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“Optimal dose of exercise [for Parkinson’s]: how much is enough?” – Webinar notes

January 27, 2022 By Parkinson's Community Help

The American Parkinson Disease Association (APDA) held a webinar in November 2021 that featured Teresa Baker, DPT, with the APDA’s Rehab Resource Center.  Dr. Baker emphasized that exercise is essential for anyone living with Parkinson’s disease (PD).  “Exercise” is a planned, structured, repetitive activity that is intended to improve physical fitness.  Dr. Baker described different types of exercises (aerobic training, strength training, flexibility training, and balance training), benefits for PD, intensity levels, and number of times per week the exercise should be done. There is no “right” exercise for people with Parkinson’s.  Everyone’s regimen will differ, depending on overall health, symptoms and previous level of activity.  

Here is an interesting question that came up in the question and answer session: 

Question:  How do you help motivate someone with PD to exercise? 


Answer:  Great question!  I hear this a lot – there can be more difficulty in motivation with PD.  I would start with what is meaningful for that person, meet a friend for a walk, perhaps playing music while exercising.  The caretaker or helper will need to develop an exercise routine that is catered to the likes and dislikes of the PD individual. 

This APDA webinar was recorded, and is accessible on YouTube.

For more resources on exercise, please see these Stanford Parkinson’s Community Outreach webpages:

PD exercise videos

PD exercise benefits

PD exercise classes live online

See my notes below for the session, which was part of the “Let’s Keep Moving with APDA” series.

Regards,

Sheela Sakariya


“Optimal dose of exercise [for Parkinson’s]: how much is enough?” – Webinar notes

Webinar Host:  American Parkinson Disease Association (APDA)

Webinar Date:  November 18, 2021

Speaker:  Teresa Baker, PT, DPT, physical therapist, APDA’s Rehab Resource Center, Boston University

Summary by:  Sheela Sakariya, Stanford Parkinson’s Community Outreach

Key components of an exercise program

Everyone should exercise for physical and mental well-being.  But being active is particularly important for people with Parkinson’s disease.  Exercise is an important way to slow the disease and control its symptoms; it helps you maintain your ability to do everyday activities, and it protects your brain cells.

Aerobic training

Studies have shown that PD participants who exercised moderate intensity showed a reduction in the motor movements symptoms – a slowing of the worsening of the motor symptoms.  Other studies have shown exercise can lead to an improvement in motor symptoms.  The type of exercise is not the critical component for PD individuals so your individual aerobic exercise routine may include brisk walking, cycling on stationary bike, or any other form of aerobic workout is acceptable.  

The critical component of exercise is the intensity matters! How hard you are working, and what your exertion is like matters in slowing down PD symptoms.  At least moderate intensity aerobic workout levels are necessary which will cause an increase in heart rate, breathing harder, and sweating.  Another way to tell is a self assessment skill of exertion is the talk test – in the midst of your exercise, a person should be able to talk and carry on a conversation , but not have enough breath to sing.  

Another critical component that matters for PD individuals is the amount of time that the person exercises for.  The recommendation is 150 minutes per week of moderate intensity aerobic exercise.  A person with PD should have a goal of incorporating aerobic activity into their routine and ensure they are in a safe setting while doing it. 

Strength training

A key principle in strength training is the use of resistance training – challenge the muscles, overload the muscles, and in time increase the strength.  There are many ways to challenge muscles with resistance: body weight, resistance bands, weights.  The PD individuals should target the following extensor muscle groups while doing resistance training: legs, arms, back, and core.  And lastly, a key component of strength training is repetition – it is recommended that 8-12 repetitions and the last 1-2 reps should feel challenging.  Repeating the exercise 2-3 sets is a minimum for strength training. 

Balance training

Just right challenge, appropriate safety measures 

Challenge balance, coordination, agility

Functional agility: turning, reaching, obstacles

Changing directions, weight shifting, bigger stepping movements

Multitasking, cognitive distraction, remembrong sequence

Incorporated with exercise, classes, other activities

Flexibility training

Goal to address: 

  • Postural alignment
  • Stiffness
  • Reduced range of motion
  • Gentle movement prior to stretching

30 second hold, x 3-4 each muscle group

2-3 x/week, consider daily

Ideas to combine elements of exercise program

Strengthening incorporating balance challenge

Exercise class with different components (warm up, stretching, aerobic, strength)

Movements combining weight shifting, holding positions for balance and flexibility (tai chi, Yoga)

Benefits of exercise program

Aerobic

  • Reduce severity of motor symptoms
  • 150 min moderate or 75-90 mins vigorous intensity per week
  • Many modes are effective so choose something you like (brisk walking, cycling)

Strength

  • Improve bradykinesia and function
  • 2days/week, 3 sets of 8-12 each exercise
  • Free weights, weight machines, resistance bands, or body weight


Flexibility

  • Percent loss of range of motion/posture
  • 2-3 days/week, 3-4 sets of 30-60 sec hold
  • Maybe incorporated into group exercise class
  • Best to perform after you exercise and muscles are warmed up

Balance

  • Best fall prevention if started early
  • 2-3 days/week, 20-30 min at a time
  • Balance and agility exercises, tai chi or dance

How to start an exercise program

Start with what you enjoy

Begin gradually

Use APDA resources: apdaparkinson.org

Consider physical therapy assessment

Some other non traditional forms of exercise that PD individuals also enjoy are dancing, hiking, and boxing.  Again, begin with what you enjoy and start slowly. 


Question and Answer Session

Question:  How do you get into balance training as an exercise program? 


Answer:  That’s a bit of a gray area and probably the most challenging – an individual assessment from a physical therapist may be the best place to start as individual person varies.  And, from the recommendation of the PT, work with a trainer to develop your own personal balance training to understand where to start.  Other forms of balance training include tai chi, yoga, and dance and generally the xercise instructors are very good at driving modifications for your own particular body

Question:  How long should your muscles be sore after exercising? 

Answer:  That’s a great question!  When it comes to exercise, there never should be any pain with exercise.  We need to distinguish between pain and exercise – particularly with strength based exercise.  The challenge should be appropriate for your individual body and to gain some strength from the exercise.  What is typical is to expect slight soreness for a day or two after doing strength exercises.  Also, we recommend taking up exercise on non consecutive days to give your body some rest and time to recover. 

Question:  How do you break down the 150 minutes per week? 

Answer:  Our studies indicate 150 minutes a week is tailored for moderate intensity aerobic exercise.  Combining other types of exercise and reducing aerobics is also another way to break down the routine.  

Question:  How do you find a physical therapist who specializes in PD? 

Answer:  APDA is a national chapter and has individual state chapters as well.  APDA is a great resource to find a physical therapist in your area.  Check out their website (apdaparkinson.org) about your state APDA, and sometimes your hospital may also have resources to find a physical therapist in your area.

Question:  Does swimming count as water aerobics exercise? 


Answer:  Movement in the water can be quite aerobic.  Sometimes when people are experiencing stiffness of joints and are uncomfortable, moving in the water can feel like it’s easier to do.  Movement in water definitely counts as aerobic exercise and can feel very intense. 

Question:  Is it better to go to the gym or better to do it at home? 

Answer:  Either option is fine! It’s up to the willingness of the individual with PD whether they enjoy and feel more comfortable at their own home or like to socialize a bit and head to the gym – it’s completely an individual choice.  Either can be quite effective as long as there is that aerobic intensity and challenging enough

Question:  How do you help motivate someone with PD to exercise? 


Answer:  Great question!  I hear this a lot – there can be more difficulty in motivation with PD.  I would start with what is meaningful for that person, meet a friend for a walk, perhaps playing music while exercising.  The caretaker or helper will need to develop an exercise routine that is catered to the likes and dislikes of the PD individual. 

Question:  When should I start exercising if I have Parkinson’s disease?

Answer:  You should begin an exercise program immediately.  People who start earlier in the Parkinson’s disease process have better outcomes and overall well-being.

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