This is all such good information.  Thanks so much for posting it!  A few months back, I'd asked you about whether my left sided weakness was due to PD or insufficient rehab (I've broken both my left arm and left leg in the past 5 years, fortunately not at the same time!).  You told me the weakness was not due to the PD and encouraged me to address it.  Thanks to your encouragement/conviction, I started lifting weights about 3 months ago (my first time ever doing weights consistently) and while my left side lags my right (and I am trying to avoid my left side 'cheating'), both sides are getting much stronger and I am seeing muscles I never knew I had!  I am so pleased! And I am definitely hooked :-)   I also hike consistently, hills and rough terraine, and bike occassionally.  Thanks so much for your help and yes!  I'd love to see additional articles about the benefits of exercise in PD!  Kristin




________________________________
From: Kevin Lockette <[log in to unmask]>
To: [log in to unmask]
Sent: Saturday, July 18, 2009 11:43:25 AM
Subject: Re: Exercise Tips

Here is more on Exercise tips.  If this is helpful information, I would be
happy to post additional articles.

Much aloha,

Kevin

Role and Importance of Exercise with Parkinson’s Disease
By Kevin Lockette PT
(www.parkinsonsmoveit.com)

The key to an effective exercise program with PD is to focus on posture and
purposeful movement.  The postural muscles are important to maintaining
range of motion in the shoulders for activities of daily living such as
dressing, key to balance and gait by keeping your center gravity over your
base of support (your feet) and to assist in  combating fatigue.  The main
antigravity and postural muscles are your scapular muscles/upper back,
back/hip extensors and your quadriceps.  The stronger your postural muscles
are, the better equipped you will be to battle “forward posturing” which is
the tendency of being pulled or stooped forward which can also trigger
freezing and a shuffling gait (festination).
PD Exercise Research
Recent studies have shown that exercise can have beneficial effects in
patients with Parkinson’s Disease.  One study looked at Treadmill exercise
and its effects between animal models with and without a loss of certain
cells that are similar to what a person with PD might suffer.  Given the
importance of dopamine in Parkinson’s Disease, the researchers looked at
changes in dopamine levels and found that the subjects with cell loss and
that exercised, indeed, had an effect on dopamine levels while normal
subjects showed less of a difference in levels. A study by Viliani,
Pasquetti, Magnolfi et al aimed to evaluate whether motor training could
improve the straightening-up sequences in patients with Parkinson's disease
and, consequently, could ease the capacity of the patients to change body's
position. The results were statistically significant differences observed in
all the motor parameters that were evaluated (supine to sitting and sitting
to supine, supine rolling, standing from a chair). The conclusion was that
physical training can be effective in improving motor performance related to
changes in position which affects the simple daily activities of the
patients.Researchers at the Washington University medical school in St.
Louis recently found that PWP can significantly improve functional mobility
by taking Argentine tango lessons and exercise classes. The tango group,
however, showed greater improvement in balance, which is critical to
avoiding falls. Additional studies with larger groups of patients are needed
to confirm these preliminary findings.
“The dance classes included stretching, balance exercises, tango-style
walking, footwork patterns, experimenting of timing of steps, and dance with
and without a partner. The exercise classes included 40 minutes of seated
exercise, followed by standing exercises supported by a chair, core
strengthening and stretching.” (U.S. News & World Report )
There many other studies that have been done and many that are currently
underway.  More research is needed to fully understand the effects of
exercise on Parkinson’s Disease and the underlying reasons for the effects.
Conclusion
The bottom line is that exercise is one thing that you can do to combat many
of the physical symptoms of PD. There are many different modes exercise that
are appropriate for PD including Tai Chi, Pilates, Dance and resistive
training. A clearly designed exercise program specifically for PD can
improve posture, reduce affects of fatigue, improve mobility and decrease
the incidence of freezing and falls..

Your Body’s Response
The purpose of addressing the physiological effects of strength training is
to give you a better understanding of how your body will react to a strength
program that you design for yourself.  Understanding the cause and effects
will allow you to better design and modify your exercise program to meet
your needs and goals.  It is important to note that PD works on a particular
area in your brain but does not directly work on your muscles, so your
muscles still can have the ability to maintain strength and flexibility if
you train them. A study by Scandalis, Bosak, Berliner et al showed that
patients with mild-to-moderate Parkinson's disease can obtain increases in
performance or strength similar to that of normal adults of the same age in
a resistance training program. Resistance training can produce functional
improvements in gait and may, therefore, be useful as part of a physical
rehabilitation and/or health maintenance program for people with Parkinson's
disease.

The human body has a remarkable ability to adapt to the stresses placed on
it. When the muscle fibers and the anaerobic energy system are stressed by
weightlifting or resistive training, they adapt.  With appropriate stress on
these systems, rest and recuperation, the muscle will become stronger as a
positive adaptation to the stress put on it.

Initial gains in strength are most likely due to both effects on the muscles
and the nervous system.  The nervous system stimulates and controls the
muscles.  During the initial training phase, the nervous system basically
learns the skill of the movements (exercises) and learns how to efficiently
recruit the muscle fibers to have the best coordination for those desired
motions.

BASIC TRAINING PRINCIPLES AND CONSIDERATIONS
Progressive Resistive Exercise (PRE)
As a muscle adapts to applied stresses, resistance must gradually be
increased for further positive changes to occur- thus the term progressive
resistive exercise.  Large increases in resistance should be avoided; if the
stress is too great, you could injure your muscle or tendons.  If your
increase in resistance results in poor technique, then it is too much
weight.  One guide that you can use is to make sure that the last 2-3
repetitions are at least somewhat challenging.  If repetitions 8,9,10 are as
easy as repetitions 1,2,3 you may want to challenge yourself more.
Sets and Repetitions
With use of the appropriate training load, the number of sets and
repetitions govern the goal and outcome of the exercise program.  Sets and
repetitions can be set up for muscular endurance, muscular strength, and
muscular power routines.  Core muscles such as the scapular and pelvic
girdle musculature are best trained via a muscular endurance routine since
they are more endurance and postural muscles.  Since keeping or achieving a
more upright posture is key, it is best to train your muscles for muscular
endurance.
Make table or box  with the below information
Muscular Endurance Routine is 8-20 reps/ 3-5 sets with Low to Medium
training load
The following can be converted to text boxes or tables
General recommendations
Consult closely with your doctor, physical therapist or health care
professional when devising your exercise program.. General recommendations on
getting started include:

    * Aim for at least 15 minutes of exercise every day.
    * Make sure to include a thorough stretching program that targets each
joint and muscle group.
    * Spend a few minutes warming up and cooling down. This could include
marching in place or stretching.
    * Start with the easiest exercises first. Slowly introduce the more
difficult exercises as your fitness increases.
    * Try to perform each movement to the best of your ability.
    * If you suffer from fatigue, try exercising first thing in the morning.

Safety suggestions
If you are at risk of falling, general safety suggestions include:

    * Perform your exercises sitting down or
    * Hold onto a chair when performing standing exercises.
    * Don’t perform floor exercises if you can’t get up by yourself.
    * Only exercise when other people are at home who can help if necessary.
    * Exercise with others.
    * Ask for assistance from a family member or friend.


Walking for fitness
Walking is excellent for overall fitness. Suggestions include:

    * Choose flat, obstacle-free terrain.
    * Taking larger strides may help you keep better balanced.
    * Focus on lifting each foot and placing it down heel first.
    * Count each step – this can help to make a smoother, more rhythmic
walking style.
    * Move your arms as you walk, if possible.
    * If walking isn’t practical or possible, explore other options such as
stationary bicycling.
.


-- 
Kevin Lockette PT
www.ohanapacificrehab.com
www.parkinsonsmoveit.com
Kailua Clinic 808 262-1118
Honolulu Clinic 808 593- 2610
Cell Phone 808 228-0340


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