By Stacy Hennis, PT, C/NDT
We all know how devastating Parkinson’s disease can be, negatively affecting quality of life for the patient, as well as the family. At this time, there is no cure for Parkinson’s. Symptoms are standardly treated with medication to provide relief. But current research is showing that medication PLUS exercise is better than medicine alone!
Currently, research hasn’t been done to show how exercise alone would do in the treatment of PD. However, the results in those who exercise and are optimally medicated are greater than those on medications alone. Exercise at a high intensity promotes cellular connections so that the neurons communicate more effectively. It helps with attention and learning. Depending on the stage of Parkinson’s, it can even help with learning those motor programs so that activity can become more automatic.
Recent research is proving that exercise can slow or reverse some of the physical decline associated with Parkinson’s. Data from the Department of Neurology at the Pittsburgh Institute for Neurodegenerative Disease, University of Pittsburgh School of Medicine, shows in animals that exercise helps to protect remaining dopamine cells by increasing GDNF, a substance important in protecting brain cells.
The George and Mary Lou Boone Center for Parkinson’s disease Research at USC-LA has also examined the effect of exercise. They are finding changes in the excitability in the basal ganglia, an area greatly affected by Parkinson’s. Researchers at the National Institutes of Health have hypothesized that exercise enhances the signals of dopamine, and improves physical function by suppressing other chemicals affecting the brain. This appears especially true after higher intensity exercise.
What these researchers are looking at is the difference in neuroprotection, neurorepair and adaptation. The earlier you begin exercise in life and especially after diagnosis can provide neuroprotection – protecting those dopamine cells. Neurorepair is a stage where the dopamine cells are not changing but the signals can improve. In the adaption stage, the benefits to your cardiac, respiratory and muscle systems are increased. Exercise can also decrease the markers of brain damage present.
Exercise also helps with cerebral oxygenation – blood flow and oxygen to the brain. Aerobic exercise increases oxygen flow and leads to improved brain functioning, cognitive functioning, learning and memory, and enhanced energy levels. It reduces oxidative stress which is damaging to your brain and body.
It is well documented that people with Parkinson’s lose muscle strength faster than other healthy adults. This leads to impaired balance and mobility. An increased risk of falls results from instability and walking difficulty. Researchers at the School of Public Health at Columbia reviewed Medicare claims and survey data. They showed a three times higher chance that someone with Parkinson’s will fall and fracture a hip as compared to their peers.
An exercise program as simple as walking can make a difference. However, it really needs to be much higher intensity. To achieve all the benefits of neuroprotection and neurorepair, it should be challenging and of a moderate to vigorous level. The earlier someone starts to exercise after diagnosis, the better and longer lasting the results. As Becky Farley, PhD, MS, PT, founder of LSVT BIG and PWR! Exercise4Brain Change states, “This provides hope that intensive continuous exercise with optimal medications may slow motor deterioration and extend quality of life.”
Until recently, traditional physical therapy for someone with Parkinson’s focused on low to medium intensity programs and accommodations for a weakened body. Some in the healthcare fields felt therapy wasn’t needed due to Parkinson’s being a progressive disease. With the current research showing how important exercise is, physical therapy is changing it’s approach as well. One newer method is the LSVT® BIG program, an innovative treatment that focuses on big movements, while addressing the sensory problems that exist with Parkinson’s. For example, someone with Parkinson’s may feel that they are walking normally when they’re actually taking small steps or shuffling. LSVT® BIG takes PD symptoms into consideration, and can only be provided by a LSVT® certified physical or occupational therapist.
The important things for you to remember about exercise are:
- Start early
- Perform interval training – high intensity, then lower, then high again
- Need more exercise with more advanced stages of Parkinson’s
- Don’t stop – do this for the rest of your life!
We can all hope for changes in the delivery of healthcare. Dr. Farley speaks of her hope to see community gyms or therapy centers that provide ongoing support, classes and services to those with people with Parkinson’s to continue with the high intensity exercise throughout their lives. Until we have that, please remember to exercise – it is medicine!
Please remember to always seek your physician’s approval before beginning an exercise program.
Stacy Hennis is the owner of New Beginning Physical Therapy, Inc., an in-home therapy company. She has a Master’s degree in Physical Therapy, as well as advanced certifications in treating adults with stroke, brain injuries and Parkinson’s. Find Stacy at ParkinsonsResource.org/spotlight/new-beginning-physical-therapy/