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Parkinson's disease and physical exercise to help improve motor control and function.

Parkinson's Disease
Parkinson’s Disease (PD) is a progressive neurological disorder which impacts an individuals physical, psychological and functional abilities.2 Parkinson’s is known to effect the older population with the average age of diagnosis being 65 years.

What causes Parkinson's Disease?
The disease is caused due to a neural degeneration in a specific section of the midbrain known as the Substantia Nigra resulting in the decline in production of dopamine.2 Dopamine is a hormone associated with smooth controlled movements, and a decline causes a difficulty in movement control and can cause symptoms such as pain, depression, immobility and tremors. There is no cure for Parkinson’s Disease, however exercise interventions have shown to improve quality of life and motor control and function.

Symptoms of Parkinson’s Disease

 * Rigidity of muscles
 * Hypokinesia
 * Tremors
 * Shaking
 * Pain
 * Depression
 * Loss of motor skills
 * Decline in proprioception 4

How does decline in proprioception effect a parkinson sufferer?
Proprioception is the ability to determine relative position of body parts in space and the contractile force they are exerting. In order for the central nervous system to simulate a smooth and controlled movement, it must be able to identify the exact location of a limb. A decline in proprioception can impact movement control and make coordinated movements very difficult to execute. As a result of this individuals can lose much of heir postural muscle control and sense of balance, which individuals with Parkinson’s suffer from daily. A majority of Parkinson’s patients experience stooped posture.4 This decline has a large effect on Parkinson’s sufferers, in particular, negative effects on gait, posture and locomotion, creating an inability to move and lift objects, and increasing risk of falls. 3

Exercise and improvement in proprioception
Proprioception is a critical source of sensory feedback for maintenance of balance, largely contributing to postural regulation. Balance exercises are very important in improving proprioception. These exercises improve an individuals proprioception feedback circle, gradually improving an individuals gait and posture. Improving proprioception in a parkinsons sufferer requires progression, through progressive exercise interventions individuals can gain the balance and skills that are necessary to maintain stability and fine tune their coordination skills to be more reliable and consistent. As proprioception continues to deteriorate due to Parkinson's it is essential that intervention is consistently carried out. Studies carried out on both Parkinson's sufferers and older adults, suggest exercise can help improve proprioception and in turn gait and posture.3

Exercise Recommendations to help improve motor function
Studies on exercise interventions show exercise as being beneficial to Parkinson's sufferers in regards to physical functioning, quality of life, strength, balance and gait speed. These benefits are due to the promotion of cell growth and survival through the release of neurotrophic factors and greater cerebral oxygenation. Exercise stimulates dopamine syntheses (which Parkinson's sufferers lack in) which helps reduce symptoms such as tremors and rigidity.

Five Principles of exercise that enhance neuroplassticity in relation to Parkinson's Disease
1
 * 1) Intensive activity maximises synaptic plasticity1
 * 2) Complex activities promote greater structural adaptation1
 * 3) Activities that are rewarding increase dopamine levels and promote learning/relearning1
 * 4) Dopaminergic neurones are highly responsive to exercise and inactivity (use it or lose it principle)1
 * 5) Where exercise is introduced at an early stage of the disease progression of the disease can be slowed

Strength
Evidence suggests exercise proves a significant improvement in strength, in particular leg strength in Parkinson’s sufferers. Strength is improved through resistance exercises (with weight or resistance bands) or through the use of light weight activities. 1

Balance
Evidence suggests exercise proves a significant improvement in overall balance and core stability, through stretching and meditation exercises as well as light core work.1

Gait
A significant improvement in walking speed and a reduction in shuffling and dragging of the feet whilst walking through aerobic, flexibility and strength exercises.1