Written by Terry Ellis, PhD, PT, NCS and Tamara Rork DeAngelis, PT, DPT, GCS
While most people know that it is important to exercise for their health, many have a difficult time staying on track and making exercise a part of their daily routine. It can help to start slowly and do a little more every day to begin to make exercise a daily habit. Use the buddy system, and find a partner to exercise with you. Do what you like to do, and vary your exercise, if possible, to prevent boredom. Tennis, dance, tai chi and yoga are examples of exercises that can help improve balance, posture, strength, flexibility, engage the mind, and can be done with partners or in groups.
Whether it is due to time constraints or simply because you become bored with your Parkinson's exercise program, the following strategies can help you stay with a program and become a lifelong exerciser.
Before you begin an exercise program, it is helpful to plan how you will overcome day-to-day challenges that may prevent you from sticking to your routine. Here is a list of some common barriers:
- I have a busy schedule and am not able to fit exercise into my life.
- I have fatigue so I am too tired for exercise.
- I am not confident in my ability to exercise successfully.
- I don't enjoy exercise and therefore find it difficult to motivate myself to participate in a long-term program.
- I don't really know where to begin or which exercises are best for me.
Once you've identified the barriers that may limit your success with exercise, use the following strategies to help you get started and stay on track:
- Schedule it. Just as you would schedule a meeting at work or a visit with a friend, you can schedule exercise. If you put it in your calendar, you are more likely to do it. Schedule a specific time during the day when you feel your best and have more energy.
- Get Guidance. If you have difficulty with fatigue or experience sleepiness during the day, speak with your doctor about possible ways to address these issues. Overt time, exercise may increase your energy level and reduce feelings of fatigue.
- Be Informed. If you aren't sure what you should be doing for exercise or if you have questions about what exercises are best for you, visit with a physical therapist who can help you get started. Once you've done that, you also can work with a personal trainer or other fitness professional who can help find new ways to make your workout challenging and fun!
- Make it Fun. Find activities that you enjoy. There are many different types of exercise and ways to make it more fun. Add music or bring a friend to make your time exercising more pleasurable. Many people also find that participating in a group exercise program adds to both their enjoyment and commitment to exercise.
- Stay Accountable. Tell friends, family, coworkers and others that you are going to start an exercise program. When they ask you about it, you can proudly report that you have been reaching your goal to make exercise a part of your life. You can also stay accountable to yourself by keeping an exercise log. Find one online by using the term “exercise log” in your favorite search engine.
- Be Focused. For various reasons, you might stop exercising for a short time period. The goal is to get back on track as soon as possible. It is important to keep in mind the reasons for your commitment to exercise and to focus on all of the benefits you experience. There will be bumps in the road to becoming a lifetime exerciser, but as long as you keep going, you can continue to make a difference in your health and well-being.
Before beginning any exercise program, you should consult with your doctor to ensure that you are healthy enough to participate in exercise. It is also helpful to see a physical therapist so that you can start off on the right foot and make sure you are choosing the types of exercise that will benefit you most. We all know how difficult it can be to find the time (and sometimes, motivation) to exercise, so it is important to get guidance on making the most of your time while exercising at the gym or at home. By finding the most appropriate exercise at the optimal intensity, you can exercise smartly, safely and effectively.
Several national organizations have published exercise guidelines for the general population (some consider factors, such as age and health status). These national organizations include the World Health Organization (WHO), the American College of Sports Medicine (ACSM) and the National Institutes of Health (NIH). While the specifics of these guidelines differ in some areas, there is general consensus on the recommended amount and type of exercise to include in the optimal program. Based on these guidelines and some considerations specific to those living with Parkinson’s, we have outlined the following exercise program recommendations, based on the four main types of exercise recommended for people living with Parkinson's: Cardiorespiratory, Strength, Flexibility and Balance.
Cardiorespiratory exercise (also known as “cardio” or aerobic exercise) is exercise that causes the body to consume more oxygen and use large muscle groups. Depending on your fitness level, cardiovascular exercise can include walking at a fast pace, jogging, swimming, biking and hiking to name a few. At this time, we don't know if one form of aerobic exercise is preferable to another for Parkinson's so it is important to find an activity that is safe to engage in at a moderate intensity. While it is very important to remain active throughout your day, it should be noted that regular self-care or household activities such as dressing, meal preparation or housecleaning don't “count” toward your cardiovascular exercise activity. This is because they are not performed at a significant enough intensity to result in positive changes for cardiovascular health.
The ACSM guidelines define moderate intensity physical activity as “working hard enough to raise your heart rate and break a sweat, yet still being able to carry on a conversation.” This is often called the talk test. If you are exercising and don't have enough breath to get the words out, you might be working too hard and need to decrease the intensity of the exercise. Conversely, if you are able to sing several verses of your favorite song while doing your cardiovascular exercise, you are likely not exercising at a high enough intensity and should be working harder in order to maximize benefits. Another common way that people monitor the intensity of their activity is through checking their heart rate. Your physical therapist will teach you how to safely monitor your heart rate during exercise and will establish your target heart rate, based on your current fitness level.
Cardiorespiratory Exercise Recommendations
(From ACSM Guidelines, 2011)
- 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).
- One continuous session and multiple shorter sessions (of at least 10 minutes) are both acceptable to accumulate desired amount of daily exercise. Therefore, 3 bouts of exercise for 10-minutes a day is another way to successfully achieve the recommendations.
- 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.
Strength training is another very important part of any exercise program. The research suggests that there may be some strength loss associated with Parkinson's. The good news is that people with Parkinson's can increase their strength through an appropriate strength training routine. However, it can be overwhelming when you go to a gym and see all of the strength training equipment including machines, pulleys, free weights, medicine balls, etc. It doesn't need to be fancy to be effective. You could do your strength training at home, if that works best for you.
Your physical therapist can determine specific strengthening exercises that might benefit you most, before starting out on your own. As an example, a therapist might identify during an examination that you have weakness in your postural muscles. He or she can then teach you the best exercises to improve the strength of those muscles and potentially help you stand taller and breathe better.
Here are some general considerations when choosing exercises:
- Some people with Parkinson's may have weakness in their extensor muscles (including large muscles in the back, buttocks and the front of the thighs), so it is important to make sure you address these muscles as part of your program.
- Focus on larger muscles groups, such as those in your legs. For example, doing a squat or a lunge uses several large muscles in your legs as well as requiring you to use your trunk muscles. The leg press machine also uses large muscles in your lower body. For your upper body, rowing or pull-downs use larger muscles groups.
- Remember that more isn't always better. Going through a complete circuit of machines can take a long time. Your time might be better spent with a handful of exercises that combine multiple muscle groups.
If you are otherwise healthy, you should work up to lifting enough weight so that your last few repetitions in the set are difficult. If it's easy for you to continue lifting that weight for another set without resting, then you should slowly increase the weight.
If you have other restrictions or health conditions, such as pain, arthritis, heart disease or any others, you should not begin strength training without first consulting with your doctor or physical therapist. You can still benefit from strength training with these conditions, but always seek advice first.
Strength Training Exercise Recommendations
- Adults should train each major muscle group on two or three non-consecutive days each week using a variety of exercises.
- For each exercise, do 2 sets of 8–12 repetitions to improve strength.
- Focus on larger muscles groups, such as those in your legs. For example, doing a squat or lunge uses several large muscles in your legs plus your trunk muscles.
Flexibility or stretching exercises are another important component of any exercise routine, but are especially important for people with Parkinson's. Two of the cardinal signs of Parkinson's, bradykinesia and rigidity, can potentially put you at risk for decreased muscle length or joint range of motion. This is because the stiffness may contribute to smaller movements, like swinging your arms less or taking smaller steps when walking. Many people with Parkinson's also report that stretching helps reduce the discomfort or the feeling of stiffness and makes movement easier.
It is safe (and often advisable) to do some stretching every day. Some people find it helpful to stretch first thing in the morning while others prefer to stretch before bed. There are also some people with Parkinson's that report doing a few stretches in the middle of the night if sleeping is difficult because of stiffness.
It is also important to stretch after you exercise. You will get the most benefit from stretching after your muscles have warmed up.
The following are general guidelines for stretching:
- If you are not able to do all your stretches every day, then do some one day and others the next day.
- Repeat each stretch 2–3 times and hold for 30 seconds.
- Do not hold your breath while stretching.
- Do not bounce while you stretch; simply hold the position.
- Do not stretch to the point of pain.
There are many ways to improve your balance, such as strengthening and stretching exercises for your legs or exercises to improve your posture. Tai chi and Yoga classes can be helpful to improve balance in a group setting. However, if you are experiencing falls or near falls, it is recommended that you consult with a physical therapist to have an individualized balance program designed for you.
Use exercise to take control of your Parkinson's. Exercise is one thing you can control and in the process, enjoy a better quality of life.