Exercise as it relates to Disease/Physical activity to reduce symptoms of Parkinson's disease

What is Parkinson’s disease?
Parkinson’s disease, also known as Paralysis Agitans, is a neurodegenerative disease (1). It is caused from the destruction of cells located within the substantia nigra (the pars compacta). These cells are responsible for releasing dopamine-secreting nerve fibers to the caudate nucleus and putamen in the Cerebrum of the brain (1). Dopamine is a neurotransmitter, which helps regulate movement and coordination (2)(3). Damage to these dopamine-transmitting areas causes involuntary rigidity, akinesia (difficulty in initiating movement), instability and tremors (1). Parkinson's disease currently affects around one in 350 Australians, and 1 per cent of people over the age of 60 will be diagnosed with the disease (5). The cause of Parkinson’s disease remains idiopathic, thought approximately 10% of cases have a familial incidence (19).

Symptoms of Parkinson’s disease
The common and visible symptoms of Parkinson’s disease are caused from the lack of dopamine production and secretion. Symptoms tend to arise when approximately 70% of the dopamine producing cells have deteriorated and ceased normal function (3).

Symptoms of Parkinson’s disease can include:


 * Tremors (shaking)
 * Rigidity of musculature (uncontrolled contraction)
 * Diminished facial expression
 * Bradykinesia (slowness of voluntary movement)
 * Lethargy
 * Shuffling gait
 * Freezing (sudden inability to move)
 * Poor balance

There are also multiple side affects, which can be an additional problem with Parkinson’s disease sufferers. These can include:


 * Depression (5)(10)
 * Sleep problems (5)(10)
 * Dementia. (5) (10)
 * Psychosis (10)(12)
 * Anxiety (19)

Predominantly, symptoms will usually appear around the ages of 50-75years, though up to 20% of people are diagnosed between the ages of 30–50 years (19). No two Parkinson’s disease sufferers will experience the exact same symptoms nor to the same degree. Symptoms and severity are progressive and usually increase over time (3). These symptoms cannot be cured, though can be managed to a certain degree with medications (1), exercise and movement (3)(4)(5)(6)(7) and multidisciplinary therapies such as physiotherapists, massage therapists and dietitians (3).

Treatments
As the brain is affected greatly and results in progressive neurological deterioration, the symptoms and physiological affect caused by Parkinson’s disease, as mentioned before are not curable. Though, a combination of medications, exercise and hands on treatments are used to control and reduce the adverse affects that Parkinson’s can create. In more serious cases where these therapies and medications in particular do not have an effect, surgery is an option (10).

Medications prescribed are used to help boost dopamine levels in the brain. While these medications are very effective in managing motor symptoms, they can cause significant side effects and overtime their effectiveness diminishes (5).

Exercise has proven, over numerous studies performed world-wide (4)(5)(6)(7)(8)(9)(10(11)(13)(14), to significantly reduce many of the daily challenges that Parkinson’s disease sufferers face, and therefore improving their quality of life (3). Exercise, more specifically ‘vigorous’ heart-rate elevating exercise, has proven to help reduce muscle cramping (3), increase muscular strength and flexibility (3)(5)(6)(8), increase motor skills and coordination (3)(5)(6)(8), reduce tremors (5)(6), provide better control over gross motor movements and gait (3)(6)(8), and of course the same benefits that any regular person who exercises would experience, such as increased blood flow and heart rate, which helps to flush out toxins from the tissues and cleanse the body, greater confidence, reduced stress levels, increased cardiovascular fitness, increased joint mobility and a positive outlook on life (3)(8).

Exercise improves and boosts dopamine production and transmission, which allows for the growth of new nerves and stronger connection within the brain to help with movement, coordination, learning and memory (9)(11)(14). Exercise also helps to preserve brain health (11)(14), which slows the deterioration process of which Parkinson’s disease is best known for (9)(11).

Multidisciplinary therapies, including physiotherapy, massage therapy, dieticians and counselors can all be excellent interveners in providing different areas of help and advise for Parkinson’s disease sufferers (3)(19). Regular physiotherapy and massage treatment along with exercise can help to improve muscular flexibility and decrease rigidity, induce relaxation, and improve balance and gait (15)(16)(17)(19). Dieticians and nutritionists can provide guidance and plans for healthy eating and suitable foods for a balanced diet (3)(17)(19). Surgical treatment options are available for those patients who suffer from severe motor symptoms that are unable to be controlled with medications. These surgical techniques include Pallidotomy, Thalamotomy and deep brain stimulation (3)(19).

Recommendations for Exercise
It is important to start off slow, with light intensity exercise and work up from there. This is to prevent injury, and to make sure the person feels comfortable and confident. As you progress, so can the intensity of exercise. Setting achievable goals is a good way to see improvement and gives the individual (and their trainer in some cases) something visible to work towards, for example climbing stairs or walking a set distance. It is recommended that individuals exercise between 15-60minutes per day. Research has shown that the higher your heart rate, the more beneficial for reduction in symptoms of Parkinson’s disease. Group exercise classes, training with a friend or partner, or even a career can be a great way to get motivated, especially for those more reluctant or new to exercising and it makes exercising a bit more enjoyable! (3) Here are some appropriate exercises recommended for Parkinson’s disease:

Aerobic:


 * Treadmill or walking/running outdoors (to help improve gait and coordination, increase heart rate, increase blood flow)
 * Swimming or wading in water (better for early stages, helps with coordination and water resistance for strength building, increase heart rate and blood flow)
 * Cycling (great for cardiovascular fitness and muscle strength. Will also help with coordination for greater gait balance)

Strength/Resistance:


 * Light weights (increase muscle tone, increase heart rate and blood flow.)
 * Resistance using own body weight or theraband (coordination and muscle tone)
 * Boxing (increases heart rate and improves coordination and stance/balance)

Stretching/Balance:


 * Active and passive stretching (increase range of motion, stretches tissue cells, increases blood flow, decrease muscular pain and cramps, prevents injury, helps with muscle repair)
 * Balance exercises and hand-eye coordination exercises (improve fine motor skills and can help with daily tasks, e.g. brushing teeth or handwriting)

It is advised to consult a GP or health care professional prior to commencing a new exercise program, and it may be beneficial to get in touch with a personal trainer or exercise consultant to work out a program that is suited to each person’s individual needs and abilities.

Further Reading and Useful Links

 * Parkinson’s Australia: http://www.parkinsons.org.au
 * Michael J. Fox Foundation for Parkinson’s Research: http://www.michaeljfox.org
 * National Parkinson’s Foundation - exercise: http://parkinsons.org/Parkinson-s-Disease/Treatment/Exercise.aspx
 * Better Health Channel – Parkinson’s disease: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Parkinson's_disease_explained