Sit to stand: https://vimeo.com/430222106
Floor rolling: https://vimeo.com/430222151
Fine motor: https://vimeo.com/430222195
What Does A Parkinson's-Specific Exercise Programme Mean?
It’s important to practice Parkinson’s specific exercises rather than general exercise training to improve movement because of the type of brain stimulation each type of exercise produces.
Your brain has the ability to help you move better. It learns from all stimulation applied to it, including exercise, and has an enormous capacity to re-wire the neural connections for improved movement. You may not have noticed, but, getting off a low chair, rolling in bed and picking up a cup of water all require infinite amounts of fine-tuning as your brain prepares, conducts and evaluates the task. Your brain is receiving constant feedback about the environment (height of your chair, the hardness of a bed, the weight of the cup) so that it can move with the appropriate amount of speed, power and accuracy to be effective and efficient.
Dopamine deficiency can lead to the continuing reduction of movement, speed and power. Instead of getting up from the chair first time round, it may mean that you have to use your arms to push up, or rock back and forth a bit to get enough momentum to stand up. It is the chronic reduction in a movement that makes big movements like walking and small movements like writing so challenging.
Training to improve difficulties in your movement specifically is important because it will help you in all of your everyday activities, not just while you are exercising, but throughout the day – every time you put your arm through a shirt, open a heavy door, walk up a step for instance. These exercises focus on the amount of effort and size you are putting in to your movement.
Parkinson’s specific exercise will teach you how to move with amplitude, power and speed in everyday tasks so that you can get back to doing the things you enjoy doing. By increasing your overall activity level, Parkinson’s specific exercise may also slow down the symptom progression of your Parkinson’s.
Effort levels – intensity is not negotiable
Intensity in the context of Parkinson’s can mean many things. In the early stages of the condition, it can focus on fitness training. In the moderate and more advanced stages, intensity may refer more to increased task-specific effort through exercise.
Intensity is important because neuroscience research is showing us that the higher the level of intensity in exercise the better the release of neurotrophic factors in your brain. It is these neurotrophic factors such as Brain-Derived Neurotrophic Factor (BDNF) and Glial Derived Neurotrophic Factors (GDNF) that are proving to be very interesting to researchers at the moment as they are uncovering ways to protect cells and possibly slow or stop their destruction in the brain.
Frequency of exercise can change depending on the demands of your programme. As a rough guide, if you are doing any form of strength training, you need two days between sessions in order to let your muscles recover. Any more than 4 sessions a week can typically lead to a reduction in your strength gains. If you are exercising for cardiovascular fitness, most of the research suggests that you will not gain anything extra from more than four sessions a week.
If you are exercising to improve your bradykinesia, stiffness, tremor or agility, then you need to be exercising every day to improve your balance and movement.
The reason it is so important to train daily if you are learning/re-learning to move better is precisely because of the plasticity of your neural circuits. To achieve skill acquisition, you need to train regularly, you need to train intensively, you need to train in a variety of environments and you need to train specifically to the task you want to improve. If you want to acquire or re-learn a movement skill you need to do your exercises every day and under the right learning parameters.
BENEFITS OF EXERCISE AND MEDICATION IN PARKINSON'S
In the last few years, the importance of exercise has become even more significant for people with Parkinson’s. Research is showing that a tailored Parkinson’s specific exercise programme is important for your health. This means that alongside medication, the right kind of exercise may improve your overall physical ability, your symptoms and the quality of your life. Exercise helps to slow symptom progression as well as to maintain general health and ward off concurrent cardiovascular risk factors, metabolic conditions, frailty and falls.
Appropriate dosing of medication is crucial in the management of Parkinson’s long-term. However, medication only is not enough to give you the best quality of life possible. Despite medication, your body will continue to adjust over time – your body starts to move less – producing smaller, slower movements, which becomes your new ‘normal’. This learned non–use and resizing of your movements is best described with this analogy: think about what happens when you take your foot off your car’s accelerator pedal. It slows down. The fuel is no longer driving the engine forward. It’s the same when your body learns to move with smaller movements. In the early stages of Parkinson’s, more often than not, you can still achieve movements that look ‘normal’, but your brain has already begun learning to take your foot off the accelerator pedal (with or without medication). To a point, the medication will improve your movements, but it will not teach you to put your foot back down on the accelerator pedal.
Exercise can provide the vehicle to teach you how to achieve that functional and efficient movement again, even if you have to work harder through the movement to achieve it. Parkinson’s medication, among other things primarily is used to enhance, replace or simulate the missing dopamine in your system. This can have very good effects on your movement, and to some extent your mood, overall. It is important that your medication is optimised for your needs as well. This often requires regular updates with your doctor to ensure you are functioning at your best.
The best approach to managing your Parkinson’s with exercise is to target your symptoms appropriately and to be optimally medicated.
TYPES OF EXERCISE WHICH ARE IMPORTANT FOR PEOPLE WITH PARKINSON’S
- Aerobic training - is also called endurance training, cardiovascular training, or fitness training. All these terms mean the same thing. In short, aerobic training consists of exercises that use your large muscle groups, like your legs, that will increase heart rate for an extended period of time. Aerobic training includes exercises such as walking, swimming, cycling, and dancing. It can also include activities such as stair climbing, gardening, and pushing the lawnmower.
- Strength training - it is not uncommon if you have Parkinson’s to report weakness as a symptom. Some people with Parkinson’s may not be strong enough to move their own body weight. This is problematic as balance and strength correlate highly and therefore weakness not only poses a risk of falls, it can also reduce your confidence. Strength training is vital in restoring independence. Strength training activities in this booklet consist of using your own bodyweight to increase the strength of the muscles.
- Flexibility training - is helpful if you experience rigidity and stiffness and find yourself stooping forward at the hips, or find it difficult to reach up and bend down. These exercises may assist in maintaining muscle length and range while you build the strength to support your posture and range of movement
- Balance training - is important to help reduce your risk of falls. It is not uncommon as symptoms progress to experience changes in your postural stability that make falls more likely. Freezing of gait, lack of weight shifting, poor foot clearance and difficulty turning can become significant risk factors when your balance is compromised.
- Amplitude training - helps re-train the normal scale of movement to improve your daily activities and independence. This is commonly used with people who struggle with slow and small movements. Learning how to exaggerate your movements helps to re-calibrate what ‘normal’ and efficient movement should look and feel like.
- Intensity training - is interchangeable with high effort or effortful exercise. This type of training is most important for people who are tremor dominant and need to increase overall motor output to improve function and efficiency.
- Dual tasking capacity - describes the ability to do more than one thing at the same time. In Parkinson’s, this can be difficult as some of the automaticity of movements can be impaired. This impacts on many daily activities such as the inability to walk safely while having a conversation.
STAGES OF PARKINSON’S
What your primary presentation or stage of Parkinson’s is helps you to tailor your exercise programme to your unique needs.
To determine if you are in the early, moderate or later stages of the condition you can use these broad guidelines. The stages do not relate to time since diagnosis, more to the presentation of your symptoms and how they impact on your daily activities, function and cognition.
At this stage you’re functioning well and are independent in all daily tasks like dressing, grooming, meal preparation, domestic chores and vocation. You’ve had no falls in the past twelve months, do not experience freezing of gait and have mild or no cognitive impairments.
Even in the very mild stages of Parkinson’s you may have already started to adapt your life; subconsciously avoiding social activities, modifying the clothes you wear to avoid doing up buttons and zips, changing what you order in restaurants and other subtle changes you may not have realised you were doing. Without specific exercises, you may continue to give up the things you enjoy.
It is very important if you are in the early stage of the condition to start establishing a regular exercise routine that is targeted to improve your Parkinson’s symptoms. Getting started early in the Parkinson’s journey will not only help you to keep active, fit and mobile, it will also help you to keep doing the things you like doing for longer.
At this stage you’re independent for most tasks. You’ve had at least one fall or significant near miss in the past twelve months. You also may experience freezing of gait and have mild cognitive impairments.
If you consider yourself in the moderate stages and are starting an exercise programme for the first time, then a general programme to get you active and fit will be sufficient in the short term.
If you are already fit and exercise regularly you may want to consider exploring a more targeted and Parkinson’s specific approach to your exercise. Your programme at this stage needs to be both physically and cognitively challenging and may favour dual task training and some agility training.
When you enter this stage, you are dependent for most daily tasks, fall more than once per year, experience freezing of gait and have mild to moderate cognitive impairments.
Being in the later stages of Parkinson’s does not mean that an exercise programme is not relevant. Building strength, mobility, preventing falls, improving independence and confidence can go a long way to improving your overall quality of life and general levels of comfort.
IDENTIFYING WHAT TYPE OF PARKINSON’S YOU HAVE
Knowing what type of Parkinson’s you have is also important in helping you to focus on the correct aspects of each exercise to make sure you get the most from them.
The three different types of Parkinson’s that will define your exercise programme are:
Bradykinesia means that slow and small movements are the dominant feature of your Parkinson’s and bother you the most in your daily activities. The reason why you experience bradykinesia is due to the loss of dopamine in your brain, specifically in the basal ganglia. As dopamine is an important neurotransmitter, the loss of it leads to ‘poverty of movement’ where the regulation of normal movement size is varied down and smaller than required for efficient movement. It is important to focus on exaggerated and large movements in your exercise programme.
If you are bradykinesic your exercise programme needs to focus on exaggerated movements and power.
Part of your exercise programme needs to help you to re-adjust what normal movement should look and feel like. It will certainly feel strange when you first start to exaggerate your movements, but in time and with practice, you will find that the exaggeration really helps with daily tasks, walking, arm swing and other movements that might be impaired.
This means that the tremor is the most dominant feature of your Parkinson’s. The tremor can come on at rest or during prolonged or sustained postures.
If you are tremor dominant medication can have a variable effect on managing the tremor. While the mechanisms that result in tremor are not fully understood, what we do know is that a tremor dominant presentation typically represents a slower progression of the condition and less impact from other concurrent features of the condition, namely rigidity, bradykinesia and dementia. As your condition progresses, your symptoms can change to one of a non-tremor dominant pathway as the dopamine deficiency increases. Parkinson’s specific exercise can help to reduce and slow down this symptom progression.
If you are tremor dominant, you will need to focus on the effort and forced use component of the exercise. You will need to work up to 80% to get the best results.
This means that you have had a least one fall in the past 12 months or several ‘near misses’ in the past three months. One fall or more in twelve months can reduce your confidence and subsequent mobility. It is important to look at how to reduce your risk of falls. Falls can be a significant problem and typically represent a postural instability coupled with or without freezing and often with difficulty doing more than one task at the same time. It is not uncommon to start feeling like your reaction times and agility are less than adequate for getting around doing everyday tasks safely. More often than not, postural instability is related to difficulty distributing your weight from one leg to the other effectively and is often exacerbated by lower limb weakness, stiffness in your limbs and trunk, freezing of gait and often cognitive changes.
Counter-acting your risk of falls takes effort, targeted falls prevention exercise and lots of practice.
If you are agility impaired, you will need to focus on the weight shifting and postural stability components of each exercise. Use a chair or wall for support and then move to hovering with finger tips as you improve.
It is likely that if you are bradykinesic or tremor dominant you may become agility impaired as the condition progresses. You can always tailor the exercises to best match your current presentation.
In any rehabilitation practice, health professionals use tests known as “Outcome Measures” to acquire baseline scores or information. They will then re-assess these standardised tests over a period of time to track your progress and to assess whether or not certain interventions such as exercise or medication are having a positive effect.
You will find reference to several questionnaires that you can do independently to assist in a self-assessment. Below are links to questionnaire that you can complete on your own.
It is recommended that you repeat these questionnaires every 6 months or if you feel any changes to your physical condition. Regular reviews will also help you to keep evaluating your goals.
A good exercise programme should be unique to you, your needs and your goals. After knowing what stage and type of Parkinson’s you have, the next step is to understand your goals and your current functional baseline. With all this information pulled together you can then create an exercise programme that is tailored to you.
A good exercise prescription will include information about the following:
- Equipment required
- Relevant Exercises – normally 3 to 4 targeted exercises
- Number of repetitions and sets of each exercise
- Evaluation or recording method
- Precautions and safety measures
- Modifications required
HOW TO STAY MOTIVATED
Make exercise a regular part of your day
Set a consistent time to exercise every day. Keep it the same time so that you know how it works in around your medication and is timed when you are typically feeling at your best.
If you are really busy, you might find breaking your programme down into several manageable 10–minute chunks suits you better. There is good evidence to show that this is still effective to receive a cardiovascular and strength training. For amplitude and motor output training this is sufficient as well. Perhaps you might schedule a few exercises for when you wake up in the morning, another round at mid–morning, lunch, mid–afternoon, and then evening. See what works best for you with your lifestyle and medication schedule, but make sure you plan it, do it and record it.
If you are particularly short of time, avoid the temptation to throw in the towel completely. Do what you have time to do. Something is better than nothing at all. Even five minutes of targeted exercises done well may yield results when done consistently.
Stay Motivated with Goal Setting
Planning your goals is essential. As well as providing a structure, setting goals can be exciting. Goals inspire self-confidence when achieved, especially when short-term achievements are linked to longer term goals and the ‘big picture’. Write your goals down and review them regularly. Post your goals up somewhere obvious where you will see them every day and remember to celebrate whenever you achieve a goal.
Start Recording and Charting in Your Diary
Record each of your sessions in the back of this booklet. Even if it is only a 10-minute session. It is important that you can add up the total number of minutes spent exercising at the end of each week.
Start by aiming to complete at least 10 minutes of good quality exercise each day. This may be from the exercises in this booklet or it may also include your daily walk, session at the gym or a yoga class. What is important though is that you are doing Parkinson’s specific exercises specifically targeting your symptoms and the tasks you want to improve.
Workout with a buddy
If you have a commitment to exercise with a ‘buddy’ you are more likely to make the effort, no matter how tired you feel. There are always a thousand excuses not to exercise but having a buddy will help you be accountable and consistent knowing someone is counting on you, rather than cancelling and letting someone down.
A buddy can also provide additional encouragement, particularly when you achieve a goal. They can push you that little bit harder and make exercising more fun. If you dread exercise, it is important you find a buddy to help you stick with it. If you can’t find a ‘buddy’ then seek out an appropriate exercise ‘group’. It is a great way to socialise with all the physical and mental benefits. Having a buddy is certainly not a deal breaker and will not stop you from being successful, it might just make it easier getting there.
Building a Strong Foundation
With a small amount of initial discipline, you can create an exercise habit that requires little effort to maintain but will reap huge rewards in how you move, think and feel with your Parkinson’s. Here are some tips for creating your Parkinson’s specific exercise habit.
- Commit to the first 21 Days - This is all you need to make a habit automatic. If you can make it through the initial conditioning phase, it becomes much easier to sustain.
- Make it Daily – Consistency is critical if you want to make a habit stick. Do your Parkinson’s specific exercise programme every day! Activities you do once every few days are trickier to lock in as habits.
- Start Simple – Set yourself up for success and start with 10 minutes each day and build up!
- Form a Trigger – A trigger is a ritual you use right before executing your habit. Perhaps it is getting out of bed, having breakfast, talking the dog for a walk, dropping the kids at school, watching TV at night? What do you already do each day that appropriate to act as a trigger for you to add your exercise programme to?
- Be accountable – Record your exercise session or find someone who will be your buddy. This helps to keep yourself motivated and accountable if you feel like quitting.
- Use “But” – If you are struggling with an exercise use the word “but” to interrupt the negative thought. “I’m no good at this, but, if I work at it I will get better later.”
PARKINSON’S SPECIFIC EXERCISE GUIDELINES
- It is important that you walk yourself through each exercise first to make sure you understand the movement. As with any exercise programme, it is unlikely, but possible that you can injure your muscles by ending a movement without enough control. Keep your movements controlled and focused as you slowly build up your effort level.
- If you have had an injury in the past or have one now, bare this in mind when you start with each new exercise and modify accordingly.
- When working your way through the exercises, be mindful of your capacity, not your confidence to maintain balance through some of the more challenging activities. Always aim to exercise with a wall or table on one side with the sturdy chair on the other, just in case you do lose your balance. Having a buddy with you is also a great way to have some additional support.
- When following a neuroplastic exercise programme, the focus is about quality of movement, not just quantity, so don’t fall into the trap of just going through the motions. Once you are up to speed with the choreography, make each repetition count.
- Be sure to tailor the exercise to your needs; stage of Parkinson’s and type of Parkinson’s. The way you do the exercise will be slightly different to the next person and it is these nuances that can take the exercise you do from good to great!
- Once you get started with the first exercise, try to keep doing and building on your exercises every day. Perhaps commit to a time frame of 6, 8 or 10 weeks. You will need long enough to build in strong exercise habits and routines. Frequency and intensity are essential components for driving the re-wiring that occurs in your brain to improve your movements.
- It is recommended that when you are fully confident with the exercises, you are doing between 3 to 5 exercises each day. Aim for 3 sets of each exercise and 12 ‘good’ repetitions of each set.
Prevention is better than cure but if you do happen to fall down it’s best to know how to get back up again. To reduce your risk of falls, it is important to discuss and manage any medical or medication-induced dizziness first. It is worth looking to minimise other risks that can come from your environment (clutter, trip hazards, pets) and exercise set-up (not having wall, chair, bench support to hand if you do lose your balance). In the event that you do fall and providing you have not injured yourself, it is worth knowing how to get up off the floor yourself. Practice ‘How to get up off the floor’, before it happens, to boost your confidence, strength and skill in maintaining your independence.
How to get up off the floor
- Check that you are not injured
- Roll onto your side or fully onto your stomach if you can
- Push through your upper body and bring your knees up so you are in four-point kneeling
- Move to a chair or stable base that will support your weight.
- Push through the chair, bring one foot forward and drive up with that leg into a standing position. Be aware of any dizziness that an upright position may bring on.
- Sit down as soon as possible and assess your body for any further injury.
How to get down to the floor
- Face a sturdy chair and have a pillow or soft cushion on the floor for your knees
- Gently place a knee on the cushion and use your arms and standing leg to lower your weight onto your knee.
- Move your other foot back so both knees are on the cushion.
- Reverse to stand up
Before getting started to familiarise yourself with the exercises, you can also watch some exercises in the online links below.
Remember to warm up
The warm up is important not only to get your muscles primed for exercise, but also to get your head in the right space and to avoid injury. During the warm up you should start to feel warm in your muscles and your breath should be slightly laboured. Using large muscle groups such as your legs, upper back and arm muscles will help. Start slowly trying to increase the effort level as you work your way through the warm up.
Depending on your level of mobility, suggestions for doing a solid warm up include going for a brisk walk around the house or block, boxing in sitting or standing, climbing a couple of flights of stairs or peddling on an exercise bike for 5 minutes.
Video demonstration: https://vimeo.com/430222253
Practicing your walking is very important if you have started to shuffle, trip, lose your confidence, or simply if you have lost your arm swing. The aim of this exercise will really depend on what your primary gait issue is but you can modify the exercise to your needs.
Mark out a runway space in your home. This could be along a corridor or length of living room floor. If you have concerns about your balance it is best that you have a wall or stable surface on one side. Identify two markers at either end of your runway. Walk from one marker to the other and count the number of steps it takes to cover the distance. If it is 10 steps, then this becomes your baseline. If you have noticed that your arm or arms do not swing while you walk, practice actively swinging the opposite arm and leg while you walk. Be sure to swing your arm through full range behind you as well as in front while walking across the runway.
If shuffling gait is your concern, aim to reduce your step count over across the distance by at least 10% consistently.
If tripping is your concern, aim to increase your step height while walking across the runway. You could put small objects in the way that you have to step over. Tissue boxes, folded card or something that does not create a trip hazard if you mis-step are recommended.
Sit to Stand
Video demonstration: https://vimeo.com/430222106
Having sufficient strength and power in your legs to enable you to get out of a chair is very important for independence and function. The average adult stands from sitting about 90 times per day and rarely for the sake of just standing up. Normally people stand to go somewhere. For this reason, this sit to stand exercise is designed first to build your strength to reduce the reliance on your arms and the second part is to bring in some stepping practice.
Start standing facing away from a sturdy chair. Slowly lower yourself until you are sitting lightly on the chair. Keep your weight through your heels and the descent controlled throughout. If you can’t get all the way to the chair, go as low as you can before you lose control and then come back up again. Repeat this activity.
Once you can get down to the chair and up again without using your hands you can progress to the next level. For this you may need to practice facing a table or kitchen bench for additional support.
Place two cups on the floor about a step length in front of you. On rising from the chair, when standing tall, tap lightly on the cup directly in front of your right foot before returning your foot back to the starting place. If you need balance support to do this, lightly hold on to the bench in front of you. As your strength and balance improve, you can progress to hover your hands over the bench as you stand and tap with alternating feet.
Fine Motor Control
Video demonstration: https://vimeo.com/430222195
Difficulties with fine motor control is typically because of bradykinesia in the hands and changes in the ability to stretch your fingers and wrist out fully. Functional examples of this might be trouble with writing, cutting up food, turning the pages of a newspaper, typing, facial grooming like shaving or applying make-up or doing up buttons or shoelaces
This exercise is best done before and during a burst of fine motor activity.
Standing or seated, clench your fists together in both hands and then explosively open your hands out in front of you as wide as you can. Be sure to splay your fingers wide and open your hand as much as you can. Imagine you are flicking something sticky off your fingers if you are struggling to get the concept. While your fingers are fully stretched, try and stretch them another 10% and hold another second before returning to a clench. Part two of the exercise is then to touch opposing fingers fully and accurately as fast as you can from index to little finger and back again, returning each finger to full extension after each touch. Alternate and repeat the flick and touch on both sides.
Video demonstration: https://vimeo.com/430222225
In Parkinson’s, balance is significantly impaired when the interference of sensory, motor and cognitive systems reaches a threshold that can no longer be compensated for. As Parkinson’s progresses, the compromise of all three systems results in an inability to anticipate or recover from instability. It is also well known that the ability to do a demanding cognitive task while simultaneously walking or carrying something can be considerably impaired at this stage.
If you feel that your confidence in balance is low, you have experienced a ‘near miss’ or fall in the last twelve months you may want to get your balance tested. Please see your health professional who can get an accurate measure of your functional balance. Trying to do this exercise independently can be unsafe or inaccurate if you have poor balance.
Given the lack of weight shift from one leg to another in walking, turning, freezing of gait and such, this exercise will focus on the shift of weight as well as a varied speed response to assist with agility of the movement. It can be helpful to use an auditory cueing strategy for this exercise such as a song with 60 beats per minute or less, or use of a metronome app to keep you in time.
Start with a solid chair positioned near a corner (wall or kitchen bench). Use your hands to hold on to the chair as much as you need to until you feel confident to stand tall and hover your hands on the chair or to let go completely.
Stand behind the chair and take a wide step sideways to clear the back of the chair and so you are facing up the side of the chair. You are going to step around the chair following a box shape. Continue to alternate steps as you track around the chair, always facing to the front so you are challenging stepping in all directions and with weight shifting. Once you complete the box. Repeat the exercise but going in the other direction.
Progress this exercise by taking bigger steps, removing your hands from the chair or leaping if you are really confident. Stay standing tall at all times though.
Rolling in Bed
If you have trouble with rolling in bed, consider what the issues might be. It is likely a combination of the following: scale in your movements, strength in your legs, butt, and arms, or lack of targeted effort in the movement to turn.
This exercise is best started on a firm surface. If you can get down and up off the floor, this is a good place to practice.
Start with lying on your back. Bend your right knee up and have both arms stretched out directly from your side. Look to your left side and with power and effort, keeping your left hand on the floor, bring your right hand over to clap your hands together on the left. You will need to push through the heel of your left foot to complete this move.
Once successful, with strong effort and scale of movement, return yourself to the centre starting point and repeat to the other side.
To progress this exercise, combine the turn with a single leg bridge from the bent leg. Rolling in bed requires hip and glute strength. Left your butt off the floor as you turn to remain in the same spot on the floor during the exercise.
Once this is mastered, move to your bed and practice on the softer surface and then progress to having the bed clothes over you as well as you practice.
Video demonstration: https://vimeo.com/430222151
You need to take this stretch slowly as it can be quite intense the first few times. You also need to be able to get up and down off the floor independently. If you have problems getting onto or off the floor you could try this on the bed. You will need a half foam roller for this exercise. If you don’t have one, you can use a large towel rolled several times.
Place your foam roller on the floor and lower yourself so that you are sitting on one end of the foam roller. Gently roll your spine down so that you are lying on the foam roller and it is along the length of your spine. Bend your knees and keep your feet apart to maintain balance and offload your lumbar spine.
If you cannot rest your head on the foam roller, use a pillow so that you can relax your head. Make sure to tuck your chin in so that you are not overextending your neck.
When you are ready, lift your hands and arms up to the ceiling and then slowly lower them out to the side away from the body. You may not be able to reach the floor but you should feel a strong stretch across the front of your chest.
For your first time, gently hold this position for about a minute. As you get comfortable with this stretch you can build up to 10 minutes each day.
To come out of the stretch, move your hands down to your side. You can either roll sideways off the foam roller onto the floor or if you are strong enough, roll yourself back up into a sitting position. Either way, be careful as you get yourself back up into a standing position.
To ensure your safety, it is best to consider the following checklist before starting.
DO get a Health Professional or GP medical clearance
DO exercise when ‘ON’ and moving at your best
DO stop working out if you feel pain, dizziness or any other adverse event. Seek health professional advice as soon as possible if any symptoms occur
DO warm up, work at your own pace and work up to higher effort levels over time to minimise injury and falls
DO schedule a consistent time to exercise every day to ensure exercise receives priority
DO be clear on your exercise goals to keep you focused
DO clear the exercise area for clutter and trip hazards
DO ensure you have good lighting and ventilation
DO prepare any equipment required before you start exercising
DO engage a buddy where possible to assist with set up, safety and motivation
DO wear layered clothing that is easy to remove as you warm up
DO ensure you are well hydrated and take drink breaks when exercising
DON’T start exercising without advice from a health professional if you have an existing medical condition outside of Parkinson’s
DON’T exercise when you are ‘OFF’. This will significantly increase your risk of falls and injury
DON’T exercise if you feel poorly, dizzy or are experiencing any pain
DON’T exercise beyond your limits. It is important to work hard but if you start too hard you risk injury or burnout.
FREQUENTLY ASKED EXERCISE QUESTIONS
Q: If one part of my body needs more attention what should I do?
If you have noticed more symptoms in one particular arm or leg, you may wish to focus on that limb more intensively during each exercise station. Make sure that the particular limb you are focusing on is leading the exercise in effort and amplitude and that you have symmetry between both sides. You may also wish to double the repetitions on that side, especially if there is a marked difference from one side to the other.
Q: How do I avoid injuring myself?
It is really important that you warm up first and follow the instructions for each exercise to avoid injury. If you are just starting out, be gentle on yourself, especially if you are new to exercise or don’t exercise regularly. As you become more confident with the exercises you can start to work towards an effort level of 80% and full range of movement – weight shift and amplitude. If anything hurts while you are doing the exercises or you feel unbalanced stop immediately. All of the exercises can be modified to be made easier as well as harder so listen to your body.
Q: What about my medication. Is there a better time to do the exercises?
Do you notice improvements in your mobility when you have taken your medication? If so, then it is recommended that you try and time doing your exercises when you are at your best, about 40- 60 minutes after taking your medication, when you are ‘on’. It is not a good idea to do your exercises when you are ‘off’. As well as being frustrating, it may also increase your risk of hurting yourself and it also reduces the training effect you can achieve from the exercises.
Q: What Clothing & Footwear Should I Wear?
Wear loose, comfortable clothing that breathes well. Layers may help if you have extremes of temperature where you train or are prone to overheating. Your footwear needs to be supportive such as trainers or walking shoes.
GET IN TOUCH
If you’d like to contact Parkinson's New Zealand and avail of our free services, then give us a call on 0800 473 4636 today!
If you’d like to show your support to the service we provide to people with Parkinson’s, then please make a donation.
To find out whom to contact and what services are available in your area, head over to Regional Support.
- Abrantes AM, Friedman JH, Brown RA, et al. Physical activity and neuropsychiatric symptoms of Parkinson disease. J Geriatr Psych Neur 2012;25:138-145.
- Agid, Y.; Javoy-Agid, M.; Ruberg, M., editors. Biochemistry of neurotransmitters in Parkinson's disease. Vol. 2. London: Butterworth's and Co; 1987.
- Ahlskog JE (2018) Aerobic exercise: Evidence for a direct brain effect to slow Parkinson disease progression. Mayo Clin Proc 93, 360-372.
- Ahlskog JE. Does vigorous exercise have a neuroprotective effect in Parkinson’s disease? Neurology 2011; 77:288-294
- Aizenstein HJ, Stenger VA, Cochran J, Clark K, Johnson M, Nebes RD, et al. Regional brain activation during concurrent implicit and explicit sequence learning. Cerebral Cortex. 2004; 14(2): 199–208. [PubMed: 14704217]
- Allen N, Canning C, Sherrington C, Fung V. Bradykinesia, muscle weakness and reduced muscle power in Parkinson’s disease. Mov Disord 2009; 24(9): 1344-1351.
- Allen N, Sherrington C, Paul S, Canning C. Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Mov Disord 2011; 26(9):1605-1615.
- Allen NE, Moloney N, van Vliet V, Canning CG. The Rationale for Exercise in the Management of Pain in Parkinson's Disease. J Parkinsons Dis. 2015;5(2):229-39. doi: 10.3233/JPD-140508.
- Allen NE, Schwarzel AK, Canning CG: Recurrent falls in Parkinson’s disease: a systematic review. Parkinsons Dis 2013, 2013:906274.
- Allen NE, Sherrington C, Paul SS, Canning CG. Balance and falls in Parkinson’s disease: a meta-analysis of the effect of exercise and motor training. Mov Disord 2011;26:1605-1615.
- Altmann LJ, Stegemoller E, Hazamy AA, Wilson JP, Bowers D, Okun MS, Hass CJ (2016) Aerobic exercise improves mood, cognition, and language function in Parkinson’s disease: Results of a controlled study. J Int Neuropsychol Soc 22, 878-889.
- Alves G, Wentzel-Larsen T, Aarsland D, Larsen JP. Progression of motor impairment and disability in Parkinson disease: a population-based study. Neurology 2005;65:1436-41.
- American College of Sports Medicine (2018) Guidelines for Exercise Testing and Prescription, 10th Edition. Lippincott Williams & Wilkins, Philadelphia.  Ellis T, Boudreau JK, DeAngelis TR, Brown LE, Cavanaugh JT, Earhart GM, Ford MP, Foreman KB, Dibble LE (2013) Barriers to exercise in people with Parkinson disease. Phys Ther 93, 628-636.
- Andrews AW, Chinworth SA, Bourassa M, Garvin M, Benton D, Tanner S. Update on distance and velocity requirements for community ambulation. J Geriatr Phys Ther 2010;33:128-34.
- Archer T, Fredriksson A, Johansson B. Exercise alleviates Parkinsonism; Clinical and laboratory evidence. Acta Neurol Scan; 2011; 123; 73-84
- Ashburn A, Stack E, Ballinger C, Fazakarley L, Fitton C: The circumstances of falls among people with Parkinson’s disease and the use of Falls Diaries to facilitate reporting. Disabil Rehabil 2008, 30:1205–1212.
- Asher L, Aresu M, Falaschetti E, Mindell J. Most older pedestrians are unable to cross the road in time: a cross-sectional study. Age Ageing 2012;41:690-4.
- Atterbury EM, Welman KE (2017) Balance training in individuals with Parkinson’s disease: Therapist supervised vs. home-based exercise programme. Gait Posture 55, 138-144.
- Backer JH. The symptom experience of patients with Parkinson’s disease. J Neurosci Nurs 2006;38:51-7.
- Bartels AL, Balash Y, Gurevich T, Schaafsma JD, Hausdorff JM, Giladi N. Relationship between freezing of gait (FOG) and other features of Parkinson’s: FOG is not correlated with bradykinesia. J Clin Neurosci 2003;10:584-8.
- Bekkers EMJ, Dijkstra BW, Dockx K, Heremans E, Verschueren SMP, Nieuwboer A. Clinical balance scales indicate worse postural control
- Bello O, Sanchez JA, Fernandez del Olmo M. Treadmill walking in Parkinson’s disease patients; adaptation and generalisation effect. Mov Disord 2008; 23 (9); 1243
- Bellou V, Belbasis L, Tzoulaki I, Evangelou E, Ioannidis JP. Environmental risk factors and Parkinson’s disease: an umbrella review of meta-analyses. Parkinsonism Relat Disord 2016; 23: 1–9.
- Beradelli A, Rothwell J, Thompson P, Hallett M. Pathophysiology of bradykinesia in Parkinson’s disease. Brain 2001; 134: 2131-2146
- Bladh S, Nilsson MH, Hariz GM, Westergren A, Hobart J, Hagell P: Psychometric performance of a generic walking scale (Walk-12G) in multiple sclerosis and Parkinson’s disease. J Neurol 2012, 259:729–738.
- Bloem BR, Grimbergen YA, van Dijk JG, Munneke M: The “posture second” strategy: a review of wrong priorities in Parkinson’s disease. J Neurol Sci 2006, 248:196–204.
- Bloem BR, Hausdorff JM, Visser JE, Giladi N. Falls and freezing of gait in Parkinson’s disease: a review of two interconnected, episodic phenomena. Mov Disord 2004; 19: 871–84.
- Bloem BR, Marinus J, Almeida Q, Dibble L, Nieuwboer A, Post B, et al. Measurement instruments to assess posture, gait, and balance in Parkinson’s disease: critique and recommendations. Mov Disord 2016; 31: 1342–55.
- Bloem, B. R., Hausdorff, J. M., Visser, J. E. & Giladi, N. Falls and freezing of gait in Parkinson’s disease: a review of two interconnected, episodic phenomena. Mov Disord 19, 871–884 (2004).
- Bloem, B. R., Munneke, M., Carpenter, M. G. & Allum, J. H. The impact of comorbid disease and injuries on resource use and expenditures in parkinsonism. Neurology 61, 1023; author reply 1023–1024 (2003).
- Brauer S, Morris M. Can people with Parkinson’s disease improve dual tasking when walking? Gait and Posture 2010; 31 : 229–233
- CaciulaMC, HorvatM, Tomporowski PD, Nocera J(2016) The effects of exercise frequency on executive function in individuals with Parkinson’s disease. Ment Health Phys Act 10, 18-24.
- Cadet P, Zhu W, Mantione K, Rymer M, Dardik I, Reisman S, Hagberg S, Stefano G. Cyclic exercise induces anti-inflammatory signal molecules increases in the plasma of Parkinson’s patients. Inter J Molecular Med 2003; 12: 485-492.
- Cakit BD, Saracoglu M, Genc H, Erdem HR, Inan L (2007) The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson’s disease. Clin Rehabil 21, 698-705.
- Calne SM and Kumar A. Young onset Parkinson’s disease. Practical management of medical issues. Parkinsonism Relat Disord 2008; 14: 133–142.
- Campenhausena S, Bornscheina B, Wickb R, Bo¨tzelf K, Sampaiod C, Poewee W, Oertelb W, Siebertg U, Bergerc K, Dodela R. Prevalence and incidence of Parkinson’s disease in Europe. European Neuropsychopharmacology 2005; 473 – 490
- Canning C, Ada L, Woodhouse E. Multiple-task walking training in people with mild to moderate Parkinson’s disease; a pilot study. Clin Rehabil e2008; 22: 226-233
- Canning C, Allen NE, Dean CM, Goh L, Fung VSC. Home-Based Treadmill training for individuals with Parkinson’s disease: a randomised controlled pilot trial. Clin Rehabil 2012; 26(9) 817-826.
- Canning C, Sherrington C, Lord S, Fung V, Close J, Latt M, Howard K, Allen N, O’Rourke S, Murray S. Exercise therapy for prevention of falls in people with Parkinson’s disease: A protocol for a randomised controlled trail and economic evaluation. BMC Neurology 2013; 28(S1).
- Carpenter MG, Allum JH, Honegger F, Adkin AL, Bloem BR: Postural abnormalities to multidirectional stance perturbations in Parkinson’s disease. J Neurol Neurosurg Psychiatry 2004, 75:1245–1254.
- Carr J, Shepherd R. Neurological Rehabilitation: Optimizing motor performance. Oxford: Butterworth-Heinemann. 1987
- Cerin E, Barnett A, Sit CH, et al. Measuring walking within and outside the neighborhood in Chinese elders: reliability and validity. BMC Public Health 2011;11:851.
- Christiansen CL, Schenkman ML, McFann K, Wolfe P, Kohrt WM: Walking economy in people with Parkinson’s disease. Mov Disord 2009, 24:1481–1487.
- Colcombe S, Kramer AF (2003) Fitness effects on the cognitive function of older adults: A meta-analytic study. Psychol Sci 14, 125-130.
- Conradsson D, Lofgren N, Nero H, Hagstromer M, Stahle A, Lokk J, Franzen E (2015) The effects of highly challenging balance training in elderly with Parkinson’s disease: A randomized controlled trial. Neurorehabil Neural Repair 29, 827-836.
- Conradsson D, Löfgren N, Nero H, Hagströmer M, Ståhle A, Lökk J, Franzén E. The Effects of Highly Challenging Balance Training in Elderly With Parkinson's Disease: A Randomized Controlled Trial. Neurorehabil Neural Repair. 2015 Oct;29(9):827-36. doi: 10.1177/1545968314567150. Epub 2015 Jan 21.
- Corcos DM, Robichaud J, Leurgans D, Vaillancourt D, Poon C, Rafferty M, Kohrt W, Comella C. A two-year randomized controlled trial of progressive resistance exercise for Parkinson's disease. Mov Disord 2013; 28(9):1230-40.
- Cramer et al. Harnessing neuroplasticity for clinical applications. Brain 2011; 134; 1591–1609
- Crenna P, Carpinella I, Rabuffetti M, Calabrese E, Mazzoleni P, Nemni R, Ferrarin M: The association between impaired turning and normal straight walking in Parkinson’s disease. Gait Posture 2007, 26:172–178.
- Cruise K, Bucks R, Loftus A, Newton R, Pegoraro R, Thomas M. Exercise and Parkinson’s; benefits for cognition and quality of life. Acta Neurol Scand 2011; 123:13-19
- Cruise KE, Bucks RS, Loftus AM, Newton RU, Pegoraro R, Thomas MG (2011) Exercise and Parkinson’s: Benefits for cognition and quality of life. Acta Neurol Scand 123, 13-19.
- Cusso ME, Donald KJ, Khoo TK (2016) The impact of physical activity on non-motor symptoms in Parkinson’s disease: A systematic review. Front Med (Lausanne) 3, 35.
- da Silva FC, Iop RDR, de Oliveira LC, Boll AM, de Alvarenga JGS, Gutierres Filho PJB, de Melo L, Xavier AJ, da Silva R (2018) Effects of physical exercise programs on cognitive function in Parkinson’s disease patients: A systematic review of randomized controlled trials of the last 10 years. PLoS One 13, e0193113.
- de Natale ER, Paulus KS, Aiello E, Sanna B, Manca A, Sotgiu G, Leali PT, Deriu F (2017) Dance therapy improves motor and cognitive functions in patients with Parkinson’s disease. NeuroRehabilitation 40, 141-144.
- Deandrea, S. et al. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology 21, 658–668 (2010).
- Dibble L, Hale T, Marcus R, Droge J, Gerber J, LaStayo P. High-Intensity resistance training amplified muscle hypertrophy and functional gains in persons with Parkinson’s disease. Mov Disord 2006 21(9): 1444-52
- Dinoff A, Herrmann N, Swardfager W, Liu CS, Sherman C, Chan S, Lanctot KL (2016) The effect of exercise training on resting concentrations of peripheral brain-derived neurotrophic factor (BDNF): A meta-analysis PLoS One 11, e0163037.
- Divac I, Rosvold HE, Szwarcbart MK. Behavioral effects of selective ablation of the caudate nucleus. Journal of Comparative and Physiological Psychology. 1967; 63(2):184–190. [PubMed: 4963561]
- Dobkin BH (2017) A rehabilitation-internet-of-things in the home to augment motor skills and exercise training. Neurorehabil Neural Repair 31, 217-227.
- Doyon J, Penhune V, Ungerleider LG. Distinct contribution of the cortico-striatal and corticocerebellar systems to motor skill learning. Neuropsychologia. 2003; 41(3):252–262. [PubMed: 12457751]
- Duchesne C, Gheysen F. Influence of aerobic exercise training on the neural correlates of motor learning in Parkinson's disease individuals. Neuroimage Clin. 2016 Sep 14;12:559-569
- Duchesne C, Lungu O, Nadeau A, Robillard ME, Bore A, Bobeuf F, Lafontaine AL, Gheysen F, Bherer L, Doyon J (2015) Enhancing both motor and cognitive functioning in Parkinson’s disease: Aerobic exercise as a rehabilitative intervention. Brain Cogn 99, 68-77.
- Ellis T, Boudreau J, DeAngelis T, Brown L, Cavanaugh J, Earhart G, Ford M, Foreman K, Dibble L. Barriers to Exercise in People with Parkinson Disease. Physical Therapy 2013: 10.2522/tj.20120279
- Ellis T, Boudreau JK, Deangelis TR, Brown LE, Cavanaugh JT, Earhart GM, Ford MP, Foreman KB, Dibble LE: Barriers to exercise in people with Parkinson disease. Phys Ther 2013, 93:628–636.
- Ellis TD, Cavanaugh JT, DeAngelis TR, Hendron K, Thomas CA, Saint-Hilaire M, Latham N (2018) Comparative effectiveness of mHealth supported exercise compared to exercise alone for people with Parkinson disease: Randomized controlled pilot study. Phys Ther. in press.
- Engeroff T, Ingmann T, Banzer W (2018) Physical activity throughout the adult life span and domain specific cognitive function in old age: A systematic review of cross-sectional and longitudinal data. Sports Med 48, 1405-1436.
- Farley B, Fox C, Ramig L, McFarland D. Intensive Amplitude-specific Therapeutic Approaches for Parkinson’s disease. Toward a neuroplasticity-principled Rehabilitation model. Topics in Geriatric Rehabilitation 2008; 24(2):99-114.
- Farley B, Koshland G. Training BIG to move faster; the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res 2005; 167 (3): 462-467.
- Fisher B Wu A, Salem G, Song J, Lin C, Yip J, Cen S, Gordon J, Jakowec M, Petzinger G. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson’s disease. Arch Phys Med Rehabil 2008; 89 (7): 1221-9.
- Fisher BE, Li Q, Nacca A, et al. Treadmill exercise elevates striatal dopamine D2 receptor binding potential in patients with early Parkinson’s disease. Neuroreport 2013;24:509-514.
- Flach A, Jaegers L, Krieger M, Bixler E, Kelly P, Weiss EP, Ahmad SO (2017) Endurance exercise improves function in individuals with Parkinson’s disease: A meta analysis. Neurosci Lett 659, 115-119.
- Forsaa, E. B., Larsen, J. P., Wentzel-Larsen, T. & Alves, G. A 12-year population-based study of freezing of gait in Parkinson’s disease. Parkinsonism Relat Disord 21, 254–258 (2015).
- Fraix V, Bastin J, David O, Goetz L, Ferraye M, Benabid AL, et al. Pedunculopontine nucleus area oscillations during stance, stepping and freezing in Parkinson’s disease. PLoS One 2013; 8: e83919.
- Franchignoni F, Martignoni E, Ferriero G, Pasetti C: Balance and fear of falling in Parkinson’s disease. Parkinsonism Relat Disord 2005, 11:427–433.
- Frazzitta G, Bertolli G, Riboldazzi G, Marinella T, Uccellini D, Boveri N, Guaglio G, Perini M, Comi C, Balbi P, Maestri R. Effectiveness of intensive inpatient rehabilitation treatment on disease progression in parkinsonian patients: a randomized controlled trial with 1-year follow-up. Neurorehabil Neural Repair 2012; 26(2):144-150.
- Frazzitta G, Maestri R, Bertotti G, Riboldazzi G, Boveri N, Perini M, Uccelini D, Turla M, Comi C, Pezzoli G, Ghilardi M. Intensive Rehabilitation Treatment in Early Parkinson’s disease: A Randomised Pilot Study with a 2-year follow up. Neurorehabil Neural Repair 2014: (epub ahead of print)
- Frazzitta G, Maestri R, Ghilardi M, Riboldazzi G, Perini M, Bertolli G, Boveri N, Buttini S, Lombino F, Uccelini D, Turla M, Pezzoli G, Comi C. Intensive rehabilitation increases BDNF serum levels in parkinsonian patients: a randomised study. Neurorehabil Neural Repair 2014: 28(2):163-168.
- Frazzitta G, Maestri R, Uccelini D, Bertotti G, Abelli P. Rehabilitation treatment of gait in patients with Parkinson’s disease with freezing: a comparison between two physical therapy protocols using visual and auditory cues with or without treadmill training. Mov Disord 2009; 24 (8): 1139-1143.
- Giladi N, Kao R, Fahn S. Freezing phenomenon in patients with parkinsonian syndromes. Mov Disord 1997;12:302-5.
- Giladi N, Nieuwboer A. Understanding and treating freezing of gait in parkinsonism, proposed working definition, and setting the stage. Mov Disord 2008;23(Suppl 2):423-5
- Glasauer S, Straka H. Postural control: learning to balance is a question of timing. Curr Biol 2017; 27: R105–7.
- Goodwin V, Richards S, Taylor R, Taylor A, Campbell J. The effectiveness of exercise interventions for people with Parkinson’s disease: a systematic review and meta-analysis. Mov Disord 2008; 23 (5): 631-40.
- Hass CJ, Buckley TA, Pitsikoulis C, Barthelemy EJ (2012) Progressive resistance training improves gait initiation in individuals with Parkinson’s disease. Gait Posture 35, 669-673.
- He Y, Zhang X, Yung W, Zhu J, Wang J. Role of BDNF in central motor structures and motor diseases. Molecular Neurobiology 2013 Dec; Vol. 48 (3), pp. 783-93
- Helmich RC, Hallett M, Deuschl G, Toni I, Bloem BR. Cerebral causes and consequences of parkinsonian resting tremor: a tale of two circuits? Brain. 2012 Nov;135(Pt 11):3206-26. doi:10.1093/brain/aws023. Epub 2012 Mar
- Hirsch MA, Iyer SS, Sanjak M. Exercise-induced neuroplasticity in human Parkinson's disease: What is the evidence telling us? Parkinsonism Relat Disord. 2016 Jan;22 Suppl 1:S78-81. doi: 10.1016/j.parkreldis.2015.09.030. Epub 2015 Sep 15
- Hirsh M, Farley B. Exercise and Neuroplasticity in Persons living with Parkinson’s disease. Eur J Phys Rehabil Med 2009; 45: 215-229.
- Hirsh M, Toole T, Maitland C, Rider R. The effects of balance training and high-intensity resistance training on persons with idiopathic Parkinson’s disease. Arch Phys Med Rehabil 2003; 84 (8):1109-1117.
- Hiyamizu M, Morioka S, Shomoto K, Shimada T. Effects of dual task balance training on dual task performance ability in elderly people; a randomised control trial. Clin Rehabil 2011;26(1):58-67
- Hoehn MM, Yahr MD. Parkinsonism: onset, progression, and mortality. Neurology 1967; 17:427-42.
- Horak FB, Nutt JG, Nashner LM. Postural inflexibility in parkinsonian subjects. J Neurol Sci 1992; 111: 46–58.
- Kelly N, Ford M, Standaert D, Watts R, Bickel C, Moellering D, Tuggle S, Williams J, Lieb L, Windham S, Bamman M. Novel, high-intensity exercise prescription improves muscle mass, mitochondrial function, and physical capacity in individuals with Parkinson’s disease. J Appl Physiol 2014: 116(5): 582-92
- Kelly VE, Eusterbrock AJ, Shumway-Cook A: A review of dual-task walking deficits in people with Parkinson’s disease: motor and cognitive contributions, mechanisms, and clinical implications. Parkinsons Dis 2012, 2012:918719.
- Kelly VE, Johnson CO, McGough EL, Shumway-Cook A, Horak FB, Chung KA, Espay AJ, Revilla FJ, Devoto J, Wood-Siverio C, Factor SA, Cholerton B, Edwards KL, Peterson AL, Quinn JF, Montine TJ, Zabetian CP, Leverenz JB (2015) Association of cognitive domains with postural instability/gait disturbance in Parkinson’s disease. Parkinsonism Relat Disord 21, 692-697.
- Kerr, G. K. et al. Predictors of future falls in Parkinson disease. Neurology 75, 116–124 (2010).
- Keus S, BLoem B, Hendriks E, Bredero-Cohen A, Munneke M. Evidence-based analysis of physical therapy in Parkinson’s disease with recommendations for practice and research. Mov Disord 2007; 22 (4): 451-460
- Keus SHJ, Munneke M, Graziano M, Paltamaa J, Pelosin E, Domingos J, Bruhlmann S, Ramaswamy B, Prins J, Struiksma C, Rochester L, Nieuwboer A, Bloem B (2014) European physiotherapy guideline for Parkinson’s disease. KNGF/ParkinsonNet, the Netherlands.
- Kim SD, Allen NE, Canning CG, Fung VS. Postural instability in patients with Parkinson’s disease. Epidemiology, pathophysiology and management. CNS Drugs 2013; 27: 97–112.
- Knaepen K, Goekint M, Heyman EM, Meeusen R (2010) Neuroplasticity - exercise-induced response of peripheral brain-derived neurotrophic factor: A systematic review of experimental studies in human subjects. Sports Med 40, 765-801.
- Kramer AF, Erickson KI (2007) Capitalizing on cortical plasticity: Influence of physical activity on cognition and brain function. Trends Cogn Sci 11, 342-348.
- Lang AE, Espay AJ (2018) Disease modification in Parkinson’s disease: Current approaches, challenges, and future considerations. Mov Disord 33, 660-677.
- Lauze M, Daneault JF, Duval C (2016) The effects of physical activity in Parkinson’s disease: A review. J Parkinsons Dis 6, 685-698.
- Lawn S and Schoo A. Supporting self-management of chronic health conditions: common approaches. Patient Educ Couns 2010; 80: 205–211.
- Li FZ, Harmer P, Fitzgerald K, et al. Tai chi and postural stability in patients with Parkinson’s disease. New Engl J Med 2012;366: 511-519.
- Lord, S. et al. Predicting first fall in newly diagnosed Parkinson’s disease: Insights from a fall-naive cohort. Mov Disord (2016).
- Mak MK, Hui-Chan CW. Cued task-specific training is better than exercise in improving sit-to-stand in patients with Parkinson’s disease: a randomised controlled trial. Mov Disord 2008; 23: 501-509.
- Mak MK, Pang MY, Mok V: Gait difficulty, postural instability, and muscle weakness are associated with fear of falling in people with Parkinson’s disease. Parkinsons Dis 2012, 2012:901721.
- Merholz J, Friis R, Kugler J, Twork S, Storch A, Pohl M. Treadmill training for people with Parkinson’s disease. Cochrane Library 2010.
- Miyai I, Fujimoto Y, Yamamoto H, Ueda Y, Saito T, Nozaki S, Kang J. Long-term effect of body-weight supported treadmill training in Parkinson’s disease: a randomised controlled trial. Arch Phys Med Rehabil 2002; 83: 1370-1373.
- Morberg b, Jensen J, Bode M, Wermuth L. The impact of high intensity physical training on motor and non-motor symptoms in patients with Parkinson’s disease (PIP): A preliminary study. NeuroRehabilitation 2014: (Epub ahead of print)
- Nadeau A, Lungu O, Duchesne C, Robillard ME, Bore A, Bobeuf F, Plamondon R, Lafontaine AL, Gheysen F, Bherer L, Doyon J (2016) A 12-week cycling training regimen improves gait and executive functions concomitantly in people with Parkinson’s disease. Front Hum Neurosci 10, 690.
- Nadeau A, Pourcher E, Corbeil P (2014) Effects of 24 week of treadmill training on gait performance in Parkinson’s disease. Med Sci Sports Exerc 46, 645-655.
- Nieuwboer A, Kwakkel G, Rochester L, Jones D, van Wegen E, Williems AM, Chavret F et al. Cueing training in the home improves gait-related mobility in Parkinson’s disease: the RESCUE trial. J Neurol Neurosurg Psychiatry. 2007; 78(2): 134-140
- Oeda, T., Umemura, A., Mori, Y., Tomita, S., Kohsaka, M., Park, K., et al. (2015). Impact of glucocerebrosidase mutations on motor and nonmotor complications in Parkinson’s disease. Neurobiology of Aging, 36(12), 3306–3313.
- Petzinger G, Fisher B, Van Leeuwen J, Vukovic M, Akopian G, Meshul C, Holschneider D, Nacca A, Walsh J, Jakowec M. Enhancing Neuroplasticity in the Basal Ganglia: The role of exercise in Parkinson’s disease. Mov Disord 2010; 25(Suppl 1): S141-S145.
- Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec MW. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurol 2013; 12:716-726.
- Petzinger GM, Holschneider DP, Fisher BE, et al. The effects of exercise on dopamine neurotransmission in Parkinson’s disease: targeting neuroplasticity to modulate basal ganglia circuitry. Brain Plast 2015;1:29-39.
- Petzinger GM, Holschneider DP, Fisher BE, McEwen S, Kintz N, Halliday M, Toy W, Walsh JW, Beeler J, Jakowec MW (2015) The effects of exercise on dopamine neurotransmission in Parkinson’s disease: Targeting neuroplasticity to modulate basal ganglia circuitry. Brain Plast 1, 29-39.
- Picelli A, Varalta V, Melotti C, Zatezalo V, Fonte C, Amato S, Saltuari L, Santamato A, Fiore P, Smania N (2016) Effects of treadmill training on cognitive and motor features of patients with mild to moderate Parkinson’s disease: A pilot, single-blind, randomized controlled trial. Funct Neurol 31, 25-31.
- Popiolkiewicz V, McConaghy M, Scrivener K, Dean C. PD Warrior Program Evaluation: Participants’ satisfaction, feedback and health status survey. [Unpublished]
- Ridgel AL, Kim CH, Fickes EJ, Muller MD, Alberts JL. Changes in executive function after acute bouts of passive cycling in Parkinson’s disease. J Aging Phys Act 2011;19:87-98.
- Ridgel AL, Phillips RS, Walter BL, Discenzo FM, Loparo KA (2015) Dynamic high-cadence cycling improves motor symptoms in Parkinson’s disease. Front Neurol 6, 194.
- Rochester L, Baker K, Hetherington V, Jones D, Willems A, Kwakkel G, Van WEgen E, Lim I, Nieuwboer A. Evidence for motor learning in Parkinson’s disease: Acquisition, automaticity and retention of cued gait performance after training with external rhythmical cues. Brain Res 2010; 1319:103-111.
- Schaafsma JD, Balash Y, Gurevich T, Bartels AL, Hausdorff JM, Giladi N. Characterization of freezing of gait subtypes and the response of each to levodopa in Parkinson’s disease. Eur J Neurol 2003;10:391-8.
- Silva-Batista C, Corcos DM, Roschel H, Kanegusuku H, Gobbi LT, Piemonte ME, Mattos EC, MT DEM, Forjaz CL, Tricoli V, Ugrinowitsch C (2016) Resistance training with instability for patients with Parkinson’s disease. Med Sci Sports Exerc 48, 1678-1687.
- Silveira CRA, Roy EA, Intzandt BN, Almeida QJ (2018) Aerobic exercise is more effective than goal-based exercise for the treatment of cognition in Parkinson’s disease. Brain Cogn 122, 1-8.
- Snijders AH, Nijkrake MJ, Bakker M, Munneke M, Wind C, Bloem BR. Clinimetrics of freezing of gait. Mov Disord 2008; 23(Suppl 2):468-74.
- Snijders AH, Takakusaki K, Debu B, Lozano AM, Krishna V, Fasano A, et al. Physiology of freezing of gait. Ann Neurol 2016; 80: 644–59.
- Springer S, Giladi N, Peretz C et al. Dual-Tasking effects on gait variability: the role of aging, falls and executive function. Mov Disord 2006; 21:950-957
- Stuckenschneider T, Helmich I, Raabe-Oetker A, Frobose I, Feodoroff B (2015) Active assistive forced exercise provides long-term improvement to gait velocity and stride length in patients bilaterally affected by Parkinson’s disease. Gait Posture 42, 485-490.
- Tanaka K, Quadros AC, Jr., Santos RF, Stella F, Gobbi LT, Gobbi S. Benefits of physical exercise on executive functions in older people with Parkinson’s disease. Brain Cogn 2009;69:435-441.
- Tanner CM, Comella CL. When brawn benefits brain: physical activity and Parkinson’s disease risk. Brain 2015; 138: 238–39.
- Tomlinson C, Patel S, Meek C, Herd C, Clarke C, Stowe R, Shah L, Sackley C, Deane K, Wheatley K, Ives N. Physiotherapy intervention in Parkinson’s disease: systematic review and meta-analysis. BMJ 2012;345:e5004 doi: 10.1136/bmj.e5004 (Published 6 August 2012)
- Uc EY, Doerschug KC, Magnotta V, Dawson JD, Thomsen TR, Kline JN, Rizzo M, Newman SR, Mehta S, Grabowski TJ, Bruss J, Blanchette DR, Anderson SW, Voss MW, Kramer AF, Darling WG (2014) Phase I/II randomized trial of aerobic exercise in Parkinson disease in a community setting. Neurology 83, 413-425.
- Uhrbrand A, Stenager E, Pedersen MS, Dalgas U (2015) Parkinson’s disease and intensive exercise therapy–a systematic review and meta-analysis of randomized controlled trials. J Neurol Sci 353, 9-19.
- Van Nimwegen M, Speelman A, Smulders K, Overeem S, Borm G, Backx F, Bloem B, Munneke M. Design and baseline characteristics of the ParkFit study, a randomized controlled trial evaluating the effectiveness of a multifaceted behavioral program to increase physical activity in Parkinson patients. BMC Neurology 2010, 10:70 doi:10.1186/1471-2377-10-70
- Victor Popiolkiewicz, Melissa McConaghy, Dr Kate Scrivener, Prof Catherine Dean. PD Warrior program evaluation: Participants’ satisfaction, feedback and health status. Sep 23, 2015 - Physiotherapy Conference 2015 Gold Coast Convention and Exhibition Centre
- Xu Q, Park Y, Huang X et al. Physical activities and future risk of Parkinson’s disease. Neurology 2010; 75:341-348.
- Ypinga JHL, de Vries NM, Boonen LHHM, Koolman X, Munneke M, Zwinderman AH, Bloem BR (2018) Effectiveness and costs of specialised physiotherapy given via ParkinsonNet: a retrospective analysis of medical claims data. Lancet Neurol 17, 153-161.