parkinsons and exercise2

Presented by: Kathy Blatt, MPTCarol Gertsch, PT, DPT, CLT-LANA

Created By: Susan Miller, SPT

PARKINSON’S DISEASE AND

EXERCISE

Describe typical movement impairments Explain the benefits of exercise for

individuals with Parkinson’s Disease Identify different programs, specific

exercises and individuals who can guide you with an exercise program

Provide recommendations for exercise to maximize full benefit from a program.

PURPOSE OF THIS PRESENTATION

VIDEO: Pre & Post Exercise Treatment Program1

http://youtu.be/wElz9jNrqns?t=6s

EXERCISE IS YOUR MEDICATION!

Chronic Neurodegenerative disorder

2nd most common movement disorder

Onset – typically 55-60 y.o. Cell death occurs causing movement impairment

OVERVIEW OF PARKINSON’S

TRAPTremor – restingRigidityAkinesia – diffi culty with

movement Bradykinesia Hypokinesia Shuffl ing Gait

Postural instability

Impaired aerobic capacity

MOVEMENT IMPAIRMENTS

Decreased: Quality of LifeFunctionMobilitySafety

Emotional & Cognitive problems

Sleep disordersFatigueDepression

ADDITIONAL SIGNS AND SYMPTOMS

OVERVIEW: BENEFITS OF EXERCISE

Exercise…Improves mood

Boost energy

Promotes better sleepReduces Stress

Improves Fitness level

Promotes Brain HealthImproves Balance

Improves Walking

Helps manage your symptomsPossibility of slowing the disease progression

Improves mobility, posture, & gaitIncreases confidence

EXERCISE IS GOOD FOR YOU!

EXERCISE CAN SPECIFICALLY HELP PD…

CONSISTENT – 4-5 hrs/week

Moderate to VIGOROUS exercise

SPECIFIC– USE OR LOSE IT!

Evidence shows exercise can result in: Optimize brain health & efficiency Slows disease protection Slow the motor & non-motor deterioration

TYPE OF EXERCISE

Is there someone

to help me get

started on a

program?

I don’t know what exercises

are safe to perform?

A Physical Therapistcan get you started!!!!

PHYSICAL & OCCUPATIONAL THERAPY

Introduce you to a programHelp improve specific impairmentsTeach you specific exercises for home Education about lifestyleEstablish effective motor strategies! Help prevent secondary impairments

AVAILABLE PROGRAMS:

Background: Developed by Dr. Becky Farley PT, MS, PhD

Also developed BIG® program and associated with LSVT LOUD®

Parkinson’s Wellness RecoveryVision:

Providing research based exercise program for the Parkinson’s community

Increase longevity & quality of life

“Exercise from Diagnosis! Stamp out chronic, end-stage Parkinson’s Disease”2

PWR!MOVES® PROGRAM2

Patient-Centered Comprehensive Exercise Program

Not a standardized protocolPerformed 1:1 or group settingExercises targeted at ALL levels of disease

severityIntegrates:

HIGH Effort LARGE AMPLITUDE Body Movements Makes exercise FUNctional

4 building block movements: UP – ROCK– TWIST– STEP

HOW DOES PWR! WORK?2

USE IT! or

LOSE IT!

SPECIFIC EXERCISES:Bed MobilityBalanceSit to StandPostureFlexibilityWalkingAerobic

Impairments include: Reduced head rotation Inability to reach to the opposite side Decrease trunk rotation No visual target

Evidence shows:3

An association with spinal flexibility and physical performance

Exercise demonstrates to improve axial mobility & balance for individuals who have Parkinson’s disease

HARD TO TURN OVER IN BED…I want to turn over

for my belly rubs!

Visual Cue: Look at the alarm clock

Throw back coversMove to the center

of the bed Say “GO”Break down the

movements

EXERCISES: BED MOBILITY

Copyright © 1999 – 2010, VHI

EXERCISES: BED MOBILITY

Copyright © 1999 – 2010, VHI

Copyright © 1999 – 2010, VHI

PWR! TWIST: TRUNK ROTATION2

Evidence shows a decrease in near falls or repeated falls with a personalized 6-week exercise program 4

ONE-HOUR exercise program performed DAILY

Exercises included: Muscle strengthen – lower extremity muscles Range of motion – whole body Balance training – static & dynamic Walking – inside & outside Strategies for fall prevention

I FEEL LIKE I AM GOING TO FALL…

Find an object to focus on

Use Upper Extremity support as needed Progress to no UE support

Stand by Kitchen Counter

EXERCISES: BALANCE

Copyright © 1999 – 2010, VHI

EXERCISES: BALANCE

Copyright © 1999 – 2010, VHI

Copyright © 1999 – 2010, VHI

PWR! ROCK: WEIGHT SHIFTS2

Impairments include: Center of gravity is shifted forward

Rigid/decreased range of motion

Decreased Spinal Mobility

Weak back muscles

Hallmark Features: Rounded shoulders

Forward headBent forwardBending of knees

I CAN’T GET MY BACK STRAIGHT…

Use mirrors to check posture

Perform stretches & posture exercises throughout the day

EXERCISES: POSTURE & FLEXIBILITY

Copyright © 1999 – 2010, VHI

Copyright © 1999 – 2010, VHI

EXERCISES: POSTURE & FLEXIBILITY

Copyright © 1999 – 2010, VHICopyright © 1999 – 2010, VHI

EXERCISE: FLEXIBILITY

Copyright © 1999 – 2010, VHI

Copyright © 1999 – 2010, VHI

Impairments include: Inadequate forward lean Downward gaze Decrease momentum Weak lower extremity

muscles

Improve sit to stand by 50% within 3 months by performing sit to stand at a minimum 2 times/week5

DIFFICULTY GETTING OUT OF A CHAIR…

Sit to stand technique

Gently rock back & forth

Verbal cue: “GO”Mental Rehearsal:

Think “FORWARD & UP”Reach BIG

EXERCISES: SIT TO STAND

Copyright © 1999 – 2010, VHI

PWR! UP: POSTURE & SIT TO STAND2

Impairments include: Reduced speed Reduced arm swing Short steps Feet glued to the ground Loss of balance Diffi cult turning

Intensive training for 4 times/week for 30 minutes sessions for 6 weeks on a treadmill can:6

Minimize impairments with walking Reduce falls Improve quality of life

SLOW, SHUFFLING WALKING…

Consult with a

professional before using a treadmill

CORRECT WALKING7

Remove obstacles from home Loose mats or cords,

big furniture in small hallways

Rhythmic Metronome Music

Adequate Lighting in the house

EXERCISE: WALKING

Copyright © 1999 – 2010, VHI

Copyright © 1999 – 2010, VHI

EXERCISE: WALKING

Copyright © 1999 – 2010, VHI

Copyright © 1999 – 2010, VHI

Impairments include: Muscle weakness Decreased endurance Decreased coordination Respiratory issues

Evidence shows the need to perform REGULAR aerobic exercise to potentially maintain normal exercise capacity. 8

DECREASED FITNESS LEVEL…

Consult with a professional

before using a machine or

signing up for a class

BikeTreadmill walking Nordic walkingWalking outsideSwimming/Water

AerobicsClasses including:

Music therapy Boxing Dancing

https://www.youtube.com/watch?v=ZKTufkzpo8E

EXERCISES: AEROBIC

*5 days/week*30 – 45 min

sessions*Moderate to

Vigorous Intensity

Exercises should be SAFEExercise should NOT cause painConsult with your physical therapist or physician before starting an exercise program

RECOMMENDATION

1. PRACTICE, PRACTICE, PRACTICE!!2. High intensity3. 5 days/week for 45 min4. Large Amplitude body movements5. THINK BIG! 6. PRACTICE, PRACTICE PRACTICE!!

TAKE HOME MESSAGE

EXERCISE is MEDICATION!

1. http: / /youtu.be/wElz9jNrqns?t=6s2. Farley, B. PWR!Moves T M Make FUNctional Exerc ise! . Tucson, AZ: Wheatmark®;

2014. 3. Schenkman M. , Keysor J . , Chandler J . , Laub K. , MacAl ler H. Axia l Mobi l i ty

Exerc ise Program: A home exerc ise program to Improve Funct ional Abi l i ty: A Therapist Manual . 2 n d Edi t ion. Claude D. Pepper Older American Independence Center at Duke Univers i ty; 1994.

4. Ashburn, A. et a l . A randomised control led tr ia l of a home based exerc ise programme to reduce the r isk of fa l l ing among people with Park inson’s Disease. J Neural Neurosurg Psychiatry 2007; 78:678-684

5. Yekutiel MP, Pinhasov A, Shahar G, Sroka H. A c l in ical tr ia l of the re-education of movement in pat ients with Park inson's disease. Cl in ical Rehabi l i tat ion. 1991; :207-214.

6. Herman T, Gi ladi , N, Gruendl inger L, Hausdorff J . S ix weeks of Intensive Treadmi l l Training Improves Gait and Qual i ty of L i fe in Pat ients with Park inson’s Disease: A Pi lot Study. Arch Phys Med Rehab. Sept. 2007; 88: 1154-1158.

7. Hoppenfeld, Stanley. Physical Examination of the Spine Extremit ies . Apple and Lange: Norwalk, CT; 1976.

8. Cannin CG, Al l ison JA, Al len NE, Groel ler H. Park inson’s disease: an invest igat ion of exerc ise capaci ty, respiratory funct ion and gai t . Arch Phys Med Rehabi l . 1997; 78: 199-207.

9. https: / /www.youtube.com/watch?v=ZKTufkzpo8E

REFERENCES:

1. http://courtney-bci.blogspot.com/2013/08/5-of-worst-things-you-could-do.html

2. http://www.neurology24.com/facts/4.jpg3. http://murtagh.fhost.com.au/html/general_practice/9780070134591_

001_ch33.htm

4. http://www.neurology24.com/facts/4.jpg5. http://alchemymartialarts.net/brazil ian-j iu-j itsu-and-brain-health/6. http://www.thehappymd.com/blog/bid/284600/Physician-Wellness-Wh

y-It-s-Such-a-Struggle

7. http://gambarbbm.mytattoo-ideas.com/lsvt-big-&-loud-parkinson's-therapy-at-touro-neuro-rehab-center.html

8. Farley, B. PWR!Moves T M Make FUNctional Exercise!. Tucson, AZ: Wheatmark®; 2014

9. http://www.gettyimages.com/detail/photo/skil led-elephant-balancing-on-a-ball-high-res-stock-photography/456501701

10. http://www.bendomd.com/986-parkinsons-disease-symptoms.html11. http://www.animationplayhouse.com/new/dogs2.html12. http://txcowboydancer.com/2014/05/18/the-reboot-cont inues-part-3-of-3/13. http://www.walkaboutfl intshire.com/nordic-walking.php14. http://www.mil i tary.com/mil i tary-fi tness/spouse-and-family/att i tude-

adjustment

REFERENCES: IMAGES