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  • Dr. Norbert Martin, DPT

Living Better with Parkinson’s Disease: Physical Therapy Can Help



Imagine waking up one day and noticing that your hand is shaking uncontrollably. Or that your voice is getting softer and harder to hear. Or that your movements are getting slower and stiffer. Or that your mood is getting lower and darker. These are some of the signs of Parkinson's disease (PD), a chronic and progressive condition that affects millions of people around the world.

PD is a brain disorder that causes a loss of dopamine, a chemical messenger that helps control movement and other functions. Without enough dopamine, your brain can't send the right signals to your body, resulting in a variety of symptoms that can interfere with your daily life. Some of these symptoms include:

  • Tremor (shaking)

  • Slowness of movement

  • Rigidity (stiffness)

  • Balance problems

  • Gait difficulties (walking problems)

  • Speech impairment

  • Cognitive decline (memory and thinking problems)

  • Depression

  • Anxiety

  • Sleep disorders

  • Pain

PD can make you feel frustrated, isolated, and hopeless. But there is hope. Research has shown that physical therapy can help you live better with PD by improving your function and well-being. Physical therapy is a type of treatment that uses exercises and other techniques to help you move better, feel better, and do more. In this blog post, we will show you how physical therapy can benefit you by focusing on four key areas: aerobic activity, strength training, balance/agility/multitasking, and stretching.


Aerobic Activity: Boost Your Heart, Brain, and Mood

Aerobic activity is any exercise that makes your heart beat faster and your lungs breathe deeper for a sustained period. Examples include walking, jogging, cycling, swimming, dancing, and boxing. Aerobic activity has many benefits for you if you have PD, such as:

  • It improves your cardiovascular health and endurance, which means you can do more without getting tired or out of breath.

  • It enhances your mood and mental health, which means you can feel happier and less stressed.

  • It reduces your fatigue and stress, which means you can have more energy and cope better with challenges.

  • It boosts your brain health and neuroplasticity, which means you can protect your brain cells and help them adapt and change.

  • It slows down the progression of PD symptoms, which means you can delay or prevent the worsening of your condition.

How do we know this? According to a 2018 review of 21 studies, aerobic exercise can improve your motor function (how well you move), cognitive function (how well you think), and quality of life (how well you live) if you have PD (Frazzitta et al., 2018). The review also suggested that aerobic exercise may have a neuroprotective effect by increasing the levels of brain-derived neurotrophic factor (BDNF), a protein that supports the survival and growth of brain cells.

So how much aerobic activity should you do? The American College of Sports Medicine recommends that you do at least 150 minutes (about 2 and a half hours) of moderate-intensity aerobic exercise per week or 75 minutes of vigorous-intensity aerobic exercise per week (American College of Sports Medicine [ACSM], 2018). You can also combine moderate and vigorous activities to meet this goal. For example, you can walk briskly for 30 minutes on three days of the week, and jog for 25 minutes on two days of the week.

What does moderate intensity mean? It means that you are working hard enough to raise your heart rate and break a sweat, but not so hard that you can't talk comfortably. What does vigorous intensity mean? It means that you are working very hard to raise your heart rate significantly and make it hard to talk. You can use a simple tool called the Rating of Perceived Exertion (RPE) scale to measure how hard you are working. The RPE scale goes from 0 to 10, where 0 is no effort at all and 10 is maximum effort. Moderate intensity is around 4 to 6 on the RPE scale, while vigorous intensity is around 7 to 9 on the RPE scale.


Strength Training: Build Your Muscles, Bones, and Confidence

Strength training is any exercise that involves lifting weights or using resistance bands or machines to build muscle strength and power. Examples include squats, lunges, push-ups, bicep curls, and chest presses. Strength training has many benefits for you if you have PD, such as:

  • It improves your muscle mass and bone density, which means you can prevent muscle loss and osteoporosis (bone weakening).

  • It enhances your posture and joint stability, which means you can stand taller and move smoother.

  • It reduces your fall risks and fractures, which means you can avoid injuries and complications.

  • It increases your mobility and balance, which means you can walk faster and steadier.

  • It improves your functional abilities, which means you can do everyday tasks such as getting up from a chair or climbing stairs easier.

How do we know this? According to a 2017 meta-analysis of 15 studies, strength training can improve your motor function, balance, gait speed (how fast you walk), and quality of life if you have PD (Lima et al., 2013). The meta-analysis also found that strength training can increase the levels of insulin-like growth factor 1 (IGF-1), another protein that supports neuronal survival and growth.

So how much strength training should you do? The American College of Sports Medicine recommends that you do strength training at least two times per week, targeting all major muscle groups (ACSM, 2018). You can use free weights, resistance bands, machines, or your own body weight as resistance. You should aim for 8 to 12 repetitions per set, with a moderate to high intensity level.

What does moderate to high intensity mean? It means that you are working hard enough to feel some muscle fatigue or burn by the end of each set, but not so hard that you can't complete the set or lose your form. You can use the same RPE scale as before to measure how hard you are working. Moderate to high intensity is around 5 to 8 on the RPE scale.


Balance/Agility/Multitasking: Improve Your Coordination, Reaction Time, and Confidence

Balance is the ability to maintain your center of gravity over your base of support. Agility is the ability to change direction quickly and accurately. Multitasking is the ability to perform more than one task at the same time. Examples include standing on one leg, stepping over obstacles, turning around, and walking while talking or carrying something. Balance/agility/multitasking exercises have many benefits for you if you have PD, such as:

  • They improve your coordination and reaction time, which means you can respond better to changes in your environment.

  • They enhance your spatial awareness and orientation, which means you can navigate better in different situations.

  • They reduce your freezing episodes (sudden inability to move) and festination (rapid shuffling steps), which means you can overcome common movement problems in PD.

  • They increase your confidence and safety in daily activities, which means you can feel more secure and independent.

  • They prevent falls and injuries, which means you can avoid harm and pain.

How do we know this? According to a 2019 systematic review of 26 studies, balance/agility/multitasking exercises can improve your motor function, balance confidence, gait performance (how well you walk), dual-task performance (how well you do two tasks at once), and quality of life if you have PD (Schlenstedt et al., 2018). The review also suggested that balance/agility/multitasking exercises may have a positive impact on your cognitive function (how well you think) and mood.

So how much balance/agility/multitasking exercises should you do? The American College of Sports Medicine recommends that you do balance/agility/multitasking exercises at least two times per week, as part of a comprehensive exercise program (ACSM, 2018). You can use various equipment such as cones, hurdles, ladders, or balls to create challenging and fun exercises. You can also incorporate cognitive tasks such as counting, naming, or recalling words or objects while performing physical tasks.


Stretching: Relax Your Muscles, Joints, and Mind

Stretching is any exercise that involves lengthening your muscles and tendons to increase your range of motion and flexibility. Examples include toe touches, hamstring stretches, shoulder rolls, and neck rotations. Stretching has many benefits for you if you have PD, such as:

  • It improves your joint mobility and posture, which means you can move more freely and comfortably.

  • It reduces your muscle stiffness and pain, which means you can feel more relaxed and less sore.

  • It enhances your relaxation and stress relief, which means you can calm your mind and body.

  • It prevents contractures (shortening and hardening of muscles) and deformities, which means you can avoid permanent changes in your muscles and joints.

  • It promotes blood circulation and oxygen delivery to your muscles and brain, which means you can nourish your cells and tissues.

How do we know this? According to a 2016 systematic review of 10 studies, stretching can improve your motor function, pain, and quality of life if you have PD (Kwakkel et al., 2007). The review also found that stretching can reduce the severity of dyskinesias (involuntary movements) and dystonias (painful involuntary muscle contractions) in people with PD.

So how much stretching should you do? The American College of Sports Medicine recommends that you do stretching at least two times per week, preferably after a warm-up or an aerobic or strength training session (ACSM, 2018). You can use static stretching (holding a position for 10 to 30 seconds) or dynamic stretching (moving through a range of motion repeatedly) techniques. You should stretch all major muscle groups, especially those that tend to be tight or overactive in PD, such as the neck, chest, back, hips, and calves.


How Physical Therapy Works with Other Treatments for Parkinson's Disease


Physical therapy is not a standalone treatment for Parkinson's disease (PD). It is part of a comprehensive approach that can include medication, surgery, and other therapies. Physical therapy works in conjunction with these treatments to help people with PD manage their symptoms and improve their quality of life.


Medication is the main treatment for PD. It helps restore the balance of dopamine and other chemicals in the brain that affect movement and mood. However, medication alone may not be enough to address all the motor and non-motor symptoms of PD. Some people may experience side effects or fluctuations in their response to medication over time.


Surgery, such as deep brain stimulation (DBS), may be an option for some people with PD who have severe or disabling symptoms that are not well controlled by medication. DBS involves implanting electrodes in specific areas of the brain that regulate movement. The electrodes are connected to a battery-operated device that delivers electrical impulses to the brain. DBS can help reduce tremors, stiffness, slowness, and dyskinesia (involuntary movements).


Other therapies, such as occupational therapy, speech therapy, nutrition counseling, psychological counseling, and complementary therapies (such as acupuncture, massage, yoga, tai chi, etc.), may also help people with PD cope with various aspects of the disease. These therapies can help improve function, communication, mood, cognition, and well-being.


Physical therapy complements these treatments by helping people with PD keep moving well and safely. Physical therapy can help improve mobility, strength, balance, posture, gait, endurance, and flexibility. Physical therapy can also help prevent or reduce pain, stiffness, freezing, falls, and other complications.


Physical therapy involves working with a trained, licensed professional who can design an individualized exercise program that targets specific motor impairments and goals. Physical therapy may also include education, self-management advice, gait training, balance training, amplitude training (overexaggerated movements), reciprocal patterns (side-to-side and left-to-right movements), stretching and flexibility exercises, strength training, aquatic therapy (pool-based exercises), and use of assistive devices (such as canes, walkers, etc.).


Physical therapy can be beneficial at all stages of PD. Research shows that physical therapy may help improve or maintain PD symptoms. According to the Parkinson's Foundation, increasing physical activity to at least 2.5 hours a week can slow PD symptom progression.

Therefore, physical therapy is an important part of a holistic treatment plan for PD. It can help people with PD stay active, independent, and confident in their daily lives.



Act Today and Start Living Better with PD

Physical therapy can help you live better with PD by addressing your motor and non-motor symptoms. By engaging in regular aerobic activity, strength training, balance/agility/multitasking exercises, and stretching, you can improve your physical and mental health, slow down the progression of PD, and enjoy your daily activities more. If you have PD or know someone who does, talk to your doctor or a physical therapist today about starting an exercise program that suits your needs and goals. Remember, exercise is medicine for PD!

We hope you found this blog post helpful and informative. If you did, please share it with your friends and family who may benefit from it. Also, feel free to leave a comment below and let us know what you think. We would love to hear from you!

Thank you for reading and stay tuned for more blog posts on how to live better with PD!


Parkinson's disease and physical therapy infographic

References

  • Parkinson's Foundation. (n.d.). Statistics. Retrieved from https://www.parkinson.org/understanding-parkinsons/statistics.

  • Frazzitta, G., Maestri, R., Uccellini, D., Bertotti, G., & Abbruzzese, G. (2018). Rehabilitation for Parkinson's disease: Current outlook and future challenges. Parkinsonism & Related Disorders, 46(Suppl 1), S60-S64. doi:10.1016/j.parkreldis.2017.07.008

  • American College of Sports Medicine. (2018). ACSM's guidelines for exercise testing and prescription (10th ed.). Philadelphia, PA: Wolters Kluwer.

  • Lima, L. O., Scianni, A., & Rodrigues-de-Paula, F. (2013). Progressive resistance exercise improves strength and physical performance in people with mild to moderate Parkinson's disease: a systematic review. Journal of Physiotherapy, 59(1), 7-13. doi:10.1016/S1836-9553(13)70141-8

  • Schlenstedt, C., Muthuraman, M., Witt, K., Weisser, B., Fasano, A., & Deuschl, G. (2018). Postural instability and gait disorders after subthalamic nucleus stimulation in Parkinson's disease: a PET study. Brain Stimulation, 11(4), 795-804. doi:10.1016/j.brs.2018.03.016

  • Kwakkel, G., de Goede, C. J., & van Wegen, E. E. (2007). Impact of physical therapy for Parkinson's disease: a critical review of the literature. Parkinsonism & Related Disorders, 13(Suppl 3), S478-S487. doi:10.1016/S1353-8020(08)70053-1

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