Exercise for Parkinson’s disease
Exercise for Parkinson’s disease
Given the vast range of functional capacity, fitness levels, their varied presentations and individual’s preferences to certain exercise modalities amongst Parkinson’s clients, it can be tricky to know where to start. When considering beginning an exercise program it’s important to consider all options to find what is best for you.
The flexibility and convenience of a home program/ home visit from an Exercise Physiologist or Physiotherapist may be most suitable. Individual sessions with your therapist may be beneficial to maximise your time on goals or you may find the atmosphere of a group class motivating.
Regardless of your choice, at Rebound we always begin with an initial assessment with your chosen therapist in which a detailed medical and exercise history can be taken while we get to know you, what you enjoy and what you are looking to get out of your therapy.
What does the research say?
A 2015 study from the Journal of Neurological Physical Therapy randomized 58 participants, all of whom had been diagnosed with Parkinson’s disease, could walk unassisted and were between 40-80 years of age into individual sessions, home based exercise or group classes. All the Parkinson’s clients in this study completed a similar exercise program regardless of the setting or number of participants. Their research found that of the 3 exercise delivery options, individual exercise (1 to 1 sessions) showed the greatest improvements in functional and balance outcomes. Participants in the group classes had the greatest improvements in gait (walking capacity.) Those who completed home exercise programs had the least improvements across all outcomes.
A 2009 paper from The International Journal of Therapy and Rehabilitation identified the most common barriers to people with neurological conditions engaging in exercise as embarrassment, perceived lack of condition specific knowledge of the fitness professionals and the impact of this knowledge gap on exercise advice. They found that facilitators to exercise participation were knowledgeable staff as well as group based exercise.
A 2006 study from Brazil considered the ways group exercise for individuals with Parkinson’s disease impacted the participant’s quality of life. They found that light to moderate physical activity, completed 3 times per week for 12 weeks in a group class lead by a physiotherapist improved quality of life scores. The main areas of improvement were found to be in emotional reactions, social interaction and physical ability.
A 2014 study out of Japan considered the benefits of exclusively home based exercise within the Parkinson’s population. The 2-month home exercise intervention consisted of self-administered by patients and home visit session lead by a physical therapist. After the intervention they compared the changes in physical function, postural changes, and activities of daily living. Their main findings were a reduced fear of falling post intervention. Physically the participants exhibited increased flexibility, muscle strength, gait (walking capacity) and balance. This study was limited by a small number of participants and a lack of control group.
The bottom line
Engaging in exercise with the guidance of a knowledgeable health professional who can not only help you get moving but also equip you with condition related education is generally a safe, meaningful and highly beneficial idea. The context in which you are exercising has been shown to affect outcome measures, group classes improving mood and walking capacity most significantly, one-to-one sessions showing greatest task specific and balance outcomes. In the research home exercise is mainly considered to be self-managed, meaning the client follows a program written by the practitioner without supervision. Home visits differ to this as the practitioner visits you at your home, or somewhere convenient to you and supports, motivates and educates you throughout the session. For this reason, I would believe home visits to have similar outcomes to one-to-one sessions in clinic.
There is no one size fits all answer to what setting you should begin your Parkinson’s exercise journey, if you are feeling confused or nervous consider booking an initial assessment with an Exercise Physiologist or Physiotherapist and we can work it out together.
References:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4772717/
King, L. A., Wilhelm, J., Chen, Y., Blehm, R., Nutt, J., Chen, Z., ... & Horak, F. B. (2015). Does Group, Individual or Home Exercise Best Improve Mobility for People With Parkinson's Disease?. Journal of neurologic physical therapy: JNPT, 39(4), 204.
Elsworth, C., Dawes, H., Sackley, C., Soundy, A., Howells, K., Wade, D., ... & Izadi, H. (2009). A study of perceived facilitators to physical activity in neurological conditions. International Journal of therapy and Rehabilitation, 16(1), 17-24.
Rodrigues de Paula, F., Teixeira‐Salmela, L. F., Coelho de Morais Faria, C. D., Rocha de Brito, P., & Cardoso, F. (2006). Impact of an exercise program on physical, emotional, and social aspects of quality of life of individuals with Parkinson's disease. Movement disorders: official journal of the Movement Disorder Society, 21(8), 1073-1077.
https://www.jstage.jst.go.jp/article/jpts/26/11/26_jpts-2014-198/_pdf/-char/ja
Nakae, H., & Tsushima, H. (2014). Effects of home exercise on physical function and activity in home care patients with Parkinson’s disease. Journal of physical therapy science, 26(11), 1701-1706.