1. Presented by:
Kathy Blatt, MPT
Carol Gertsch, PT, DPT, CLT-
LANA
Created By:
Susan Miller, SPT
PARKINSON’S DISEASE
AND EXERCISE
2. 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
3. VIDEO: Pre & Post Exercise Treatment Program1
http://youtu.be/wElz9jNrqns?t=6s
EXERCISE IS YOUR MEDICATION!
4. Chronic Neurodegenerative disorder
2nd most common movement disorder
Onset – typically 55-60 y.o.
Cell death occurs
causing movement
impairment
OVERVIEW OF PARKINSON’S
5. TRAP
Tremor – resting
Rigidity
Akinesia – difficulty with
movement
Bradykinesia
Hypokinesia
Shuffling Gait
Postural instability
Impaired aerobic capacity
MOVEMENT IMPAIRMENTS
8. Helps manage your symptoms
Possibility of slowing the disease
progression
Improves mobility, posture, & gait
Increases confidence
EXERCISE CAN SPECIFICALLY HELP PD…
9. 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
10. Is there
someone to
help me get
started on a
program?
I don’t know
what
exercises are
safe to
perform?
A Physical Therapist
can get you started!!!!
11. PHYSICAL & OCCUPATIONAL THERAPY
Introduce you to a program
Help improve specific impairments
Teach you specific exercises for home
Education about lifestyle
Establish effective motor strategies!
Help prevent secondary impairments
13. Background:
Developed by Dr. Becky Farley PT, MS, PhD
Also developed BIG® program and associated with LSVT LOUD®
Parkinson’s Wellness Recovery
Vision:
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
14. Patient-Centered Comprehensive Exercise Program
Not a standardized protocol
Performed 1:1 or group setting
Exercises targeted at ALL levels of disease severity
Integrates:
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!
17. 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!
21. 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…
25. Impairments
include:
Center of gravity is
shifted forward
Rigid/decreased range
of motion
Decreased Spinal
Mobility
Weak back muscles
Hallmark Features:
Rounded shoulders
Forward head
Bent forward
Bending of knees
I CAN’T GET MY BACK STRAIGHT…
29. 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…
32. Impairments include:
Reduced speed
Reduced arm swing
Short steps
Feet glued to the ground
Loss of balance
Difficult 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
36. 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
38. Exercises should be SAFE
Exercise should NOT cause pain
Consult with your physical therapist or
physician before starting an exercise
program
RECOMMENDATION
39. 1. PRACTICE, PRACTICE, PRACTICE!!
2. High intensity
3. 5 days/week for 45 min
4. Large Amplitude body movements
5. THINK BIG!
6. PRACTICE, PRACTICE PRACTICE!!
TAKE HOME MESSAGE
EXERCISE is MEDICATION!
40.
41. 1. http://youtu.be/wElz9jNrqns?t=6s
2. Farley, B. PWR!MovesTM Make FUNctional Exercise!. Tucson, AZ: Wheatmark®;
2014.
3. Schenkman M., Keysor J., Chandler J., Laub K., MacAller H. Axial Mobility Exercise
Program: A home exercise program to Improve Functional Ability: A Therapist
Manual. 2nd Edition. Claude D. Pepper Older American Independence Center at
Duke University; 1994.
4. Ashburn, A. et al. A randomised controlled trial of a home based exercise
programme to reduce the risk of falling among people with Parkinson’s Disease.
J Neural Neurosurg Psychiatry 2007; 78:678-684
5. Yekutiel MP, Pinhasov A, Shahar G, Sroka H. A clinical trial of the re-education of
movement in patients with Parkinson's disease. Clinical Rehabilitation. 1991;
:207-214.
6. Herman T, Giladi, N, Gruendlinger L, Hausdorff J. Six weeks of Intensive
Treadmill Training Improves Gait and Quality of Life in Patients with Parkinson’s
Disease: A Pilot Study. Arch Phys Med Rehab. Sept. 2007; 88: 1154-1158.
7. Hoppenfeld, Stanley. Physical Examination of the Spine Extremities . Apple and
Lange: Norwalk, CT; 1976.
8. Cannin CG, Allison JA, Allen NE, Groeller H. Parkinson’s disease: an investigation
of exercise capacity, respiratory function and gait. Arch Phys Med Rehabil. 1997;
78: 199-207.
9. https://www.youtube.com/watch?v=ZKTufkzpo8E
REFERENCES:
Thompson WR, Gordon NF, Pescatello LS. ACSM’s Guidelines for Exercise Testing and Prescription. 8th ed. Philadelphia, PA: American College of Sports Medicine; 2010: 211-212.