parkinsons and exercise2
TRANSCRIPT
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