Crafting Your Personal Exercise Routine
So your neurologist has told you to “exercise more,” you’ve heard members of your Parkinson’s disease support group touting the benefits of exercise, or read an article proclaiming the potential neuroprotective effects of vigorous exercise for Parkinson’s disease. Maybe all three. You’re finally motivated to get off the couch, but you’re faced with so many choices–running, walking, Nordic walking, cycling, fitness machines, boxing training, dance, pilates, stretching, weight training, tai chi, yoga, etc. How do you craft the optimal exercise routine for you?
First and foremost, be safe. If you’ve been living a sedentary lifestyle or are elderly or suffer from balance problems or other Parkinson’s symptoms that make exercise difficult or dangerous, consult with your doctors and/or a physical therapist for help finding the right exercise program for you. This is not simply a standard legal disclaimer (although it is also that–on balance exercise is good, but it carries risks that only you and your doctors can reasonably assess). Dr. Michael S. Okun, the co-founder of the University of Florida Center for Movement Disorders and Neurorestoration and the National Medical Director for the National Parkinson Foundation, recently observed in his blog that his clinicians have been observing “an alarming number of patients presenting to the clinic” who have been pushed to cycle too hard by personal trainers who have heard about the “forced exercise” studies that show benefits to PD patients who pedal at a very high pace. Dr. Okun warns that it “may be ok for select early Parkinson’s disease patients in outstanding physical health to immediately be pedaling this fast, however for many patients this level of intensity could be inappropriate.” He recommends that patients talk with their doctors and start slow before working up to a more vigorous pace.
Choose Activities That Are Fun And Sustainable
Rather than punish yourself with a military-style exercise drill, choose exercises that you enjoy because you are more likely to stick with them. Several illuminating studies are summarized or linked on our PD Exercise Research page, but a review of recent clinical trials published by The Mayo Clinic’s J. Eric Ahlskog, PhD, MD, in Neurology in 2011 best lays out the case for stressing vigorous exercise in the treatment of PD. While Dr. Ahlskog cautioned that these trials, in the aggregate, do not prove exercise slows PD progression, he concluded that a neuroprotective effect is certainly plausible, if not compelling, and that the overall body of evidence suggests that vigorous exercise should be accorded a central place in our treatment of PD. Several of Ahlskog’s specific conclusions deserve emphasis:
1. Clinicians should specifically counsel patients with PD to engage in regular exercise, sufficient to establish and maintain physical fitness.
2. The choice of exercise should not only be tailored to the patient’s capabilities, but also their interests, so that they will be motivated to maintain a regular routine. The literature does not intuitively endorse any one specific type of exercise, but rather vigorous exercise in general. Any routine ultimately leading to physical fitness should be beneficial.
3. Physicians may utilize physical therapists to design programs for deconditioned patients who need a graduated program. The instructions to the physical therapy team should be clear in stating a goal of physical fitness, beyond simply stretching, gait training, and balance exercises.
4. Although age-related orthopedic conditions may limit some activities, the array of exercise equipment in local gyms and health centers allow many exercises tailored to such problems, including machines where exercises are done while seated.
5. Clinicians must facilitate exercise by appropriately aggressive use of PD drugs. Over the last 2 decades, very conservative symptomatic medical treatment has often been advised, “saving” the best PD treatments for later and arbitrarily limiting dosage. There is no compelling evidence that medication responses can be saved for years later, and similarly there is no good evidence that low doses convey some beneficial effect in the long term. Rather, this approach may translate into lost opportunities. A reasonable goal when prescribing PD medications is to maximize patients’ capabilities to engage in physical activities and potentially achieve the best level of physical fitness possible.
How Much Exercise Is Enough?
The American College of Sports Medicine (ACSM) has released recommendations on the quantity and quality of exercise for adults, definitively answering the age-old question of how much exercise is actually enough. While these recommendations are not geared specifically towards people with Parkinson’s disease, they are consistent with Dr. Ahlskog’s suggestion to exercise a sufficient amount to maintain fitness and guide individuals toward a variety of activities that counter Parkinson’s deficits.
The ACSM’s position stand, entitled “Quantity and Quality of Exercise for Developing and Maintaining Cardiorespiratory, Musculoskeletal, and Neuromotor Fitness in Apparently Healthy Adults: Guidance for Prescribing Exercise,” reflects current scientific evidence on physical activity and includes recommendations on aerobic exercise, strength training, flexibility, and neuromotor exercise. The basic recommendations are as follows:
(1) Cardiorespiratory Exercise
- Adults should get at least 150 minutes of moderate-intensity exercise per week.
- Exercise recommendations can be met through 30-60 minutes of moderate-intensity exercise (five days per week) or 20-60 minutes of vigorous-intensity exercise (three days per week). CLICK HERE for guidance on how to measure the intensity of your workout, including specific activities.
- One continuous session and multiple shorter sessions (of at least 10 minutes) are both acceptable to accumulate desired amount of daily exercise.
- Gradual progression of exercise time, frequency and intensity is recommended for best adherence and least injury risk.
- People unable to meet these minimums can still benefit from some activity.
(2) Resistance Exercise
- Adults should train each major muscle group two or three days each week using a variety of exercises and equipment.
- Very light or light intensity is best for older persons or previously sedentary adults starting exercise.
- Two to four sets of each exercise will help adults improve strength and power.
- For each exercise, 8-12 repetitions improve strength and power, 10-15 repetitions improve strength in middle-age and older persons starting exercise, and 15-20 repetitions improve muscular endurance.
- Adults should wait at least 48 hours between resistance training sessions.
(3) Flexibility Exercise
Adults should do flexibility exercises at least two or three days each week to improve range of motion.
- Each stretch should be held for 10-30 seconds to the point of tightness or slight discomfort.
- Repeat each stretch two to four times, accumulating 60 seconds per stretch.
- Static, dynamic, ballistic and PNF stretches are all effective.
- Flexibility exercise is most effective when the muscle is warm. Try light aerobic activity or a hot bath to warm the muscles before stretching.
(4) Neuromotor Exercise
- Neuromotor exercise (sometimes called “functional fitness training”) is recommended for two or three days per week.
- Exercises should involve motor skills (balance, agility, coordination and gait), proprioceptive exercise training and multifaceted activities (tai chi and yoga) to improve physical function and prevent falls in older adults.
- 20-30 minutes per day is appropriate for neuromotor exercise.
INSTANT SURVEY: CLICK HERE to take the survey–Research suggests that exercising at an intensity outside of your comfort zone is most likely to slow the progression of Parkinson’s disease. What’s your most intense regular workout? See the results so far instantly.
The Power of Community-Based Group Exercise
One recent study (see Hirsch, Iyer et al) concluded that substantial investments in community-based infrastructure–supporting and empowering places–to exercise and novel strategies for developing and implementing community-based exercise programs are necessary if we are to expect PWPs to exercise for the long-term starting at diagnosis. The authors believe that community-based exercise provides opportunities for developing social networks that might not develop as readily in clinic or hospital-based settings. Research suggests that social networking may increase physical activity participation in the early stages of the disease and broadening the social network may result in improved compliance with exercise, reduced anxiety or phobic behavior.
Our personal experience with group exercise programs bears out this hypothesis. We believe that the Parkinson’s community needs to (a) create an accessible and fun exercise infrastructure–a social and support experience that encourages continued participation through peer reinforcement–and (b) convince neurologists to prescribe participation in these community-based exercise programs with as much or more enthusiasm as they prescribe the medicines that only mask our symptoms. Because most of our dopamine-producing capacity is lost by the time we are diagnosed, it is critical to establish an effective, fun and varied exercise program as soon as after diagnosis as possible and then fight with every ounce of strength you have to sustain it!