As a supplement to the journal _Neurology_ 1998;50(Suppl
3):Sl, C. Warren Olanow, MD, FRCPC, and William C. Koller, MD,
PhD wrote "An algorithm (decision tree) for the management of
Parkinson's disease: Treatment guidelines."
It is one of the best and up to the minute accounts of what
is happening in PD. I wish I could reproduce the entire 50 some
odd pages here for everyone to read but the copyright laws would
prohibit that. Here, below, is a short exerpt dealing with
exercise and diet under the supplement's heading,
NONPHARMACOLOGIC TREATMENTS
Exercise. Exercise is an important adjunctive therapy for PD
and can be one of the most beneficial activities in which the
patient is involved (breakout 2).10 Although exercise has not
been shown to have direct effects on the cardinal symptoms of
bradykinesia, tremor, postural instability, or rigidity, it can
slow the secondary effects of these problems that further limit
mobility and functional activity. 11,12
*** *** [The chart Breakout 2 should go here with the
following caption:] Breakout 2. Although exercise has not been
shown to directly change the cardinal symptoms of PD, a regular,
focused exercise program that includes aerobics, stretching, and
strengthening activities can have positive effects on mobility
and mood.
Patients should be educated about the positive effects of
exercise on mobility and mood. An exercise program should
include aerobic, strengthening, and stretching activities. One
does not replace the other. Aerobic exercise should be done at a
training heart rate of 60 to 70% maximal heart rate. Stretching
should be done when muscles are warm, and strengthening should be
done with light weights.
The goal should be to improve flexibility and strength but
not bulk. The emphasis should be placed on the extensor muscles
to counteract the flexor postures that tend to develop in PD. A
reasonable goal is to work up to 20-minute exercise sessions
three times a week.
Patients who are interested in an exercise program but are
not sure how to get started should be referred to a physical
therapist or a PD exercise group. Before an exercise program is
started, other potentially complicating medical problems, such as
heart disease, should be ruled out. The baseline level of
fitness can be determined by measuring maximal heart rate. Other
limitations of mobility, such as decreased range of motion,
should be identified to minimize the risk of injury.
Non-weight-bearing exercise (e.g., water aerobics) may be
particularly beneficial for a PD patient.
*** *** [The chart Breakout 3 goes here and has the following
caption:] Breakout 3. Establishment and maintenance of good
nutritional habits are integral components of the manage ment of
PD. Clinicians should obtain a thorough dietary history and
identify current eating habits. It is essential to help patients
become aware of their dietary habits and to educate them about
the elements of a balanced diet and about techniques for
successfully altering poor eating habits. Nutritional counseling
may be beneficial in some patients.
Nutrition. Patients with PD are at increased risk for poor
nutrition, weight loss, and reduced muscle mass in comparison to
healthy controls.13,14 Good nutrition is essential to the overall
well-being of patients with both early- and late-stage disease.
Although no specific diet is required, patients should eat a
balanced diet that contains sufficient fiber and fluid to prevent
constipation and enough calcium to maintain existing bone
structure. Although patients often ask about dietary protein
restriction, this is usually a concern only for patients with
late-stage disease, in which amino-acid competition for levodopa
absorption causes erratic responses to levodopa therapy.15
It is important to establish and maintain good eating habits
in patients with early PD (breakout 3). Clinicians should obtain
a thorough dietary history and identify current eating habits.
This is an opportunity to identify those patients who are
following nontraditional diets that may be harmful. Helping
patients become aware of their dietary habits and educating them
about the elements of a balanced diet and the techniques to
successfully alter poor eating habits is essential. Increasing
the quantity of fiber and fluids in the newly diagnosed patient
is useful and may prevent or minimize constipation later in the
course of the disease. 16 In some instances, nutritional
counseling with a clinical dietitian may be of value.
Patients who have difficulty maintaining a balanced diet may
be candidates for a supplemental multiple vitamin, with or
without calcium supplementation. A large body of literature
supports a role of oxidative stress in the pathophysiology of PD
.17-21 However, at present there is no evidence that
supraphysiologic or megadoses of antioxidants (e.g., a-tocopherol
or vitamin E) alter the course of the disease '22-24 and such
treatments may be very costly. On the other hand, there is no
current information suggesting that these agents are harmful.
[The numbers within the above text from 1 thru 24 represent footnotes
which I have not reproduced here.]
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Sid Roberts 68/dx3
[log in to unmask] Youngstown, Ohio
