Home fitness can help Parkinson's patients
Published: July 13, 2009

 Second of three parts.
Last week, we described various forms of exercise to reduce the symptoms 
associated with Parkinson's disease. Now we'll outline a comprehensive home 
exercise program for people with Parkinson's.
You should begin with the easiest exercises first, slowly introducing the 
more difficult ones as your fitness level improves. If you fatigue easily, 
try exercising in the morning. Plan to perform your routine three times each 
week. For safety, all exercises can be performed while seated.

Warm-up
Take a slow walk or slowly march in place for two to three minutes. If 
standing is difficult, "march" while seated.
Flexibility stretching
This should be gentle and pain-free. Hold each position for 15 to 30 seconds 
and repeat two or three times.
- Neck: look up and down; tilt head to right and left; turn and look 
right; turn and look left.
- Torso: With hands on hips, lean slightly forward; lean slightly 
backward, pushing belly forward; squeeze shoulder blades together.
- Arms: Raise to the front and overhead; out to the side and overhead; 
clasp hands behind head and open elbows out to sides; reach behind buttocks 
and up the back with one hand, then repeat with the other hand.
- Legs: While seated, straighten one knee and then repeat with the other; 
while seated with knee straight, point toes toward nose, then repeat with 
other side, and do the same pointing toes away from the nose; while seated, 
pull one knee toward chest, then repeat with the other side; while seated, 
open and close knees.
- Facial exercises: surprise - lift eyebrows and open mouth; displeasure - 
frown and purse lips; disgust - crinkle nose; pleasure - make a big smile.

Muscle strengthening
- Perform 10 slow, full and pain-free repetitions without weights. 
Exercise left and right limbs. Complete repetitions with one side, then the 
other. To increase difficulty, slowly advance the number of repetitions. 
When three sets of 10 repetitions can be performed comfortably, weights can 
be added.
- Weights with velcro straps can be purchased, or household items may be 
used, such as soup cans or water-filled bottles.
- Starting weight should allow pain-free completion of at least 10 
repetitions. Weight should not be advanced until three sets of 10 
repetitions can be completed comfortably. Don't advance weight more then one 
pound at a time. When weight is advanced, reduce repetitions back to one set 
of 10 and advance to three sets as tolerated.
- Arms (both simultaneously): Shrug shoulders up and down; raise arms out 
to the front, but not higher than shoulders, then out to the side; bend 
elbows up and down; with elbows at 90 degrees, bend wrists up and down; open 
and close fingers as if making a fist.
- Legs: Hold onto a stationary object and place feet shoulder-width apart; 
keeping knee straight, move leg out to side, then backward; then bend knee. 
Using both feet simultaneously, lift toes toward the ceiling, then rise up 
on toes. While seated, lift knee toward the ceiling, then straighten knee.

Endurance exercise
- Start with no more than 10 minutes; gradually increase by a minute or 
two as tolerated, to 30 minutes.
- Walking: Choose flat, obstacle-free terrain. Focus on taking long 
strides while lifting each foot and placing the heel down first. Counting 
each step can facilitate rhythm and smoothness. Swing arms while walking. 
Use a walker with wheels if balance is a problem or if pain prevents 
progression.
If walking is not an option, try stationary bicycling.
Cool-down
Take a slow walk or slowly march in place for two to three minutes. If 
standing is difficult, march while seated.

Next week: Home safety and preventing falls.

JANET CAPUTO, P.T., O.C.S., guest contributor, is a physical therapist 
specializing in the management of orthopedic and sports injuries, with a 
special interest in vestibular rehab and falls prevention, at Mackarey 
Physical Therapy in downtown Scranton. She is completing her doctor of 
physical therapy degree at the University of Scranton.

PAUL J. MACKAREY, P.T., D.H.Sc., O.C.S., is a doctor in health sciences 
specializing in orthopedic and sports physical therapy. He is in private 
practice and is an affiliated faculty member at the University of Scranton 
physical therapy department. His column appears every Monday. E-mail: 
[log in to unmask]

Rayilyn Brown
Director AZNPF
Arizona Chapter National Parkinson Foundation
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