The One Best Exercise for Parkinson’s Disease

nocera_joePosting for Dr. Hackney this month is Dr. Joe Nocera, PhD, an Assistant Professor in Neurology at Emory and a Health Science Specialist in the Atlanta VA Rehabilitation R&D Center of Excellence for Visual and Neurocognitive Rehabilitation. Dr. Nocera’s research interests include interactions between physical function and cognition with particular emphasis on the impact of dual tasking on locomotion and balance control. He is also interested in the efficacy of exercise intervention programs for improving mobility and cognitive function in older adults and individuals with in Parkinson’s disease.

What is the one exercise that is best?

As an Exercise Scientist with a background in strength and conditioning I hear this A LOT. And what is typically meant by this question is, Madeleine E. Hackney, PhD The Exercise Files blog‘what is the ONE exercise I can do in the shortest amount of time that will fix all that ails me and will make me look good?’ While we all want a magic exercise pill we know there is no such thing. And there is also no one exercise that will address the functional changes associated with having Parkinson’s disease. Decades of data consistently show that an all-inclusive exercise regimen that focuses on muscular strength, cardiovascular fitness, balance and flexibility is key for overall health and fitness, particularly for those with a progressive disease like Parkinson’s.

I should point out that I do have an answer for the question about the one exercise, sort of. My response to that is always the same, “the best exercises for you to dno-one-exerciseo are the ones you enjoy doing.” It doesn’t really answer the question but people typically get the point. The great thing is that there are A LOT of options. Walking, running, hiking, swimming, biking, aerobics, weight lifting, dancing, boxing (non-contact), zumba and the list goes on. And to further your options, you can do many of the above in a host of different settings, alone, with new friends or old ones. You could take a vigorous walk through your neighborhood or around (up) Stone Mountain. You could exercise at the gym and meet new friends, walk through the mall with a spouse or take a quiet walk through nature.

While picking the right exercise might not be a challenge for you, knowing how much and how intense, might be. In our exercise facility we constantly hear people say something to the effect of, ‘well, I walk my dog for 30 minutes most days but I have no idea if that is what the doctor means when he says, ‘do you exercise regularly?’ The truth is there is a lot of misinformation out there when it comes to exercise. We see magazines in the grocery store that promise ‘abs in 60 sec’ or a ‘dazzling figure in 2 weeks.’ Unfortunately, these promises are misguided and false. The truth is that there are evidence-based exercise recommendations that should be followed to improve your overall health and fitness. The American College of Sports Medicine, Health.gov, and The American Heart Association, to name a few, provide objective numbers on the amount and intensity of physical activity you should be getting each week. These guidelines are as follows:

intense-exercise150 minutes (2.5 hours) per week of moderate-intense aerobic activity or 75 minutes (1 hour 15 minutes) of vigorous-intense aerobic activity. Whether you choose moderate or intense or a combination you should aim to do your chosen activity for at least 10 minutes consecutively at a time. So perhaps you are asking, ‘what exactly is moderate vs. vigorous exercise and how is it measured?’ One commonly used way to assess this is that if you’re working at a moderate intensity you’re able to talk but unable to sing the words to a song. Vigorous-intense aerobic exercise is where you’re breathing hard and fast. If you’d like to be more precise there are numerous commercial devices that will measure and calculate your heart rate and heart rate training zones based on your age.

Importantly, it is not just aerobic activity and cardiovascular fitness that we need to be mindful of. As one ages, muscular strength and muscular flexibility decline resulting in decreased range of motion and less ability to perform common tasks like carrying groceries, walking long distances or up stairs. Due to this, the evidence based guidelines recommend doing muscle strengthening on the major muscle groups (legs, trunk, arms and shoulders) 2 or more times per week.

tai-chi-balanceLastly, and perhaps most critical for individuals with Parkinson’s disease, exercise that will improve or maintain balance must be done. If you are reading this, I probably do not need to tell you how common and how devastating fall and fall related injuries are. As such, an all-inclusive exercise program should include exercises that challenge your balance system and these should be done at least 2 times per week. It is important to point out that some of the exercise examples above can count towards both your weekly aerobic and balance recommended guidelines. For example, the PD Gladiators boxing class and various forms of dancing can provide a stimulating aerobic workout while simultaneously challenging the balance system.

Exercise is the only proven therapy that can increase aerobic fitness, strength, balance and flexibility. Moreover, it makes us feel really good and improves our sleep! The key is to identify exercises and programs that you ENJOY and adequately challenge you. The examples and guidelines provided above will provide benefits to people with Parkinson’s disease while improving overall fitness and quality of life. So move often and HAVE FUN!

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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