Parkinson’s Disease and Exercise: What You Need to Know

 

Exercise and physical activity have been deemed essential components for management of the primary and secondary effects of Parkinson’s disease (PD). Exercise should be used as an adjunct to pharmacological and surgical interventions to address all aspects of the disease from a holistic standpoint.

The Brain Body Connection of Parkinson’s

Parkinson’s disease is a progressive neurodegenerative disease characterized by slowness of movements, rigidity, tremors, decreased arm swing, and balance dysfunction. It is the second most common neurodegenerative disorder, after Alzheimer's disease.

Parkinson’s disease affects the basal ganglia, the part of your brain responsible primarily for motor control, as well as other roles such as motor learning, executive functions and behaviors, and emotions. This part of your brain relies on the secretion of dopamine from dopamine-containing neurons to function properly.

 
 

Researchers have found that Parkinson's disease is the result of the loss of dopamine-producing brain cells. This deficit results in greatly reduced voluntary movement and motor functions along with impacts to a broad array of behavioral processes such as mood, reward, addiction, and stress. People diagnosed with PD commonly experience episodes of freezing, where it is difficult to initiate movement, and hesitation when starting or turning. Postural stability is also affected by the disease progression, leading to increased risk of falls.

Individuals diagnosed with PD may also experience cognitive dysfunction which impacts the processes and tasks involved with executive functioning, the coordination and execution of movement, and motor learning capacity. Cognitive dysfunctions may aggravate motor symptoms and vice versa, leading to imbalances that may compromise quality of life and ability to participate in activities of daily living.

Neuroprotection Through Exercise

There is evidence to support that sustained vigorous exercise programs may influence the progression of PD. Regardless of medical history, known positive effects of exercise include the prevention of osteoporosis, reduction of fracture risk, and psycho-social activation. These are great goals for everyone! And they are crucial for the management of PD in order to enhance overall function and quality of life.

Regular exercise may be ‘neuroprotective’ and help slow down degeneration of the central nervous system.

Exercise may also have a positive impact on self-efficacy and motivation, significantly reducing barriers to self-management of deficits and symptoms. The WAV promotes mental relaxation and sensory stimulation that may have a positive effect on overall attitude and motivation towards exercise. When we like something, we do it more! It’s as simple as that. But also, the WAV is a sensorimotor device that further stimulates the central nervous system to help promote changes in our brain chemistry.

High intensity exercise involving high repetitions, velocity, and complexity promotes activity dependent neuroplasticity. Activity-dependent neuroplasticity is defined as “alterations within the central nervous system in response to physical activity that include such processes as neurogenesis, synaptogenesis, and molecular adaptations”. These processes promote new growth and development of nerve cells, as well as increased synapses or connections between communicating neurons. There is evidence to support that plasticity in the central nervous system may mediate improvements in procedural learning and performance on motor sequence learning tasks following exercise.

It is essential to establish or maintain a fitness program in the early stages of the Parkinson’s disease progression. People diagnosed with PD may have the ability to improve motor performance and potentially slow the progression of symptoms through both general and targeted physical activity. Prevention of inactivity and de-conditioning are main goals of any program.

Targeted Physical Therapy Interventions for Parkinson’s 

Exercise and physical therapy may address both muscular and neuromuscular impairments associated with PD. Therapeutic interventions often include gait training, static and dynamic balance training, dual task completion, and strengthening with the goal of reducing the risk of falls in patients diagnosed with PD. 

Many physical therapy programs emphasize high amplitude movements, cueing strategies, and cognitive movement strategies to counteract the effects of the disease on motor processing and execution of motor tasks and sequences. Use of the WAV allows individuals to independently adjust their movement strategy based on their internal and external experiences. The WAV acts as a biofeedback mechanism, however, prolonged training may lead to improved self-correction of muscular asymmetries and coordination of movement patterns.

A WAV Training exercise I use with Parkinson’s clients is the Dynamic Seated Press. It promotes strength, power, and postural stability while remaining in a seated position. This exercise challenges core stability during movement of the trunk and upper extremities. The benefits of this exercise translate to improved functional ability to perform tasks including weight shifting, reaching for objects, getting up from a chair, and many others. 

 
 


Dynamic Seated Press

Add rotation to encourage full system integration.
  1. Sit with your feet roughly hip width apart. Sit with good upright posture by activating the muscles of the core and trunk.

  2. Hold the WAV with an overhand grip at the outer bands. Reach your arms out in front of you at chest height grounding your torso to your pelvis. Achieve good posture with your shoulder blades integrated into a neutral position. Be sure not to shrug your shoulders upwards!

  3. Keep the WAV at chest level and begin to hinge forward at your hips. Reach forward as far as you can without feeling unsteady. Keep the fluid equally distributed on both sides

  4. Quickly sweep the WAV up and overhead without allowing the fluid to become unequally dispersed on one side. Be mindful to remain sitting with good posture. Do not lean backwards.

  5. Bring the WAV down to the starting position in front of you with your arms straight out at chest height.

  6. Repeat.

  • What am I doing?

    Stabilizing sore and trunk during dynamic upper extremity movement.

    Functional task practice with emphasis on leaning forward and weight shifting. 

    Creating good length in your spine needed for maintaining a healthy upright position.

    Combating compensatory trunk movements while changing positions.

  • What am I mindful of?

    Where do you feel the control of your movement as you move into the forward lean position?

    Are you moving with good speed? Is it more difficult to distribute the liquid evenly when performing this motion too slowly? 

    Can you keep your head, shoulders, and hips in alignment when the WAV is overhead, without leaning backwards?

    Do you feel one arm holding more weight of the WAV compared to the other?

    Are you moving with your breath throughout the movement sequence? 


Footnotes

References for exercise and Parkinson's disease cited in this article can be found here:

1) Duchesne, C., Lungu, O., Nadeau, A., Robillard, M. E., Boré, A., Bobeuf, F., . . . Doyon, J. (2015). Enhancing both motor and cognitive functioning in parkinson's disease: Aerobic exercise as a rehabilitative intervention. Brain and Cognition, 99, 68. doi:10.1016/j.bandc.2015.07.005

2) Earhart, G., Canning, C., Dibble, L., Rochester, L., & Ellis, T. (2015). Rehabilitation and parkinson's disease: Exercise is as important as medication. Physiotherapy, 101, e20-e21. doi:10.1016/j.physio.2015.03.028

3) Fisher, B. E., Wu, A. D., Salem, G. J., Song, J., Lin, C. H., Yip, J., … Petzinger, G. (2008). The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease. Archives of physical medicine and rehabilitation, 89(7), 1221–1229. doi:10.1016/j.apmr.2008.01.013

4) Redecker, C., Bilsing, A., Csoti, I., Fogel, W., Ebersbach, G., Hauptmann, B., . . . Müngersdorf, M. (2014). Physiotherapy in parkinson's disease patients: Recommendations for clinical practice. Basal Ganglia, 4(1), 35-38. doi:10.1016/j.baga.2014.03.001

Resources and more information about Parkinson's Disease can be found at the NIH National Institute of Nuerological Disorders and Stroke and the Michael J Fox Foundation.


Andrea Olsen graduated in May 2019 with her Doctorate in Physical Therapy from Stockton University. Andrea works with Parkinson's and other patients at the Body in Balance Rehabilitation and Fitness Center, an outpatient clinic and Parkinson’s Life Center located in Linwood, NJ. She utilizes mindful movement strategies in order to promote physical, mental, and emotional wellness.

Want to know more about using the WAV for Parkinson's and other rehabilitation? Contact us for more information about our sensory-based training approach.