Exercise in Parkinson’s
Nora Lea Arcand attends a professionally-led exercise class for people with Parkinson’s twice a week at a recreation centre in her Sudbury, Ontario community. “If I didn’t exercise, I wouldn’t move. I mean that seriously,” says Arcand. “After 20 years of living with Parkinson’s, I know I would seize up. When I walk after supper and when I’m doing the exercises, I move much better during the day.”
Parkinson’s disease is a movement disorder that affects over 100,000 Canadians. With symptoms such as tremor, slow movement, muscle rigidity and walking difficulties, it would not be surprising if people became sedentary. However, research indicates that people with Parkinson’s who exercise fare better over time than those who are inactive.
“When people with Parkinson’s have those really bad days where rigidity is a problem and slow movement makes life difficult, the people who exercise regularly have more resources to draw on because their bodies are stronger,” says kinesiologist Maria Fragapane.
As co-supervisor of the Wellness Centre at the Cummings Centre for Seniors in Montreal, Fragapane has several years’ experience in developing kinesiology-based programs for people with Parkinson’s. She says, “What makes for a good program is to try to target the things that people are having problems with, then train for that with task-specific exercises.”
In addition to tackling the usual Parkinson’s symptoms, her programs address some of the lesser-known areas affected in Parkinson’s.
Dual-tasking. People with Parkinson’s often have difficulty performing activities such as walking and talking at the same time or being able to turn a corner while carrying a parcel. The exercise classes incorporate obstacles courses to train the body and brain.
Proprioception. Some people have trouble sensing where their own bodies are positioned in space. Class facilitators give cues and constant verbal reminders about proper body positioning. Are you stepping with your heel or with your toes? Swing your arms. Keep your head up. Stand straight. Chin up.
Reaction time. Reaction times can be slower in Parkinson’s. The program makes innovative use of boxing exercises to work on coordination and strength. As the instructors constantly switch directions, the participants are forced to react. Fragapane believes that boxing, like dance, offers a combination of focus and rhythm that keeps people moving. “It seems to stop the freezing during the time they’re doing it.” For some participants, the seven-minute boxing segment is the highlight of their day. Fragapane says, “There’s something exhilarating about punching a bag.”
Fragapane is a firm believer in using exercise gadgets such as balance boards and Wii technology and adapting them to suit a person’s mobility level.
For people who want to develop their own exercise routines, Janet Millar, clinical director and physiotherapist at the Maritime Parkinson’s Physiotherapy Clinic in Halifax offers some recommendations:
Exercise regularly, meaning daily. Make it challenging. “Those are the two criteria in which the literature tells us Parkinson’s can be slowed down.”
Focus on five key areas: endurance, flexibility, balance, posture, strength. “Walking is one of the most beneficial activities. It addresses several of those five issues and it provides opportunities to pay attention to stride length, gait pattern and arm swing, which are all affected in Parkinson’s.”
Emphasize the anti-gravity muscle group. “These are the muscles that straighten you or make you taller.” Back extensors, knee straighteners, triceps – the muscles at the back of the elbow that straighten the arms, enabling you to reach up, to the side and behind the back, shoulder blade squeezes. “These work against the typical stooped posture in Parkinson’s.”
Make exercise a lifelong habit. “There is something every single person can do – right from the person who can work out in the gym alongside everyone else to the person who may be confined to a bed and need extra support and intervention.”
Get active and stay active. If you enjoy group exercise, look for classes at community recreation centres. If not, find something you can do on your own or with a buddy. Millar: “Find physical activities that the person likes or will, at least, tolerate. I think that is the secret to compliance.”
Parkinson Society Canada, in partnership with Canadian Physiotherapy Association, has created a new Physical Activity and Parkinson’s Disease information sheet that describes the benefits of aerobic, strengthening, flexibility and balance activities for people with Parkinson’s. It includes a tracking tool to chart and record physical activity and progress. This Physical Activity and Parkinson’s Disease resource is available in English and French, online and in print, and can be downloaded at www.parkinson.ca.