This American Parkinson Disease Association (APDA) webinar in December focused on tips and tricks to help everyone stick with a Parkinson’s disease (PD) exercise program. The speaker was Nick Wendel, DPT, with the APDA National Rehabilitation Resource Center for Parkinson’s Disease at Boston University.
Here is an interesting question that came up in the question and answer session:
Question: I am struggling to stick to my exercise routine. Who should I go to for help?
Answer: There is not one place for everyone. A lot of people are having trouble sticking to their routine especially after COVID. A great place to start is finding a local physical therapist who has experience working with people with PD. The therapist can help set some goals, and help you get started with appropriate exercises, and keep track of your progress.
This APDA webinar was the last part of a three-part series of “Let’s Keep Moving with APDA.” It was recorded, and is accessible on PD Exercise videos
PD Exercise classes live online
See my notes below for the session.
Regards,
Sheela Sakariya
“Maintaining Momentum: Let’s Keep Moving” – Webinar notes
Webinar Host: American Parkinson Disease Association (APDA)
Webinar Date: December 9, 2021
Speaker: Nick Wendel, PT, DPT, APDA National Rehabilitation Resource Center for Parkinson’s Disease, Boston University
Summary by: Sheela Sakariya, Stanford Parkinson’s Community Outreach
4 basic elements for PD exercise
Aerobic exercise
- 150 min/week
- Moderately high intensity
- Brisk walk, cycling
Strength exercise
- Major muscle groups x2-3/week
- Squats, calf raise, rows
- Progressive resistance challenge
Balance exercise
- Appropriate challenge
- 20-30 min x2-3/week
- Tai chi, dance
Flexibility exercise
- After warm-up
- Hold 30-60 sec x 2-3/week
- Calf stretch, trunk rotation
How do you stick with exercise?
- High self efficacy: confidence in your ability to do something
- Positive expectation of exercise: time spent is really worth their while
- Feedback on performance: helps reinforce good behaviors
- Mastery experience: repetition gives you mastery
- Rewards: external reward or experience
- Peer and profession support
- Forming a habit
Goal setting: SMART
S : Specific
M: Measurable
A: Attainable
R: Relevant
T: Time-based
Feedback/self monitoring
This allows you to track yourself and give feedback on how you are doing with your exercise routine. This feedback can be in many forms: Apple Watch, Fitbit, another app, or just a fitness calendar. What is important is that the exercise time is tracked, identify days that have gone well for exercise, and also identify when you have to change the exercise routine a little bit to accommodate not such good days.
Mastery experience
Setting goals and tracking your progress will eventually lead to mastery – mastery can be as formal as a black belt in karate, or as informal as when you correctly complete a dance step. Mastery doesn’t happen right away! You need to work at it overtime, step by step, until eventually you reach your goal.
Rewards: extrinsic and intrinsic
When a person has achieved his goal, it’s normal to give yourself a reward. This reward is to keep yourself going – the rewards can be very formal, for example, going out for a nice dinner, or going on a shipping trip. Rewards can also be informal like meeting up with friends and doing something fun or getting a badge on an exercise app. Setting up these rewards helps build that sense of accomplishment and can help motivate you to continue to exercise.
Rewards do not need to be external rewards. A person with PD can also reward themselves by intrinsic rewards:
- Walking faster
- Better balance
- Improved mood
- Symptoms less bothersome
Intrinsic rewards take time but can be hugely important with PD.
The best part of exercise is you only get the benefits and not the side effects.
Peer support
Many PD people benefit from people who are in similar situations as them – these people are peers who they can learn from or get motivation from. Oftentimes, PD people will get support from exercise groups (tai chi class or boxing class), or from their support groups. We encourage using support groups to keep yourself moving.
Professional support
Professional support can come from many places – movement disorder specialist, neurologist, physical therapist, or a personal trainer. Building a team can help you maintain an exercise schedule and hold you accountable for your exercise.
The ultimate goal of all the above strategies is to create an exercise habit!
Forming a habit
To create an exercise routine, another tip is to add a cue to your day to get the PD person moving. For example, setting your exercise clothes the night before will be a subtle reminder in the morning that it’s time to exercise. Another example is meeting with a neighbor or friend daily for exercise will be your cue to exercise. The most important thing is to make exercise a routine – a cue will help you lead to a routine. When you are in the routine, eventually you are able to take advantage of those rewards.
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Question & Answer Session
Question: I am struggling to stick to my exercise routine. Who should I go to for help?
Answer: There is not one place for everyone! A lot of people are having trouble sticking to their routine especially after COVID. A great place to start is finding a local physical therapist who has experience working with people with PD. The therapist can help set some goals, and help you get started with appropriate exercises, and keep track of your progress.
Question: Is it typical to feel clumsy and awkward when beginning an exercise routine?
Answer: Yes! It’s definitely something that a lot of people with PD experience – when you are new to a certain exercise, you will not be as fluid. The important thing is to stick with it and take advantage of the benefits that it offers over time. With practice, you will get better over time.
Question: I have tried a number of activities and none of them work for me. Does that mean I will never be able to exercise?
Answer: You need to find an exercise routine that works for you. Sometimes, it just takes a little bit of practice! There is no correct or perfect routine – do whatever works for you and your body. Invest in some help and see a physical therapist or work with someone you know who also has PD.
Question: Is there a best strategy to stick to exercise?
Answer: The options and strategies we detailed today work for many people with PD. Perhaps, you should think about what you were doing in the past and what worked for you. And you can better utilize your energy to see what was working for you before and start that routine again. The cues and techniques we provided today are certainly helpful for many people with PD, but not everyone. So, you have to figure out what speaks to you and work with that.
Question: Is there an example that we can use the SMART goal strategy?
Answer: Sure! I would start using the Apple Watch or a fitness app and set the goal of 2000 steps per day for 2 weeks, and once you attain that goal, increase your goal to maybe 3000 steps per day. You can also add specific goals like walking to get your mail everyday or taking the trash out everyday. That’s one way of using the SMART goal strategy we discussed earlier today.