This document provides information on exercise for individuals with Parkinson's disease. It describes typical movement impairments in Parkinson's such as tremors, rigidity, and impaired mobility. It explains that regular exercise can help manage symptoms, possibly slow disease progression, and improve mobility and quality of life. The document recommends consistent, moderate to vigorous exercise 4-5 times per week and identifies specific programs such as PWR!Moves and exercises including bed mobility, balance, sit-to-stand, walking, and aerobic exercises. It emphasizes practicing exercises regularly with guidance from a physical or occupational therapist.

1. Presented by:
Kathy Blatt, MPT
Carol Gertsch, PT, DPT, CLT-
LANA
Created By:
Susan Miller, SPT
PARKINSON’S DISEASE
AND EXERCISE

2.  Describe typical movement impairments
 Explain the benefits of exercise for
individuals with Parkinson’s Disease
 Identify different programs, specific
exercises and individuals who can guide you
with an exercise program
 Provide recommendations for exercise to
maximize full benefit from a program.
PURPOSE OF THIS PRESENTATION

3. VIDEO: Pre & Post Exercise Treatment Program1
http://youtu.be/wElz9jNrqns?t=6s
EXERCISE IS YOUR MEDICATION!

4. Chronic Neurodegenerative disorder
2nd most common movement disorder
Onset – typically 55-60 y.o.
Cell death occurs
causing movement
impairment
OVERVIEW OF PARKINSON’S

5. TRAP
 Tremor – resting
 Rigidity
 Akinesia – difficulty with
movement
 Bradykinesia
 Hypokinesia
 Shuffling Gait
 Postural instability
 Impaired aerobic capacity
MOVEMENT IMPAIRMENTS

6. Decreased:
Quality of Life
Function
Mobility
Safety
Emotional & Cognitive
problems
Sleep disorders
Fatigue
Depression
ADDITIONAL SIGNS AND SYMPTOMS

7. OVERVIEW: BENEFITS OF EXERCISE

8. Helps manage your symptoms
Possibility of slowing the disease
progression
Improves mobility, posture, & gait
Increases confidence
EXERCISE CAN SPECIFICALLY HELP PD…

9.  CONSISTENT – 4-5 hrs/week
 Moderate to VIGOROUS exercise
 SPECIFIC– USE OR LOSE IT!
Evidence shows exercise can result in:
 Optimize brain health & efficiency
 Slows disease protection
 Slow the motor & non-motor deterioration
TYPE OF EXERCISE

10. Is there
someone to
help me get
started on a
program?
I don’t know
what
exercises are
safe to
perform?
A Physical Therapist
can get you started!!!!

11. PHYSICAL & OCCUPATIONAL THERAPY
 Introduce you to a program
 Help improve specific impairments
 Teach you specific exercises for home
 Education about lifestyle
 Establish effective motor strategies!
 Help prevent secondary impairments

12. AVAILABLE PROGRAMS:

13.  Background:
 Developed by Dr. Becky Farley PT, MS, PhD
 Also developed BIG® program and associated with LSVT LOUD®
 Parkinson’s Wellness Recovery
 Vision:
 Providing research based exercise program for the
Parkinson’s community
 Increase longevity & quality of life
“Exercise from Diagnosis! Stamp out chronic, end-
stage Parkinson’s Disease”2
PWR!MOVES® PROGRAM2

14.  Patient-Centered Comprehensive Exercise Program
 Not a standardized protocol
 Performed 1:1 or group setting
 Exercises targeted at ALL levels of disease severity
 Integrates:
 HIGH Effort
 LARGE AMPLITUDE Body Movements
 Makes exercise FUNctional
 4 building block movements:
 UP – ROCK– TWIST– STEP
HOW DOES PWR! WORK?2
USE IT!
or
LOSE IT!

16. SPECIFIC EXERCISES:
Bed Mobility
Balance
Sit to Stand
Posture
Flexibility
Walking
Aerobic

17.  Impairments include:
 Reduced head rotation
 Inability to reach to the opposite side
 Decrease trunk rotation
 No visual target
 Evidence shows:3
 An association with spinal flexibility and physical performance
 Exercise demonstrates to improve axial mobility & balance for
individuals who have Parkinson’s disease
HARD TO TURN OVER IN BED…
I want to turn
over for my
belly rubs!

18.  Visual Cue:
 Look at the alarm clock
 Throw back covers
 Move to the center of
the bed
 Say “GO”
 Break down the
movements
EXERCISES: BED MOBILITY
Copyright © 1999 – 2010, VHI

19. EXERCISES: BED MOBILITY
Copyright © 1999 – 2010, VHI
Copyright © 1999 – 2010, VHI

20. PWR! TWIST: TRUNK ROTATION2

21.  Evidence shows a decrease in near falls or repeated falls with
a personalized 6-week exercise program 4
 ONE-HOUR exercise program performed DAILY
 Exercises included:
 Muscle strengthen – lower extremity muscles
 Range of motion – whole body
 Balance training – static & dynamic
 Walking – inside & outside
 Strategies for fall prevention
I FEEL LIKE I AM GOING TO FALL…

22.  Find an object to
focus on
Use Upper Extremity
support as needed
Progress to no UE
support
Stand by Kitchen
Counter
EXERCISES: BALANCE
Copyright © 1999 – 2010, VHI

23. EXERCISES: BALANCE
Copyright © 1999 – 2010, VHI
Copyright © 1999 – 2010, VHI

24. PWR! ROCK: WEIGHT SHIFTS2

25. Impairments
include:
Center of gravity is
shifted forward
Rigid/decreased range
of motion
Decreased Spinal
Mobility
Weak back muscles
Hallmark Features:
Rounded shoulders
Forward head
Bent forward
Bending of knees
I CAN’T GET MY BACK STRAIGHT…

26. Use mirrors to check
posture
Perform stretches &
posture exercises
throughout the day
EXERCISES: POSTURE & FLEXIBILITY
Copyright © 1999 – 2010, VHI
Copyright © 1999 – 2010, VHI

27. EXERCISES: POSTURE & FLEXIBILITY
Copyright © 1999 – 2010, VHI
Copyright © 1999 – 2010, VHI

28. EXERCISE: FLEXIBILITY
Copyright © 1999 – 2010, VHI
Copyright © 1999 – 2010, VHI

29.  Impairments include:
 Inadequate forward lean
 Downward gaze
 Decrease momentum
 Weak lower extremity muscles
 Improve sit to stand by 50%
within 3 months by performing
sit to stand at a minimum 2
times/week5
DIFFICULTY GETTING OUT OF A CHAIR…

30. Sit to stand technique
 Gently rock back &
forth
 Verbal cue: “GO”
 Mental Rehearsal:
 Think “FORWARD & UP”
 Reach BIG
EXERCISES: SIT TO STAND
Copyright © 1999 – 2010, VHI

31. PWR! UP: POSTURE & SIT TO STAND2

32.  Impairments include:
 Reduced speed
 Reduced arm swing
 Short steps
 Feet glued to the ground
 Loss of balance
 Difficult turning
 Intensive training for 4 times/week for 30 minutes sessions
for 6 weeks on a treadmill can:6
 Minimize impairments with walking
 Reduce falls
 Improve quality of life
SLOW, SHUFFLING WALKING…
Consult with a
professional
before using a
treadmill

33. CORRECT WALKING7

34. Remove obstacles from
home
 Loose mats or cords, big
furniture in small hallways
Rhythmic
 Metronome
 Music
Adequate Lighting in the
house
EXERCISE: WALKING
Copyright © 1999 – 2010, VHI
Copyright © 1999 – 2010, VHI

35. EXERCISE: WALKING
Copyright © 1999 – 2010, VHI
Copyright © 1999 – 2010, VHI

36.  Impairments include:
 Muscle weakness
 Decreased endurance
 Decreased coordination
 Respiratory issues
 Evidence shows the need to
perform REGULAR aerobic
exercise to potentially
maintain normal exercise
capacity. 8
DECREASED FITNESS LEVEL…
Consult with a
professional before
using a machine or
signing up for a class

37. Bike
Treadmill walking
Nordic walking
Walking outside
Swimming/Water
Aerobics
Classes including:
 Music therapy
 Boxing
 Dancing
 https://www.youtube.com/
watch?v=ZKTufkzpo8E
EXERCISES: AEROBIC
*5 days/week
*30 – 45 min sessions
*Moderate to Vigorous
Intensity

38. Exercises should be SAFE
Exercise should NOT cause pain
Consult with your physical therapist or
physician before starting an exercise
program
RECOMMENDATION

39. 1. PRACTICE, PRACTICE, PRACTICE!!
2. High intensity
3. 5 days/week for 45 min
4. Large Amplitude body movements
5. THINK BIG!
6. PRACTICE, PRACTICE PRACTICE!!
TAKE HOME MESSAGE
EXERCISE is MEDICATION!

41. 1. http://youtu.be/wElz9jNrqns?t=6s
2. Farley, B. PWR!MovesTM Make FUNctional Exercise!. Tucson, AZ: Wheatmark®;
2014.
3. Schenkman M., Keysor J., Chandler J., Laub K., MacAller H. Axial Mobility Exercise
Program: A home exercise program to Improve Functional Ability: A Therapist
Manual. 2nd Edition. Claude D. Pepper Older American Independence Center at
Duke University; 1994.
4. Ashburn, A. et al. A randomised controlled trial of a home based exercise
programme to reduce the risk of falling among people with Parkinson’s Disease.
J Neural Neurosurg Psychiatry 2007; 78:678-684
5. Yekutiel MP, Pinhasov A, Shahar G, Sroka H. A clinical trial of the re-education of
movement in patients with Parkinson's disease. Clinical Rehabilitation. 1991;
:207-214.
6. Herman T, Giladi, N, Gruendlinger L, Hausdorff J. Six weeks of Intensive
Treadmill Training Improves Gait and Quality of Life in Patients with Parkinson’s
Disease: A Pilot Study. Arch Phys Med Rehab. Sept. 2007; 88: 1154-1158.
7. Hoppenfeld, Stanley. Physical Examination of the Spine Extremities . Apple and
Lange: Norwalk, CT; 1976.
8. Cannin CG, Allison JA, Allen NE, Groeller H. Parkinson’s disease: an investigation
of exercise capacity, respiratory function and gait. Arch Phys Med Rehabil. 1997;
78: 199-207.
9. https://www.youtube.com/watch?v=ZKTufkzpo8E
REFERENCES:

42. 1. http://courtney-bci.blogspot.com/2013/08/5-of-worst-things-you-
could-do.html
2. http://www.neurology24.com/facts/4.jpg
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1_001_ch33.htm
4. http://www.neurology24.com/facts/4.jpg
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Why-It-s-Such-a-Struggle
7. http://gambarbbm.mytattoo-ideas.com/lsvt-big-&-loud-parkinson's-
therapy-at-touro-neuro-rehab-center.html
8. Farley, B. PWR!MovesTM Make FUNctional Exercise!. Tucson, AZ:
Wheatmark®; 2014
9. http://www.gettyimages.com/detail/photo/skilled-elephant-
balancing-on-a-ball-high-res-stock-photography/456501701
10. http://www.bendomd.com/986-parkinsons-disease-symptoms.html
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REFERENCES: IMAGES