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 SPECIAL NOTE: This communication is intended solely for the individual or the entity to which it is addressed and may contain information that is privileged, confidential, and/or prohibited from disclosure. If the reader of this communication is not the intended recipient, you are hereby notified that any dissemination, distribution, or copying of this communication is strictly prohibited. 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