Exercise for Parkinson Patients

SOURCE: Center for Neurological Studies

Know the facts. The maintenance of normal muscle tone and function is an important aspect of the treatment of parkinsonism. In part, medication administered for your illness achieves this goal. However, to realize the full benefit of the medication daily exercise and activity are essential. This booklet outlines some of the exercises capable of maintaining muscle power and tone and preventing deformities of the limbs and spine. Their daily performance has proved most beneficial to patients with this illness.
TEN BASIC EXERCISES FOR THE PARKINSON PATIENT

1. Bring the toes up with every step you take. In Parkinson's disease, "you never make a move", without lifting the toes.
2. Spread the legs (10 inches) when walking or turning, to provide a wide base, a better stance, and to prevent falling. It may not look "beautiful," but neither does falling.

3. For greater safety in turning, use small steps, with feet widely separated. Never cross one leg over the other when turning. Practice walking a few yards and turn. Walk in the opposite direction and turn. Do so fifteen minutes a day.

4. Practice walking into tight corners of a room, to overcome fear of close places.

5. To insure good body balance, practice rapid excursions of the body. Backward, forward and to the right and left, five minutes, several times a day. Don't look for a wall when you think you are falling. It may not be there. Your body will always be there to protect you, if you will practice balance daily.

6. When the legs feel frozen or "glued" to the floor, a lift of the toes eliminates muscle spasm and the fear of falling. You are free to walk again.

7. Swing the arms freely when walking. It helps to take body weight off the legs, lessens fatigue, and loosens the arms and shoulders.

8. If getting out of a chair is difficult, rise with "lightning speed," to overcome the "pull of gravity." Sitting down should be done slow, with body bent sharply forward, until one touches the seat. Practice this at least a dozen times a day.

9. If the body lists to one side, carry a shopping bag loaded with books or other weights in the opposite hand to decrease the bend.

10. Any task that is difficult, such as buttoning a shirt. or getting out of bed, if practiced 20 times it day, becomes easier the 21st time.

FOR TIGHT MUSCLES AND POOR POSTURE

STANDING

1. Stand ln front of a wall, facing it about 8" away. Raise arms and reach as high as possible toward the top of the wall. Lean toward the wall and stretch.
2. With your back to the wall, alternate raising legs as high as possible by bending the knee as if marching in place.

3. Holding on to something secure, squat down as far as possible, bending knees; then come up.

SITTING

1. Sitting in straight-back chair, place your arms behind the chair and bring your shoulders back as far as possible; raise your head up and look at the ceiling.
2. Sitting In the same chair, grip the ends of a broom or mop stick with both hands, try to raise it over your head until you get it behind your head. Keep head and shoulders as erect as possible.

3. Sitting in same chair, place one leg at a time on another chair and press the knee straight. Keep it there 15 minutes. Try both legs together.

4. Sitting in a chair, raise legs up from the knee alternately, as if stamping your feet.

LYING ON A FIRM BED OR FLOOR

1. Lie on the floor or bed, flat on your back; try to press your body to the floor as flat as possible. Move your head from right to left as far as possible. Make sure your head, shoulders, back, and knees touch the surface.
2. Lie on the floor or bed on your abdomen. Do the following one by one:

Put your hands behind back and look up to ceiling, trying to raise your chest off the floor.
Kick your legs alternately, as if swimming.
Turn your head from right to left.
FOR BETTER BALANCE

1. Stand with hands on hips, feet spread apart:
Practice marching in place
Practice raising leg straight out to the rear.
Practice raising leg out to the side.
Practice drawing a circle with the leg.
2. Standing with hands at side, feet spread apart:
Lean forward and back
Lean to both sides
Lean in a circular motion and reverse the motion
FOR WALKING

1. When walking, REMEMBER:
Take as large a step as possible
Raise your toes as you step forward, hitting ground with your heels
Keep legs apart and posture straight
Swing arms and look straight ahead - your feet know where the floor is located.
2. Collect a dozen magazines; lay them out in a straight line. Space them so that you can take as long a step as possible. Practice walking over these magazines without stepping on them.
3. For a better swing to arms, walk holding a rolled magazine in each hand; keep elbows straight.

4. Practice walking sideways, backwards, and take big steps.

FOR TURNING

1. When practicing turning:
Keep feet spread-apart and head high
Use small steps; rock front side to side
Raise legs from the knees
2. If you feel glued to the floor:
Raise your head, relax back on your heels and raise your toes
Rock from side to side, bend knees slightly and straighten up and lift your toes
It sometimes helps if the arms are raised in a sudden short motion
FOR GETTING IN AND OUT OF A CHAIR

1. If you become glued a few steps before you reach the chair, try this: Don't aim for the chair but some object past it. Pass the chair as closely as possible and as you go by it sit down.
2. To sit down, bend forward as far as possible and sit down slowly. Get close to the chair. Do not fall into the chair.

3. To get up, move to the edge of the chair, bend forward and push up vigorously using your arms; try to count 1 2 3 GO! If you have a favorite armchair, raise the back legs with 4" blocks. This will help you to get up easily. Don't let people drag you up by your arms, but help you by pulling you under your arms, or with a slight push on your back.

FOR GETTING OUT OF BED

1. Place blocks under the legs of the head of the bed. This will elevate the head of the bed, & make it easier for you to sit up and swing the legs off the bed.
2. A knotted rope tied to the foot of the bed can help you to pull yourself up.

3. To get to a sitting position, shift the body down and rock yourself by vigorously, throwing your arms and legs toward the side of the bed.

FOR USING YOUR ARMS AND HANDS

1. Practice buttoning and unbuttoning your clothes; practice cutting food and writing. Squeeze a ball or work with "Silly Putty." Keep your fingers busy many times a day. Tear paper; take coins out of the pocket; play the piano.
2. Always try to dress yourself completely. Use shoehorns, elastic laces, or extra-long shoelaces to get a better grip. Dress in the most relaxed and comfortable position, sitting or standing, but make sure you are in a safe position.

3. To keep elbows straight and shoulders loose, install a pulley in doorway, place a chair under it or slightly in front. Stretch your arms and shoulders in all directions. By working the pulley when seated, you can get a more vigorous pull.

FOR GREATER SAFETY IN BATHTUB AND TOILET

If it is difficult to sit down in a bathtub, try the following:
1. Place a bench, stool or chair inside the tub; have the legs sawed off to tub height. Sit on the chair and soap yourself. Use shower to rinse, or rubber shower extension.

2. Bathtub grab bars are available. Purchase only those that attach securely.

3. Raised toilet seats are commercially available.

4. Toilet armrest for getting on and off the toilet are available.

FOR SPEECH, FACE AND CHEWING DIFFICULTIES

1. Practice singing and reading aloud with forceful lip movements. Talk into a tape recorder, if one is available.
2. Practice making faces in front of a mirror. Recite the alphabet and count numbers with exaggerated facial motions. Massage your face with vigor when washing and bathing.

3. When chewing food, chew hard and move the food around; avoid swallowing large lumps.

The previously outlined general exercises and suggestions are designed to help you. They are ancillary to medical treatment which should be carried out in consultation with your physician. In special instances where other diseases are associated with parkinsonism, your physician may wish to limit the intensity of your physical activity. Conversely, more intensive physical therapy may be indicated and in some instances should be done under the direction of a physical therapist.

All activities possible should be engaged in: work, walking, shopping, house chores, gardening, visiting, senior clubs, church organizations, travel, theater, swimming, sports, gymnasium, health clubs, "Y" activities, etc.

Physio sessions help patients with Parkinson's disease

Dileas Sweetenham sits back in her chair and says "aaah".

She's not at the doctor's – but she might as well be.

For she is one of a group of people getting regular physiotherapy for Parkinson's disease.

Exercise is a central part of a monthly session run by the Bath branch of the Parkinson's Disease Society.

Members are offered a range of exercises designed to keep joints supple and improve general fitness.


The aim is to make automatic movement easier, with even facial muscles targeted.

Roughly half of people with the disease develop speech and communication problems, so speech exercises are also taught.

Exercises are done sitting and standing and sometimes include tai chi.

Retired GP Dileas said: "I believe exercise keeps our bodies in use – if you don't use it, you lose it. The exercise keeps me supple."

Physiotherapist Gay Moore also gives advice on specific problems associated with Parkinson's disease, such as posture and gait, balance and dexterity.

The sessions at the United Reformed Church in Odd Down finish with five minutes of dancing as movement to music has been found to help with improving sufferers' rhythm in walking.

Dileas discovered she had Parkinson's in 2003 and the 75- year-old joined the branch a year later.

Now chairman of the Bath group, she is closely involved in co-ordinating a parallel set of monthly meetings at Foxhill Community Centre.

She regularly invites medical speakers such as neurologists and academics.

Dileas said: "The lectures are very useful and it lets us keep abreast with what is going on.

"It's a chance to meet other sufferers and forge friendships."

The disease affects one in 500 people around the UK. Symptoms will usually appear in people over the age of 50 but one in 20 of those diagnosed every year will be under 40.

This year is the 40th anniversary of the Parkinson's Disease Society and the charity says it wants 2009 to be a "breakthrough year".

The branch meets twice a month, once at the church hall in Odd Down for physiotherapy sessions and once at the community centre for a social meeting.

Tai chi may help Parkinson's patients

MIAMI (Reuters Health) - While people with Parkinson's disease are very interested in using complementary and alternative medicine to treat their symptoms, there has been little study on whether such therapies can help them, Lyvonne Carreiro reported here at the Seventh International Congress of Parkinson's Disease and Movement Disorders.

But two small studies--one conducted by Carreiro and her colleagues--suggest that Tai Chi and the herb yohimbine, respectively, may help reduce falls in Parkinson's patients. People with this progressive neurological disorder suffer from tremor, muscle rigidity and movement problems.

Carreiro, a Parkinson's disease care coordinator at the University of Florida in Jacksonville, surveyed 75 patients at her center about their knowledge of complementary and alternative medicine.

"There is a lot of interest in alternative therapies for Parkinson's disease, but not enough information," she told Reuters Health. "Patients should let their physicians know if they're interested in such treatments."

Carreiro's team found that 54% of the respondents understood the definition of complementary and alternative medicine. Among the respondents, 23% mistakenly believed these treatments were part of most medical schools' coursework, and 51% believed herbs can be safely taken with medication. Most said they were interested in such therapies, but would only use them if prescribed by their medical doctor.

In the past year, 48% of the respondents had used these treatments. Among those who had, 45% had taken Tai Chi classes; 36% had used yoga and 27% had used acupuncture. Carreiro noted that several respondents had used multiple strategies and that 36% of respondents had used massage, 24% had practiced meditation, 45% used spiritual healing or prayer, and 15% used herbal therapies.

Noting that 80% of respondents believe that complementary and alternative medicine could improve their Parkinson's disease, Carreiro pointed out that there is a need for more well-controlled scientific studies to see if this belief is warranted.

In her own practice, she and her colleagues found that Tai Chi appeared to reduce the number of falls in Parkinson's patients. The investigators followed 30 patients with Parkinson's disease who were randomly assigned to a Tai Chi group or a "control" group. The people who evaluated their records of falls and stability scores did not know which patients were controls and which received Tai Chi lessons. Tai Chi patients had one-hour weekly Tai Chi classes for 12 consecutive weeks.

The Tai Chi patients were less likely than controls to have an increase in the severity of their Parkinson's disease and less likely to have a decline in motor function. The reduction in fall frequency was 18 times greater for the Tai Chi patients, said Carreiro. She told Reuters Health that people with Parkinson's disease who want to study Tai Chi must make sure the instructor is familiar with their condition and will accommodate their needs.

Other research on complementary and alternative medicine shows that some herbal or botanical therapies bear out their good reputations while others deliver less than adequately.

In a study on yohimbine, Dr. Ruth Djaldetti and colleagues at Rabin Medical Center, Beilinson Campus in Petach Tiqva, Israel, found that the use of yohimbine was associated with a 50% reduction in the number of falls. They treated 11 patients who either had Parkinson's disease or other parkinsonian syndromes.

Dr. M. G. Jabre and colleagues in Byblos, Lebanon, studied the use of fava beans as the only treatment in five patients who had not yet received any Parkinson's medication. Their rationale was that fava beans are chemically similar to levodopa, the mainstay medication in Parkinson's treatment. Although the investigators found no statistically significant improvement in the patients' conditions, two of the five were satisfied and wanted to continue with fava beans.