game, along with facilitating dual-task engagement, can improve motor function, balance, and cognition and executive function as well as processing speed. These have the advantage of being fun, which encourages increased adherence and participation.
Resources[edit | edit source]
- LSVT-BIG for Parkinson's
- Parkinson Wellness Recovery
- Rock Steady Boxing
- Ping Pong Parkinson
- General guidelines for exercise with Parkinson's
References[edit | edit source]
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