HEALTH LINE: Targeted Exercise Benefits Parkinson's Patients

CINCINNATI—Can exercise help people with Parkinson’s disease? Maureen Gartner, MSN, a nurse practitioner with the University of Cincinnati (UC) Neuroscience Institute’s Gardner Family Center for Parkinson’s Disease and Movement Disorders, answers with an emphatic "Yes!”

"Everyone with Parkinson’s disease is encouraged to exercise,” Gartner says. "Research strongly suggests that exercise holds significant quality-of-life benefits for people with Parkinson’s. Studies show that patients’ motor and non-motor scores improve after only three months of targeted exercise.” (Motor scores involve muscle strength, mobility, flexibility, balance, walking, swallowing and speaking. Non-motor scores involve depression, apathy, fatigue and constipation.)

"In short, exercise is a win-win for people with Parkinson’s,” Gartner says.  Exercise also reduces the risk of other diseases that may develop, including cardiovascular disease, osteoporosis, cognitive impairment and Alzheimer’s disease.”

Gartner will be a panelist at the Parkinson’s Disease Symposium and Expo Sept. 6 at the Oasis Conference Center in Loveland, Ohio, part of the 2014 Sunflower Revolution. The Sunflower Revolution Fitness Festival, featuring a 5-kilometer run/walk and 25K, 40K and 100K bike rides, will be held Sept. 7 at Yeatman’s Cove on the Ohio River at downtown Cincinnati.

Also appearing at the symposium will be Becky Farley, PT, PhD, founder and chief executive officer of Parkinson’s Wellness Recovery, a nonprofit organization based in Tucson, Arizona. Her topic will be "Exercise as Medicine: Essentials for Parkinson’s.”

With exercise high on the priority list for people who have Parkinson’s disease and their families and caregivers, Gartner answered some questions about it:

What is "targeted” exercise?
Targeted exercise for people with Parkinson’s is different from simply getting on a treadmill three days a week. Getting on a treadmill will help your fitness, but by itself it will not help your Parkinson’s. The goal of "targeted” exercise is to challenge your brain to develop or strengthen a variety of neural connections. You can do this by performing different movements rather than a single, repetitive movement.  Exercising in a variety of ways will yield the greatest benefits.

How often should I exercise, and for how long?
Your doctor can recommend a program that is appropriate for you based on your symptoms, fitness level and overall health. Your doctor can recommend how many times a week you should exercise and how long and how intensely you should exercise. Stop exercising if at any time you begin to feel pain or feel sick.

What types of exercise are best? 
An ideal exercise program for people with Parkinson’s is a "targeted” exercise program that includes stretching, strengthening, walking, balance training and aerobic activities that get your heart pumping. It could include time spent on a treadmill or stationary bike. Water aerobics and swimming are other good options. In addition, there are forms of exercise that we don’t always think of as exercise, such as yoga, tai chi and just getting out on the dance floor. You can also exercise your hand muscles and reflexes with the Nintendo Wii, whose games include tennis, bowling, baseball and a balance board. It’s important to stick with your exercise program. Keep in mind that exercise is a way to take control of your Parkinson’s. You cannot always control your disease, but exercise is part of your health that you can control.

Who can help create an exercise program that’s right for me?
There are a growing number of personal trainers who are knowledgeable about Parkinson’s disease. The local chapter of the American Parkinson’s Disease Association also sponsors multiple exercise classes. These classes are led by personal trainers whose passion is helping people with Parkinson’s disease.

Is it safe for me to exercise by myself?
To exercise safely is to exercise with a partner or caregiver. Someone should always be with you in case you fall or freeze in place. Wherever you exercise, you should avoid slippery floors, rooms with poor lighting and throw rugs. If you have balance problems, you should exercise in an environment where you can grab onto something if you begin to fall.  Nevertheless, there are a few exercises that you might prefer to do alone in the comfort of your home. These include exercises for your facial muscles. You can smile, yawn, shout, sing, make faces in the mirror and make chewing movements to help keep your facial muscles as strong as possible.

What are cues and what role do they play in exercise?
Cues are hints given by another person, a sound, an image or an object to help you stay balanced or in the right position so that you do not hurt yourself. Cues can be verbal, musical, written (on reminder cards) or visual. For example, if you have freezing of gait, a trainer might put blocks on the floor for you to walk around. The trainer also might also give you verbal cues by saying "BIG STEP” or "BIG STRIDE” to help your brain send that message to your legs.

What should I wear when I exercise?
Wear loose, comfortable clothing and comfortable shoes.

When is the best time to exercise?
Exercise when your medicines are working well, not when they are wearing off.

I have always been a couch potato. How do I begin?
First, be realistic. Check with your doctor and then start slowly. Perhaps you can begin by walking around the block or doing a few crunches while watching TV. Soup cans or soda bottles can be used as simple weights. Next, find an exercise buddy, perhaps your spouse or someone from your support group, neighborhood or church. Be on the lookout for ways to incorporate more activity into your day. Make exercise more enjoyable by listening to music. Remember that exercise can help you live better with Parkinson’s.