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Exercise and Parkinson’s

5 Mar 2023

If there is one thing that I want you to take away from this talk, it is the power of positive mental attitude. There is a great saying we use when applying exercise to Parkinson’s which is, “the body won’t achieve it if the mind don’t believe it”.
I have seen fantastic results when working with my clients. During this talk, I want to explore the various techniques that I use to help my clients maintain their basic and instrumental activities of daily living.

When training someone living with Parkinson’s disease (PD), you must look past the condition and find the individual. Each person’s experience with PD will be unique to them. Remember, before they where diagnosed, they had jobs, hobbies and played sports that would have given their bodies imbalances, tension, and injury long before the PD diagnosis. When you are prescribing PD specific exercise, you need to consider that the individual in front of you may have a history of knee pain, a bad back or poor posture which will need to be addressed too, alongside the neuroplasticity PD exercises. No one size fits all!
For example, with one client the main symptom that personally troubles him is tremors in his arms but another client of mine has hardly any tremor but his personal main symptom is reduced axial extension.

If we look at the three main symptoms of Parkinson’s disease, they are:
• Tremors, involuntary shaking of parts of the body
• Rigidity, stiff and inflexible muscles
• Bradykinesia or slow movement.

Parkinson’s makes you slow and small, exercises should work to counteract this, using fast and large movements. You can push back and control these symptoms with exercise but it doesn’t come easy and takes consistency and dedication. Exercise is an investment, the more you put in, the more you get out.
Neuroplasticity and PD Warrior

I’m trained in PD Warrior so I’ll start with that. With PD Warrior, we are trying to achieve neuroprotection, neurorestoration and neuroplasticity. The exercises are designed to slow the progress of PD by helping the brain to naturally rewire and protect itself. It is an exercise rehabilitation programme for individuals with mild to moderate idiopathic Parkinson’s Disease but I still use elements of it with a client who is 77 years old and has been living with PD for 15 years.

PD warrior works by re-wiring the brain which helps you move more freely without having to think about it. The exercises are short but effective and need an 80% effort output. They concentrate on dual-tasking training, performing two tasks at once, as with PD, the movements that you don’t normally have to think about become less automatic due to the damage in the basal ganglia which controls speech, movement and posture.
As well as other examples of PD based exercise classes are:

High intensity interval training HIIT for PD
Research has shown that HIIT can stimulate growth and function of nerves and reduce rigidity and stiffness, improving balance and muscle control. A typical HIIT session is 30 seconds hard then a recovery period (depending on fitness level) repeated over a 20 minute period, carried out three times a week. The one thing to watch out for when trying to raise the heart rate (80% max heart rate) for the intense phase is that Parkinson’s medication can reduce blood pressure and resting heart rate. Because of this you will want to take into account the individual’s resting HR, so don’t follow the 220-age scale too closely. If you are trying to get to 140 bpm from a resting HR of 45 bpm there will be a greater strain on the heart than going from a resting HR of 80 bpm, so reduce maximum accordingly.

I use boxing a lot in my exercise classes. For one, it is high intensity, again helping to improve motor skills, but also a great dual-tasking exercise, especially when adding foot-work. Boxing will help to address symptoms such as tremor, balance, strength and posture but will also increase fitness levels. Let’s not forget about psychological symptoms; depression and anxiety are also symptoms of PD and I have found boxing sessions help with this.
If boxing is not your thing, a cushion slam can also be effective. This is where, in a standing position, you raise the cushion with both arms behind your head and then slam it onto the floor with all your might. After a few of those you will feel the heart pumping and your mood lifting.

Consistent cycling at 80 rpm
There have been many studies that show high cadence cycling is said to promote improvement in all motor symptoms of PD. This involves cycling on a static exercise bike with an rpm of over 80. Pedal for Parkinson’s recommend doing so for 40-minutes so this is something to build up to. It seems like a lot but once you have your rhythm, you will be surprised how attainable it can be. Using an exercise bike is also a great way of working dual-tasking. When I have clients on the bike, I often strike up a conversation or ask questions which work memory. For example, once someone is up to speed and pedalling along at 80 rpm, ask a question like ‘name as many states in the USA that you can think of’. Initially, you will see the RPM decrease as the brain is taken away from the task of turning the pedals. With practice, this will reduce or even stop and the rpm stays constant. You can also add in a few HIIT intervals for good measure as well. The bike is a really good all-rounder and there is also the recumbent option for people with reduced mobility or joint issues.

Walking is a must, not only for fitness and motor function but you will see a shocking decline in ability after a few weeks of not walking. There is obviously massive anxiety associated with walking and a risk of falling, but you must try. You want your client to keep their independence and mobility. It won’t take long for confidence to slip because someone is too worried about falling so stops going for a walk. Aim for 10-20 minutes daily and use Nordic walking poles. As you can see with the video demonstration, when Barry is using the poles, his walking is superb.
I always see a decline in my clients who stop walking in the colder months due to the risk of fallen leaves and ice. If you can’t walk outside, do it inside and even better, try barefoot walking when at home. Did you know that as you age you can lose up to 50% of the sensation in your feet. You can improve the somatosensory system just from walking barefoot around the house. Barefoot training is something to really consider when working with someone with PD.

Music with Parkinson’s Disease
Music therapy benefits for PD have been well established over the years. The benefit of music, dance and physical activity is tried and tested so should definitely be added into PD sessions. I find the most important aspect of this is cuing. It can help with freezing as rhythm and rhythmic cuing can help with initiation, coordination and maintenance of movement. It also helps with mood and communication. One of the first books I read about PD was by Alex Kerten and this heavily leans toward the benefit of music and breathing to music. Well worth a read.

Reducing rigidity
My final focus on this talk is the importance of reducing rigidity. It is the main symptom I deal with when I visit my clients. For me personally, this is the symptom that will reduce function the most but frustratingly, is the easiest to solve. As I said earlier, each person you see with PD will have their own unique symptoms but also, each time you see them the tension and stiffness in their muscles will vary. I used to massage my PD clients frequently and still do, but now I have discovered something even better, the massage gun. People living with PD will have a wide range of problems with their mobility and for some, getting on and off the massage bed can be problematic. It would often frustrate me that a client would really be suffering with pain and stiff muscles but the massage to reduce rigidity would only take 5-minutes, the same time it can take to undress and assist getting onto the couch. This is where the massage gun comes into place. The results are instant and can be done sitting on a chair or lying on a bed. I wish everyone with PD could have access to a massage gun as they are simple to use and get consistent results.
Another great ally in helping to reduce rigidity is heat. Use either an electric heat mat (great for lying on to ease the back and legs) or microwaveable wheat bag. I tend not to recommend hot water bottles due to the risk of boiling water and scalding hands. Heat relaxes the muscles and can be effective.

Final thoughts
Be prepared.
Falls unfortunately are inevitable and are bound to happen at some point so practice for them. Your client might have excellent mobility and is able to get up from the floor with minimal effort but one day that might change. It is better to be prepared for this which is why at least once a week, I practice drills getting up and down from the floor. Depending on ability, I use a sofa, chair or bed and get the client to practice lunging down to the floor to a lying position and then back up again. This is one of many examples of checklists that are useful to use as a trainer or someone working with someone living with PD.

I just wanted to mention a trial that seems promising that is using vibration to combat symptoms of PD. Vibrations have been known to help with PD since the 19th century when Professor Jean-Martin Charcot noticed an improvement in his Parkinson’s patients after a bumpy carriage ride. A company called Charco Neurotech is trialling the cue1, a wearable device that produces a pattern of vibrations that help with focused stimulation and cueing.
The technology is also being trialled by the Michael J. Fox Foundation but they are using vibrating gloves whereas the cue1 is a device that adheres to your chest. These trials are definitely worth looking at.


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