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Exercise And Parkinson’s Disease

“The earlier people begin exercising after a Parkinson’s diagnosis, and the higher the intensity of exercise they achieve, the better they are”

Susan Sills, a Brooklyn artist who until recently made life-size cutouts on plywood using a power saw, long suspected she might be at risk for developing Parkinson’s disease. Both her mother and grandfather had this neurological movement disorder, and she knew that it sometimes runs in families.

So she was not surprised when at age 72 she first noticed hand tremors and a neurologist confirmed that she had the disease. But to watch her in action three years later, it would be hard for a layperson to tell. She stands straight, walks briskly, speaks in clarion tones and maintains a schedule that could tire someone half her age.

Having wisely put the power saw aside, Ms. Sills now makes intricately designed art jewelry. She is also a docent at the Brooklyn Museum, participates in a cooperative art gallery and assists her husband’s business by entertaining customers.

Ms. Sills attributes her energy and well-being partly to the medication she takes but primarily to the hours she spends working out with a physical therapist and personal trainer, who have helped her develop an exercise regimen that, while not a cure, can alleviate Parkinson’s symptoms and slow progression of the disease.

The exercises opened me up,” said Ms. Sills, allowing such symptoms as small steps, slow movements and tiny, cramped handwriting to subside.

The earlier people begin exercising after a Parkinson’s diagnosis, and the higher the intensity of exercise they achieve, the better they are,” Marilyn Moffat, a physical therapist on the faculty of New York University, said. “Many different activities have been shown to be beneficial, including cycling, boxing, dancing and walking forward and backward on a treadmill. If someone doesn’t like one activity, there are others that can have equally good results.”

Unfortunately, Dr. Moffat added, “no one tells people with Parkinson’s what they could and should be doing unless they get to a physical therapist.” The typical delay in starting an effective exercise program also stems from the ability of medication to alleviate early symptoms, leaving patients with little incentive to exercise.

While everyone can benefit from exercise, it is especially important for people with a progressive movement disorder like Parkinson’s that can result in weakness, stiffness, difficulty walking, poor balance and falls, as well as impaired cognitive processing. Regular exercise bestows increased levels of fitness; a greater sense of well-being; stronger muscles and bones; healthier joints; more efficient breathing; and better digestion and blood circulation. The result is enhanced physical, mental and cognitive health, all of which are especially important to people with a chronic ailment.

For Parkinson’s patients in particular, regular exercise tailored to their needs can result in better posture; less stiffness; improved flexibility of muscles and joints; faster and safer walking ability; less difficulty performing the tasks of daily living; and an overall higher quality of life.

Patients who participate in exercise programs designed to mitigate symptoms and perhaps delay progression of Parkinson’s “can function independently at a higher level, have stronger feelings of well-being, and are happier about their quality of life,” said Dr. Moffat, who has witnessed major improvements in people she’s worked with.

Among the many exercise options is an agility programthat incorporates the principles of tai chi, kayaking, boxing, lunges and Pilates. It was developed and proved safe and effective by Laurie A. King and Fay B. Horak at Oregon Health and Sciences University. The agility course includes navigating turns, doorways, hallways and small areas; tasks like walking with knees high and hands touching them; skipping; and shuffling from side to side.

In a report on their work in Physical Therapy, the journal of the American Physical Therapy Association, Dr. King and Dr. Horak explained that intense exercise can improve “plasticity” of the brain, protect against nervous system degeneration, and even reverse motor deficits.

Another program, called Rock Steady Boxing, was founded by Scott C. Newman, a former prosecutor in Marion County, Ind., who developed Parkinson’s at age 40. He reported significant improvements in his physical health, agility, daily functioning and quality of life shortly after he began high-energy workouts doing boxing moves a few years after his diagnosis.

Mr. Newman has pointed out that Parkinson’s is not a muscle wasting disease. Rather, the brain forgets how to tell the muscles what to do. He believed it should be possible to teach the brain to get muscles to work more effectively, which is what Rock Steady Boxing and other exercise programs for Parkinson’s disease seem to have achieved.

While it is best to begin a challenging exercise program early in the disease, Dr. Moffat and Mr. Newman say it can help at any stage. Rock Steady Boxing, for example, has created training programs suited to fitness levels at all stages of Parkinson’s.

Another personal experience, by a cross-country cyclist, resulted in a tandem cycling program for Parkinson’s patients. In a 200-mile trip across Iowa in 2003, Jay Alberts, a biomedical engineer at the Cleveland Clinic, pedaled in the lead position with a woman who has Parkinson’s. The pace he set forced her to pedal a third faster than she would have done on her own. The woman’s tremors disappeared while she was pedaling with Dr. Alberts, and he later showed in a controlled study that the ability of forced pedaling to suppress Parkinson’s symptoms can persist for weeks afterward.

Dr. Alberts suspects that the high-intensity exercise changes how the brain processes movement, resulting in improved motor function over all. The benefits of tandem cycling can be achieved indoors and out, even without a biking partner.

The exercise program that has mainly helped Ms. Sills, called L.S.V.T. BIG, evolved from the Lee Silverman Voice Treatment program – L.S.V.T. LOUD — created to improve the speech of Parkinson’s patients, who tend to talk more and more softly. Developed specifically to counter the unique movement impairments associated with Parkinson’s, it trains patients to “make big strong movements, not little weak ones,” Ms. Sills said, for example, taking big steps and swinging your arms widely when you walk. “This is the normal way to walk, but not when you have Parkinson’s, but it no longer feels strange to me,” she said.

Other programs tailored to benefit Parkinson’s patients include ParkFit, which fosters a more active lifestyle; Dance for PD, which has classes in every New York City borough and many other countries; and Microsoft Kinect Adventures, which uses Xbox games geared to different stages of the disease.

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