Can Exercise Help People Who Have Parkinson’s?

By Tanya Bellon, Biokineticist

What is Parkinson’s?

Parkinson’s is a progressive neurological disorder caused by a decrease in the neurotransmitter, dopamine, in a part of the brain known as the substantia nigra. The decrease in dopamine is due to the death of dopaminergic cells. There are no known causes of Parkinson’s, however genetics and environmental factors have both been considered as contributing factors. Other contributing factors are aging, autoimmune response as well as mitochondrial dysfunction.

Common symptoms of Parkinson’s:

·        Tremor

·        Slow movements

·        Rigidity in joints

·        Shuffle walking

·        Freezing while performing an exercise, pauses before initiating movement e.g. chair rocking before standing, recurring falls.

·        Absence of associated movements e.g. no arm swing while walking

·        Loss of facial expressions

·        Activities of daily living (ADLS) are affected e.g inability to cut food, difficulty swallowing, rising from a chair, dressing or bathing

·        Speech – volume control and understandability

Symptoms do not appear until 80% loss of dopaminergic cells.

How does Parkinson’s affect exercise?

People with Parkinson’s experience fluctuations in their symptoms depending on exercise and changes in position. This is due to the autonomic nervous system dysfunction, which affects their thermal regulation. This leads to altered heart rate and blood pressure.

The efficiency of the exercises that are performed decreases due to the slowness of movements and rigidity that is common amongst people with Parkinson’s. This leads to an increased heart rate and oxygen consumption. Akinesia (freezing) may make certain activities more difficult to perform.

Tip 1

Don’t exercise in intense heat or get very hot when exercising.

Tip 2

Exercise when your medication is at its peak circulation in your body.

Tip 3

Getting out of a chair! (This is for everyone)

Next time you feel you are rocking yourself out of a chair, I want you to stop, move towards the edge of the chair, make sure your feet are firmly on the ground, shoulder width apart,  take a nice deep breath in and stand up as you breathe out, pushing your weight through your heels.  Try it!

Can exercise change the brain of a Parkinson’s patient?

Due to the lag time between loss of neurons and symptoms becoming noticeable, patients only get help once their condition is at a progressive stage. However studies have found the brain is malleable and compensates for the changes. The brain reshapes itself in response to experience this is known as exercise-dependent neuroplasticity. Exercise may contribute by maintaining old connections, form new ones and restore lost ones.

Exercise performed at the correct intensity can maintain certain connections and possibly improve certain activities of daily living. Exercise needs to be performed at the correct intensity, specificity, difficulty and complexity in order to improve motor skills like walking and balance. These two motor skills are very important in preventing falls. Research suggests that exercise increases the amount of binding sites (D2 receptors) on the receiving cells of dopamine signal. This enables the signal to be passed more efficiently, reducing the amount of dopamine left in the synapse between the cells. This indicates that the signal is finished, therefore reducing the amount of Parkinsonian symptoms e.g. tremor.

Exercise has also been shown to help with the regulation of the glutamate molecule that signals between brain cells. Dopamine keeps glutamate at lower levels.

In Parkinsonian animal research it has been found that with the decrease in dopamine, there is a build - up of glutamate which damages cells that control body movement. Animal exercise studies indicate that exercise may play a role in normalizing the glutamate levels.

Suggested modalities of exercise for someone who has a movement disorder like Parkinson’s

·        Walking or Swimming

·        Aqua aerobics

·        Stretching

·        Activities of daily living

Additional exercises that would be performed in Biokinetic therapy:

·        Balance exercises

·        Steps

·        Stepping over items

·        Functional exercises e.g. buttoning a shirt, picking up marbles, tying shoe laces, standing up from a chair, getting on and off the floor

·        Hydrotherapy (water therapy)

·        Walking on treadmill or bike depending on stability and progression of Parkinson’s

The verdict is still out on how this condition is caused and whether or not exercise can help people who have Parkinson’s. From a Biokineticist’s perspective, exercise is an essential part of a patient’s management programme, as it not only reduces falls, but also empowers the patient to think he/she is in control of his/her body and not the disease.

Please consult with your neurologist or consult with a medically trained biokineticist before starting any new exercise regime.