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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