I teach classes in Movement and Voice for people with PD at several
hospitals in the San Francisco Bay Area. I've been working with PD
for 12 years. The following is the best article I've come across on
the exercise topic; I give a copy to all my students. There is a copy
of this article on the PD Website, if you lose this copy.
John Argue
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PARKINSON'S DISEASE AND EXERCISE
by James W. Tetrud, M.D.
The Parkinson's Institute
1170 Morse Avenue
Sunnyvale, California 94089-1605
(408) 734-2800
Bradykinesia
A symptom of Parkinson's disease which is nearly always
experienced sometime during the course of the disease is
slowness of movement. Often this is interpreted as weakness,
fatigue or lack of coordination, but it is actually related
to a phenomenon known as "bradykinesia," a term which means
slow movement. Bradykinesia is likely caused by an
impairment of "automatic" movements. Throughout the day,
individuals ordinarily execute thousands of small and large
automatic motor-movements of the limbs and neck which
provide continuous stretching of the ligaments and muscles.
The reason for slowness in Parkinson's disease is that these
automatic movements break down, so that an individual with
the disease must voluntarily think out each movement in
order to perform a certain task. It is the loss of automatic
movement which leads to much of the disability in
Parkinson's disease. For example, symptoms such as loss of
arm swing, impaired handwriting, dragging of a leg or foot,
impaired balance and even loss of voice inflection, are all
related to this phenomenon.
Although some automatic "motor programs" are stored in
the spinal cord, many of the more complex motor programs are
believed to be stored in the "striatum". The striatum is a
region of the brain which receives inputs from other brain
cells located in the midbrain (substantia nigra) which
produce dopamine. These are the cells which degenerate in
Parkinson's disease. We all know that replacement of
dopamine by L-dopa (Sinemet) therapy improves bradykinesia.
Muscle and Joint Injury
It is commonly believed that bradykinesia is related to
many of the joint difficulties and pain syndromes
experienced by individuals with Parkinson's disease. It
seems logical that the loss of automatic movements might
lead to stiffening of ligaments and muscles and thereby
result in eventual loss of joint range of motion. This
likely develops insidiously and might not be a problem until
an individual is required to make certain movements which
overextend the capacity of the ligaments and muscles,
resulting in sprain or strain. Not infrequently situations
do occur when we physically extend ourselves (e.g. catching
a ball, lifting furniture, or playing with children) and at
these times we become vulnerable to such an injury. Thus, we
must prepare our bodies for such situations by exercising
regularly.
Exercise
For most people with Parkinson's disease, an exercise
program should be regarded as a high priority; it may be as
important as the anti-parkinson medication. However,
choosing the appropriate exercises may be confusing, as
there are so many programs currently being promoted. In this
regard, it is best to follow certain basic guidelines:
1. When beginning a program, start slowly and gradually
increase activity at a comfortable pace.
2. Choose a set of exercises which fit into your daily
routine.
3. Avoid extending the exercise beyond the point where pain
develops.
4. If exercise consistently causes pain (e.g. joint, muscle
or chest pain), consult your physician.
Exercise is vitally important for maintaining optimum
motor function in individuals with Parkinson's disease. An
appropriate exercise routine designed for the individual can
compensate for the lack of movements that accompany the
disease and considerably improve mobility. Probably the best
exercise program is one which combines stretching and
"aerobic" activity. Stretching is particularly important
since this is the best way to regularly achieve maximum
range of motion of joints. There are several stretching
programs available in the Parkinson's literature. Aerobic
activity usually improves cardiovascular and pulmonary
function and can also improve mood. Examples of aerobic
exercise would be swimming, "power walking" (i.e. marching),
stationary bicycle, rowing machine and jogging. Swimming and
power walking are probably the most helpful for individuals
with Parkinson's disease.
It should be noted that a motor function often
neglected is that of voice production. The many muscles that
are involved in producing speech are clearly affected in
Parkinson's disease and therefore require routine exercise.
Voice training (even singing) can do wonders for speech; a
speech therapist can provide considerable assistance.
Exercise classes which are specifically designed for
Parkinson's patients are valuable not only for the expertise
provided, but for companionship and support. Peer pressure
works wonders when "the spirit is willing but the flesh is
weak". Occupational or physical therapists can design a
program tailored to the individual's needs by focusing on
increasing flexibility, strength, endurance and gait. For
those who are home bound, the services of a home care
therapist may also be provided. The ultimate goal of home
care is to assist individuals in achieving a level of
function which enables them to return to regular family,
recreational and community activities.
In summary, exercise for individuals with Parkinson's
disease is much more than a pursuit of physical fitness; it
is a lifelong necessity and is as much a part of the
treatment program as the medication. Remember the old adage
"use it or lose it."
