Kevin,

This post is most timely for me.  I would appreciate any other information 
you would be willing to share.


----- Original Message ----- 
From: "Kevin Lockette" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Saturday, July 18, 2009 12:43 PM
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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