Staying Committed to Your Exercise Routine

Doherty Riebesell PhotoPosting for Dr. Hackney this month is Doherty Riebesell, PT, DPT, GCS, a physical therapist in Austin, TX and the co-founder–along with Dr. Hackney and Tricia Creel–of MDT Educations Solutions, the mission of which is to equip health and fitness professionals, care partners, caregivers and people with PD with the knowledge and resources to form and participate in community-based exercise programs. Doherty earned her Bachelor’s degree in Exercise Science from Indiana University where she was an All American swimmer. She earned her Doctorate of Physical Therapy from University of Alabama at Birmingham in 2009. Doherty specializes in the treatment of geriatric patients and those with neurological dysfunction and is a Board Certified Geriatric Specialist (GCS). She has written articles for the American Parkinson Disease Association (APDA) on physical therapy for Parkinson’s disease, as well as presented at multiple patient/family seminars on Parkinson’s disease.

Hopefully you’ve heard it many times… from your doctor, therapist, care partner, and other people with Parkinson’s Disease (PD): “don’t forget to exercise.” We know that PD is a progressive disease and that exercise can assist with management of movement, posture, gait, balance, mood, cognition, cardiovascular endurance, and reduce fall risk… all are important for maintaining a great quality of life! Sounds easy enough, however, PD presents unique obstacles to exercise maintenance.Madeleine E. Hackney, PhD The Exercise Files blog

  1. Apathy. Miriam-Webster defines apathy as “a lack of feeling or emotion, a lack of interest or concern.” Apathy is one of the non-motor symptoms of PD that affects 17-60% of people with PD. It is important to note that the apathy is actually caused by decreased dopamine in the basal ganglia. Dopamine, a neurotransmitter, is responsible for goal oriented behavior and “feel good” activities. Without adequate amounts, apathy sets in.
  2. Unique Barriers. In 2013, Ellis et al., studied barriers to exercise in people with PD. They found that low outcome expectation, lack of time to exercise, and fear of falling were the most important perceived barriers to exercise adherence.
  3. Fatigue. Fatigue is very common in PD and can feel like a sense of tiredness, low energy, lethargy, sleepiness, or weakness. When fatigue is present, it can make everyday tasks seem overwhelming. It is often exacerbated by PD motor symptoms as movement becomes less efficient and requires greater energy expenditure to overcome deficits.
  4. Depression. Depression is reported in approximately 50% of people with PD. It is thought that the biochemical changes from serotonin, dopamine, and norepinephrine significantly affect mood, and when coupled with the other circumstances and frustrations of PD, the prevalence is high.

Fun Parkinson ExercisesThese barriers may seem overwhelming, but there are many tools available to overcome the obstacles and reap the many benefits that exercise has to offer!

1. Identify your personal barriers- especially consider whether your barriers of lack of time and fear of falling are real or perceived. There are many safe ways to exercise, regardless of your balance (e.g., start with seated exercise and progress to dynamic exercise). And, with exercise, both balance and fall risk can decrease significantly.

2. Self Efficacy- In another Ellis et al., study from 2011, 260 people with PD were questioned regarding their exercise habits. Of the 63% classified as “exercisers” vs. “non-exercisers”- self efficacy, not disability, was most closely correlated with exercise maintenance.

3. Schedule- Write down your regular exercise schedule, and cross it off when completed. You will feel a sense of accomplishment, and it will eventually become routine.

4. Speak with a Doctor- Address fatigue, sleepiness, and depression. Often, medication changes can assist with the management of these symptoms and make exercise more feasible.

5. Be informed- A neurologic physical therapist or specialty trained exercise instructor will be able to provide you with an individualized exercise plan to get you started on the right foot. It is important to update this program on regular intervals to ensure it is novel, challenging, engaging, and impairment-specific.

6. Stay accountable- Find an exercise buddy or join a class that interests you! There is an ever-growing number of interesting and engaging exercise classes specific for people with PD- boxing, yoga, tai-chi, Zumba… pick something you love and make friends that will hold you accountable for being there.

7. Make it fun- If you don’t like it, you won’t do it… or enjoy doing it! Exercise should be enjoyable. Pick an activity you love, and maybe even something you have never tried before to aid in neuroplasticity. There is no “wrong” way to exercise, so whatever is fun for you will be most effective at managing your PD symptoms.

Exercise is medicine- keep moving!

Dr. Madeleine E. Hackney, Ph.D, is a Research Health Scientist at the Atlanta VA Center for Visual and Neurocognitive Rehabilitation and an Assistant professor of Medicine in the division of General Medicine and Geriatrics at the Emory School of Medicine. She holds a Ph.D. in Movement Science from Washington University and a BFA in Dance from NYU, Tisch School of the Arts and has also been an American Council on Exercise certified personal trainer since 2000. Dr. Hackney’s extensive research interests include inquiry into challenging exercise programs–traditional exercise, Tai Chi and partnered tango classes–designed to improve physical function and quality of life in people with PD, older adults and those with serious mental illness. In 2014, she co-founded MDT Education Solutions, which has trained dozens of fitness and allied health professionals how to develop and lead safe, evidence-based exercise programs for people with PD at all stages of the disease, including almost all instructors in the PD Gladiators Metro Atlanta Fitness Network (including the YMCA of Metro Atlanta).

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