The symptoms of Parkinson’s disease (PD) were first described by London practitioner James Parkinson in the 19th century, and some writings of medicine dating back thousands of years mention the same symptoms PD patients present today. With an estimated one million individuals in the United States currently having Parkinson’s disease, and 50,000 to 60,000 new cases being diagnosed per year, the Centers for Disease Control and Prevention (CDC) ranks complications from PD as the 14th leading cause of death in the U.S.

Parkinson’s disease predominantly affects adults in their 60’s and older (Adult-onset PD). However, it can also be diagnosed in younger adults as early as in their 20’s (Young-onset PD), with a much more rare onset before the age of 21 (Juvenile PD). The severity and progression of symptoms are unique to each individual, but generally affect gait (walking), balance and strength. We often hear the terms tremors (shaking at rest), bradykinesia (slowness of movement) and rigidity (stiffness) of the limbs and trunk. All of these can affect mobility and make activities of daily living more challenging and hazardous, especially when difficulty balancing increases the risk and fear of falling.

Exercise can help improve these common symptoms, in addition to enhancing overall health.  Studies that tested the effectiveness of various types of exercise and activity over two decades found that exercise can help both motor (gait, balance, strength) and non-motor (depression, apathy, fatigue) symptoms of Parkinson’s disease, as well as secondary complications (cardiovascular, osteoporosis). Exercise has also been shown to have a positive influence on mood and quality of life for individuals with neurological conditions.1,2

It’s not surprising that exercise is beneficial in managing symptoms and overall health, but if exercising with Parkinson’s disease is new to you or someone close to you, you may wonder where to begin. Always check with your physician for recommendations and possible referral to a physical therapist or fitness professional knowledgeable in working with individuals with your symptoms. Setting realistic goals and learning about guidelines, recommendations, and exercise options is the next step.

The 2008 Physical Activity Guidelines for Americans, released by the Department of Health and Human Services (DHHS), include guidelines for cardiovascular, strength, flexibility and balance (neuromotor) exercises and are as follows:

You will see intensity specified in the guidelines. An easy way to judge how hard you are working during aerobic activity is to think in terms of a 1 to 10 scale, with 1 being very light (breathing not changed) and 10 being an all-out or maximum effort (breathing very heavily).  Moderate activity falls within the 4 to 6 range (breathing more heavily but can carry on a conversation) and vigorous activity falls within the 7 to 8 range (on the verge of becoming uncomfortable, conversation requires a lot of effort).

Another simple way to measure intensity is by using the Talk Test. In general, if you’re doing moderate-intensity activity you can talk, but not sing, during the activity. You will not be able to say more than a few words without taking a breath if you are doing vigorous-intensity activity.

Recommended Physical Activity for Adults 2 hours and 30 minutes a week of moderate Intensity, or 1 hours and 15 minutes (75 minutes) a week of vigorous-intensity aerobic physical activity, or an equivalent combination of moderate and vigorous intensity aerobic physical activity. Aerobic activity should be performed in episodes of at least 10 minutes, preferably spread throughout the week. Additional health benefits are provided by increasing to 5 hours (300 minutes) a week of moderate-intensity aerobic physical activity, or 2 hours and 30 minutes a week of vigorous-intensity physical activity, or an equivalent combination of both. Muscle-strengthening activities that involve all major muscle groups performed on 2 or more days per week

Special Considerations for People with Chronic Conditions Any activity is better than none. Adults with chronic health conditions obtain important health benefits from regular physical activity. When adults with chronic conditions do activity according to their abilities, physical activity is safe. Adults with chronic conditions should be under the care of healthcare providers. People with chronic conditions and symptoms should consult their healthcare providers about the types and amounts of activity appropriate for them. The recommendations for older adults also include activities that promote balance at least 3 days per week

That may seem like a great deal of exercise, but these can be long-term goals. Goals are easier to achieve when broken up into short-term segments that lead to long-term success. Go low and slow at first. Low means low intensity and low duration. You may exercise for five or 10 minutes at a time, every other day. Slow means giving your body time to adjust. Add time and intensity as you adjust and find a balance between too much and not enough and experiment with different types of exercise. Your body will let you know how it’s doing!

There is not one “best” exercise choice for cardiovascular exercise. The safest activities are low impact, moderate-intensity exercises, such as water exercise, walking, dancing, and a variety of cardio machines that may be available if you have access to a fitness facility. Some studies have found that greater intensity may be beneficial; however, be certain you are ready for that and/or are working with a fitness professional for safety. Do some research to see what programs are available in your community. Your local chapter of the National Parkinson Foundation may recommend classes or programs of interest.

Muscle strengthening can be accomplished in many ways. You can use resistance bands, light weights, your own body weight (e.g., pushups, sit-ups, lunges), or machines at a gym. The most important thing about doing resistance exercises is to learn to do them correctly for your ability and experience. Once again, low and slow. Be certain that core exercises are included for postural stability.

Balance is a major concern for individuals with Parkinson’s disease. The fear of falling and the recovery from a fall can affect activities of daily living and impede movement. Balance activities, such as Tai Chi, standing on one foot, a variety of walking forward, sideways, and backwards, and posture awareness can help you to move with more confidence and be able to react to a situation that may cause a fall. Balance activities can and should be included in daily activities for the most benefit. Learn more about balance exercises and fall and fall injury prevention here.

The rigidity associated with PD may cause joints to be stiff and limited in their range of motion. Flexibility exercises can help to regain and maintain the range of motion in your joints that make doing tasks possible. Daily flexibility exercises for your lower body (e.g., low back, knee, hip, toes and ankle) and upper body (e.g., neck, shoulder, elbow, wrist and fingers) are important to keep those joints moving. stretch effect

Always stop any activity that causes pain – it is important to recognize pain versus discomfort. You may experience some discomfort in your joints and surrounding muscles during and after exercise because your body is not accustomed to the movement. That does not mean exercise is not for you. Some tips can help to alleviate the discomfort. Modify the program by decreasing the frequency (days/week) and/or the intensity and time. Always warm up and cool down before and after exercise, and experiment with different types of activity. Be certain your shoes fit well.

You may have days that are better or worse than others – it is okay to take a break one day if you need to, but you will find that regular and consistent exercise will provide the most benefits. Enjoy the short-term and small successes and, most importantly, find what works for you – it might be a great time to start dancing again!

Sources:

1. Kolk, N., & King, L. (2013). Effects of exercise on mobility in people with Parkinson's disease. Movement Disorders, 28(11), 1587-1596.
2. Haworth, J., Young, C., & Thornton, E. (2009). The Effects Of An 'exercise And Education' Programme On Exercise Self-efficacy And Levels Of Independent Activity In Adults With Acquired Neurological Pathologies: An Exploratory, Randomized Study. Clinical Rehabilitation, 23(4), 371-383.
3. What are the symptoms of Parkinson's disease? National Parkinson Foundation. Retrieved from http://www.parkinson.org/Parkinson-s-Disease/PD-101/How-do-you-know-if-you-have-PD-
4. Medifocus Guidebook on Parkinson's Disease. (2015). Retrieved from http://www.medifocus.com/2009/landingp2.php?gid=NR013&?a=a