Enhance Your Wellbeing With Exercise

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Enhance Your Wellbeing With Exercise

• Laurel Beck, PT, NCS
• November 10, 2007

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Exercise ex- out of acere, to restrain

• An act of putting into use.
• Discharge of a function, duty, or office.
• Activity requiring physical or mental exertion,
  esp. when performed to maintain or develop
  fitness.
• Something practiced so as to increase ones skill
  lta piano exercisegt.

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Purpose of Exercise

• Reducing effects of Parkinsons
• Health promotion and maintenance
• And it makes you feel better!

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PD Motor Symptoms

• Tremor
• Bradykinesia and Akinesia
• Rigidity
• Impaired Postural Responses
• Decreased Automatic and Spontaneous Movement
• Difficulty with Initiation and Cessation of
  Movement
• Difficulty with Rapid Alternating Movements
• Dyskinesia

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Secondary Complications of PD

• Balance Problems
• Gait Deviations
• Deconditioning Weakness
• Soft Tissue Adaptation
• Loss of Joint Motion
• Reduced postural alignment
• Loss of Function

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Secondary Complications

• Dysphagia
• Drooling
• Hypoventilation
• Constipation
• Urinary Problems
• Depression
• Social Isolation

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Lower Your Risks with Exercise

• Premature death
• Colon cancer
• Heart disease and high blood pressure
• Diabetes
• Falls and fractures
• Osteoporosis
• High cholesterol

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Fall Risk

• PD impacts normal postural responses
• Risk of falls is 9 times greater in PD, than age
  matched controls
• Absent or diminished ankle, hip, arm and stepping
  responses
• May take several steps to recover from postural
  perturbation or rigidly fall

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Even more reasons to Exercise!

• Maximize posture
• Preserve muscle strength and flexibility
• Improve cardiovascular endurance
• Maintain weight
• Improve sleep
• Reduce stress, anxiety, and depression
• Boost energy level
• NEUROPROTECTIVE

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Neuroprotective

• Early non-use is especially relevant, as recent
  research in animal models of PD has shown that
  inactivity may actually contribute to
  degeneration
• Continuous practice and forced use of impaired
  limbs prevent and/or reverse motor impairments

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Research Supports Exercise!

• Exercise improves overall performance in PD
  patients
• Exercise of moderate intensity leads to an
  increase in the level of dopamine
• Specific measures of improvement include better
  stride length, walking speed ability, and
  activities of daily living

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Exercise per Hoehn and Yahr Stages

• Focus on health promotion, optimizing general
  strength, flexibility, balance, endurance and
  prevention of impairments
• General conditioning, flexibility, and fall
  prevention/gait strategies
• Focus on fall prevention. Also general exercise
  with emphasis on safety
• Maximizing flexibility for ADLs and mobility

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Its Not Giving Up. Its Replacing.By Hal Newsom

• Giving up is part of living with this disease.
  I have had to give up running but I have replaced
  it with walking each day. I have had to give up
  swimming the crawl stroke in Lake Washington but
  I have replaced it with the backstroke and a
  floatation device around my waist that keeps my
  legs from sinking. I have had to give up hiking
  up steep trails in the woods but I have replaced
  it with shorter day hikes.

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• I urge my Parkinsons friends not to give up
  anything without replacing it. You cant beat
  this disease but you can surely initiate new
  activities that take into account your changing
  physical condition. My skiing days are over but
  I have a world of new opportunities ahead of me.
  I call them replacements.

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Traditional Exercise

• Stretching
• Strengthening
• Cardiovascular training

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Complete Exercise Program

• Deep breathing
• Relaxation
• Stretching
• (Strengthening)
• Balance
• Coordination
• Cardiovascular training

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Deep Breathing Improves

• Posture
• Air exchange
• Sleep
• Mood
• Stress management
• Energy
• Attention (ability to focus)

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Lets Practice!

• Sit comfortably (may lie down at home)
• Relax shoulders
• Become aware of your breathing pattern
• Inhale through nose
• Slowly, effortlessly
• Exhale through mouth
• Fully, allow tension to leave body

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Relaxation

• Relaxation can restore physical and mental energy
  levels
• Relaxation may help dystonia and dyskinesia
• Relaxing tight muscles can ease discomfort
  (headache, sore back, fatigue)
• Find time daily for your favorite relaxation
  techniques deep breathing, relaxation tape,
  meditation, biofeedback

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Stretching

• Flexibility allows for better muscular balance
  and efficiency of movement
• Include rotation and extension
• Start rotational movements at limbs, then trunk
  for rigidity
• Stretching improves circulation to the muscles
  and can reduce pain
• It is recommended to try lying flat for at least
  30 minutes daily

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Strengthening

• Generally with light weights
• Closed chain exercises preferred
• Use large/full movements
• Builds muscle mass
• Helps bone density
• Allows for less effort with activities

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Balance and Coordination

• Specific exercises from physical therapy
• Activities that require balance and coordination
  (tai chi)
• Challenge yourself with change in tempo or
  activity or direction (random practice)
• Dancing, walking, yoga, tai chi, walking, ball
  sports, aerobic classes

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Cardiovascular Training

• Aerobic exercise increases endurance, strengthens
  the heart and lungs, tones muscles, and increases
  striatal dopamine
• Examples are walking, jogging, bicycling,
  swimming, stair stepper, and dancing
• Ideally at least 3-4 times a week

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General Rules

• Cool down period!
• Exercise and walk in a safe environment
• Pace yourself
• Guidelines are 3-4x/week for gt30 min.
• Avoid pain
• Avoid over-exhaustion
• Goal is to achieve subsequent invigoration and
  relaxation
• Check with MD or PT if questions

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Variety of Exercise Options

• Dance
• Exercise Classes
• Gardening
• Golf
• Hiking and Outdoors Activities
• Martial Arts
• Swimming
• Walking
• Yoga

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Tai Chi

• Integrates mind, body, and spirit
• Traditionally used to facilitate flow of chi
• Yang and Chen styles
• Helps improve balance
• Can be adapted to level of physical ability

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Qigong

• Exercise therapy based on the principles of
  traditional Chinese medicine
• Combines the practice of motion and rest
• Guided by mental imagery
• Improvements in many areas
• Constipation
• Postural stability
• Sleep
• Energy

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Video
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When do I start?

• Now!!!
• Slow down the progression and complications from
  Parkinsons
• Stay as active as you can (variety)
• Stay in shape (mentally and physically)
• Improve your quality of life

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Definition of Wellbeing

• n. The state of being healthy, happy, or
  prosperous.

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Ideas for Wellness Resource List

• If you highly recommend a wellness institution or
  provider, please write down the following
  information
• Name of person or facility
• Physical address (especially city)
• Phone number
• E-mail address

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Thanks to All!!!

• Volunteers for video project
• Aquatic Therapy photos courtesy of Tom Blaschko
  of Idyll Arbor, Inc.
• APDA booklet Be Active!
• Douglas Kinnaird ATRIC, LMP
• Terry King with medical photography

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General Exercise Information

• www.americanheart.org
• www.justmove.org
• www.cdc.gov
• www.shapeup.org

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References

• Albanese, Alberto Can falls be prevented in
  Parkinsons disease? J Neurol Neurosurg
  Psychiatry 2007 78661
• Crizzle AM, Newhouse IJ Is Physical Exercise
  Beneficial for Persons with Parkinsons Disease?
  Clin J Sport Med, Sept 2006 vol 16, no 5422-425
• Boelen M The role of Rehabilitative Modalities
  and Exercise in Parkinsons Disease Dis Mon
  2007 53259-264

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More References

• Farley BG, Koshland GF Training BIG to move
  faster the application of the speed-amplitude
  relation as a rehabilitation strategy for people
  with Parkinsons disease Exp Brain Res (2005)
  167462-467
• Adkin, AL, Bloem, BR, Allum JHJ Trunk sway
  measurements during stance and gait tasks in
  Parkinsons disease Gait and Posture (2005) 22
  240-249