Parkinson's Disease Clinic & Research Center - UCSF

Chris, it is hard to find stuff on swimming and PD - do you have anything?
I  walk in my pool myself because it is the only way I can walk, am now 
doing 60 min daily on motorized cycler.

Ray

Exercise and physical therapy for Parkinson's disease

Should I exercise?

Research has shown that regular exercise benefits people with Parkinson's 
disease. Exercise reduces stiffness and improves mobility, posture, balance 
and gait. Exercise may also reduce depression.

What types of exercise are best for people with Parkinson's disease?

Although research on this subject remains scant, it does appear that 
exercise that challenges the individual to change tempo, activity, or 
direction (what is referred to as "random practice" exercise) benefits 
people with Parkinson's disease. It is also important that there is some 
variety in exercise activities, because individuals with Parkinson's disease 
often have difficulty in shifting from one activity to another or in 
performing two activities at the same time. Exercises that require balance 
and preparatory adjustment of the body are also important. Finally, 
exercises that promote upright posture are beneficial. What types of 
exercises do this? Walking outside or in a mall, dancing, yoga classes, Tai 
Chi classes, as well as most sports and aerobics classes. Therefore, these 
should be the first choice. What types of exercise do not challenge motor 
planning? These are riding a stationary bicycle, weight lifting, treadmill 
walking, lap swimming. These exercises should probably be pursued as an 
addition to other forms of exercise or when other forms are not possible.

What is the value of strength training?

Weight lifting per se is not the best choice of exercise for the person with 
Parkinson's disease. However, it does have some value. As one ages, more 
exercise must be performed to maintain muscle mass. Muscle mass and strength 
allow an individual to complete daily chores and to maintain balance. 
Additionally, strengthening postural muscles may help to maintain a more 
upright posture. Exercises other than weight-training may strengthen muscles 
in ways that are more beneficial to a person with Parkinson's disease. For 
example, legs can be strengthened by activities in a standing position, 
e.g., pushing onto toes or modified squats. Helpful arm exercises include 
arms push-ups or wall pushups. A second problem with weight-lifting is that 
it may actually increase stiffness. Light weights are just as effective as 
heavy weights in maintaining muscle tone and do not increase stiffness as 
much. Moderation is the best word for strength training without other forms 
of exercise.

What about swimming?

Swimming provides good cardiac-pulmonary training and maintains muscle 
strength. However, it does not challenge balance or stimulate variety of 
movements. Therefore, it is a second-choice activity. However, since the 
arms, legs and head may be doing different things, it may increase 
coordination. The resistance of the water increases stiffness in some people 
and decreases it in others. Some individuals with Parkinson's disease have 
difficulty in breathing well when swimming. Thus, swimming may be an 
appropriate choice of exercise for some individuals, particularly those who 
have enjoyed it in the past.

Will exercise make my muscles less stiff?

Exercise that requires large movements through a full range of motion in a 
rhythmic fashion has been shown to decrease rigidity. In addition, rotating 
at the trunk appears to decrease stiffness. In a program of aerobic exercise 
using music, there was a reduction in rigidity in 9 of 10 participants 
immediately after the exercise program.

When should I exercise in relation to medication?

The best time to exercise is when mobility is best. For individuals who take 
medications for Parkinson's disease, the best level of function often occurs 
about 1 hour after a dose of medications.

How often should I exercise?

The guidelines for people with Parkinson's disease are no different from 
those without the disease, i.e. 3-4 times a week for at least 30 minutes. 
For many, it is also helpful to stay active throughout the day. For example, 
one should walk whenever possible instead of driving. For many, it may be 
helpful to participate in activities with other people, perhaps because it 
is more stimulating. Long periods of time watching TV and or using a 
computer should be avoided.

Is there anything else I should know?

A "cool-down period" is important. After exercise, allow yourself a longer 
time for a cool-down than others would need. (Individuals who exercised 
before developing Parkinson's disease typically double their cool-down 
time.) A cool-down period accomplishes two goals- (1) it promotes a slow 
decrease heart rate and (2) it allows the muscles time to cool down 
gradually so they do not become stiff. A cool-down period consists of the 
same exercise activity but at a progressively slower pace. During the 
cool-down, all muscles need to go through a slow, full range of motion. If 
you wants to fall asleep immediately after exercise, then you are not 
cooling down slowly enough.


When should I request a referral for Physical Therapy?

Ideally, one should consult with a physical therapist when symptoms begin to 
limit range of motion or ability to walk effortlessly, so that the therapist 
can have a baseline record of your physical abilities. As the disease 
progresses, periodic re-evaluations are helpful so that your exercise 
program is having the maximum benefit. If you develop difficulty with 
balance, a physical therapist can assist in providing specific exercises for 
you. A program of individualized exercises has been shown to be beneficial 
in decreasing the risk of falling. In some cases these exercises may require 
outpatient treatments 1-3 times per week. Posture exercises may also be 
helpful.

The therapist will also work on improving gait with practice using visual 
and auditory cues, as well as without those cues. These activities are 
frequently helpful for many patients.

Are there techniques to help me walk?

A frequent problem for individuals with Parkinson's disease is of abruptly 
halting or "freezing," when walking. Visual and auditory cues can help with 
freezing. For some, having a friend or family member place their foot in 
front of you as a cue to step over is often helpful. One person found that 
throwing pennies and stepping over them was helpful. ("But," he added, 
"don't bend down to pick them up.") A loud clap can also be helpful. When 
walking for exercise, some people find it helpful to visualize taking large 
steps with exaggerated leg movements.

Are there hints to help me get out of bed?

For some people with Parkinson's disease, getting out of bed may become 
difficult. Try rolling over in bed, put your feet over the edge of the bed 
and then sit up. This technique is better for your back and may make it 
easier to get out of bed. If you are seeing a physical therapist, this is 
one of the activities that should be practiced. Another technique is to wear 
satin pajamas or use satin sheets (although not both).

Rayilyn Brown
Director AZNPF
Arizona Chapter National Parkinson Foundation
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--------------------------------------------------
From: "Chris" <[log in to unmask]>
Sent: Wednesday, August 05, 2009 2:50 PM
To: "rayilynlee" <[log in to unmask]>
Subject: swimming and PD

> Would you please address the benefits of swimming as a helpful form of 
> exercise for PWP.
> signoff parkinsn.
> Cheers.
> Chris Cowing
>
>
>
>
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