Parkinson’s Disease Treatment: Physical Therapy and Exercise

Parkinson’s Disease (PD) is a complex progressive neurodegenerative disease.  There are several different specific disease processes that fall under the umbrella of Parkinson’s Disease, each slightly different from the other. 

PD includes both motor and non-motor symptoms. 

Motor Symptoms can include:

·      Bradykinesia: slow, small movements and postural responses

·      Rigidity: stiffness, other forward/rounded (flexed) posture, pain

·      Tremors: 70% of people with Parkinson’s have tremors.

·      Incoordination:  inefficient, unreliable movements

·      Postural instability: unable to stay upright when experiencing loss of balance

Non-Motor Symptoms can include:

·      Autonomic dysfunction:  constipation, urinary dysfunction, drooling, decreased temperature control, lightheaded when changing positions

·      Emotional: depression, anxiety, apathy

·      Cognitive changes:  difficulty sustaining attention and doing two things at the same time, decreased memory, inhibition, problem solving

·      Disturbed sleep

·      Sensory changes:  smell, vision, awareness of where the body is in space

A majority of these symptoms are related to a decrease in dopamine production.  Dopamine is a neurotransmitter that helps with motivation, coordination movement, memory and sleep along with other important activities. When someone has Parkinson’s Disease, there is a significant decrease in dopamine production.  To some degree this happens for everyone as we age but it is more intense when someone has PD. 

At this point, medications are the primary tool to promote symptom management.  But more and more research is showing that exercise should be considered as important as medications for the management of PD symptoms.  Exercise alone at a moderate to high intensity has been shown to improve the effectiveness of PD medications.  Exercise has been shown to decrease the impact of the symptoms of PD as well as improve quality of life of people with PD. 

Physical therapists can help assess and design specific exercise programs at the appropriate intensity to maximize someone with PD’s quality of life.  Exercise programs should include aerobic endurance training, strength training, balance and fall prevention training and stretching.  Rock Steady Boxing program, dancing, cycling, and ping pong are great ways to get all of these benefits from exercise.

There is also a program called PWR!  Parkinson’s Wellness Recovery.  This is a research based frame work that PTs can use for treatment and creation of an exercise program specifically for the goals of the person with Parkinson’s Disease. 

PWR! Treatments target rigidity, bradykinesia, incoordination treatment through different sequences of exercises.  These include trunk extension, weight shift, trunk rotation and stepping.  The goal is to include adequate intensity of exercises to promote improved brain health, increase blood flow and decrease inflammation. 

For physical therapy the goal is to maximize one’s potential to remain active and safe thru daily routine.  Exercise should be part of everyone’s daily routine which means finding ways to safely exercise at home or in the community.