PARKINSON'S DISEASE AND EXERCISE

Parkinson's disease (PD) affects many aspects of a person's daily life. The condition can make it difficult to initiate movements or maintain balance. Lack of dexterity can make fine movements such as doing up buttons difficult.

Walking may be impaired so that the person no longer wishes to get up and walk for fear of falling. Exercise cannot cure these problems but it is thought to minimise their effects on the individual.

The basis of good health is a positive attitude. One way to be positive in a realistic way is to have good nutrition and physical fitness.

The aims of exerciseThe main aims of exercise are to obtain and maintain as high a level of function as is possible. This can be achieved by:
encouraging motivation and will-power; you must resist the temptation to do nothing;
constant practice of functional activities such as dressing, eating, showering and walking. Make them a part of your daily routine so as to keep up the activity.

Write your exercise time in an appointment book, so it is given equal value with other appointments;
instruction for the family so that they can help when needed. This should, however, be only in activities that you cannot perform alone. Although relatives and carers may think they are helping, too much help can mean loss of independence;
exercising using full rhythmic movement, which will utilise the joints as well as the muscles.

Exercise should become a part of your normal daily routine. If you can manage it, 15 minutes a day is the minimum amount of time that should be spent on formal exercise, sport or hobbies. You should rest at any time if you become tired, as over-exertion will only lead to increased tremor and rigidity and excessive fatigue.
The benefits of exercise

Exercise can benefit all people, including those with PD. It assists by:
increasing the range of movement and helping prevent deformities of the joints;
stretching muscles;
strengthening muscle groups, improving posture, balance and movement patterns;
improving the initiation, rhythm and co-ordination of movement and hence safety when mobile;
helping maintain fitness of heart and lungs by improving circulation and rate and depth of respiration;
actually making people feel better more alert and fitter, leading to more awareness of care of the body. To avoid fatigue, the best time to exercise is in the morning when your body is rested and ready for action. Look for ways to make your exercise time fun, such as joining an exercise group or involving family members. Exercising to music is another excellent way to maintain enjoyment and motivation.
Australian Parkinson's Associations have an exercise video for loan or purchase, produced specifically for people with PD.
General exercisesThese are useful to maintain general fitness.
Walking (stretch calf and hamstring muscles first) improves fitness and feelings of well-being.
Fear of a new terrain may cause problems.
Increase the step size; a larger step may help to straighten up.
If slowness is a problem, count to help keep the rhythm.
Swing arms where possible.
Shoes should have good arch supports and low heels.
Walk on a flat surface with no obstacles.
Exercise in water (aquarobics, hydrotherapy).
Cycling, bowls, gym, golf and dancing are good for aerobic exercise.Before any aerobic programme is commenced, check for heart, blood pressure or other medical limitations.
Specific exercisesThese are included as a guide to the kinds of exercises that are available. Consult a physiotherapist to help develop your own exercise regime or if you have any problems. Exercises should be stopped if you feel pain.
Go slowly, gradually increasing direction, intensity and frequency.
Face
Make faces in the bathroom mirror, such as surprise, frown, smile, bad smell, 'don't know' expressions.
Head and shoulders
To loosen the tightness in your neck, pull yourself upright and raise your hands over your head.
Turn your head to the left and look over your left shoulder, then turn your head to the front. Turn and look over your right shoulder, then back to the front.
Look up to the ceiling. Tilt your head back so that your chin is pointing towards the ceiling. Now look straight ahead. Tilt your head forward so that your chin is on your chest. Bring your head up to the front position again. (Avoid this exercise if it makes you feel dizzy.)
While looking to the front and keeping your shoulders still, tilt your left ear to your left shoulder. Lift your head up again. Then tilt your right ear to your right shoulder, and bring your head back again.
Arms and trunk
Sit with hands clasped, then lift your arms as far as possible. Slowly lower your arms back to your lap.
Sit holding the left side of the chair with your left hand. Raise your right arm and stretch it behind you and then back to your side. Repeat on the other side.
While seated, raise your arms in front of you to above your head, then lower them to your sides again.
Place your hands behind your head and push your elbows as far back as possible (taking care not to pull head forward). Hold for 2 seconds and relax.
With hands on hips, lean forward minimally, slowly return to upright position and then lean backward. Use this to help maintain a good posture.
Place your hands on your hips and reach to the right as far as possible. Return to an upright position then lean over to the left.
With hands on hips, tip your pelvis forwards (i.e. arching the lower back a little) and back, then side to side.
With hands on hips, rotate to the right, return to the front and then rotate to the left.
Hands and wrists
Bend your elbows until your hands hit your shoulders, then straighten them out in front of you. Relax.
With arms at side and elbows at right angles, alternately turn your palms up and down as far as possible. Keeping the same position, alternately bend your wrists up and down as far as possible.
Holding your hands flat on your lap, make a fist with your left hand, then relax it. Repeat with your right hand.
Legs
While sitting, tilt your pelvis to one side. Leaving your weight on that side, move the other pelvis up and forwards. Continue 'walking' your thighs forwards then back in the chair.
While sitting, straighten your leg and move your foot in a large circle; repeat. Lower your leg and repeat with your other foot.
Again while seated and keeping your knees bent, swing your foot into the middle and out to the side.
Point your foot down while curling your toes, then bring your foot upwards, your toes toward you.
March, lifting your knees as high as possible.A properly directed exercise programme is essential for people with PD. It will enhance balance, co-ordination, motivation and the effects of medication.
Don't overdo things. If you become dizzy, faint, short of breath or have chest pain, stop and call your doctor.