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From the pages of
Kate Lynch, Editor
Copyright 2004-PRESENT
The Activity Director's Office
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Regular physical activity improves the quality of life
of residents with Parkinson’s disease
(Reprinted from the March 2004 issue of ElderCare Activities Guide)
By Lorena Tonarelli
Activities Guide Research Reporter

At least 40% of people with Parkinson’s disease in the US look for alternative therapies in the hope of maintaining their
independence and improving their quality of life.  This is because most of the symptoms of Parkinson’s disease are
resistant to pharmacological treatments.

As research has widely shown, exercise relieves many of the disabling symptoms of Parkinson’s disease, like difficulties in
initiating and sustaining movements and maintaining balance, for example.  Since your main goal, as a committed activity
professional, is to provide all residents with activities that contribute to their well-being and autonomy, your programming
should also include activities that are specific to the treatment of residents with Parkinson’s disease.

A properly planned exercise program will provide parkinsonian residents with benefits like:
•        Better movement initiation and coordination.

•        Improved balance and decreased risk of falls.

•        Correct posture and proper breathing.

•        Increased efficacy of medications.

Before starting any exercise program with people suffering from Parkinson’s disease, consider that they are unable to
perform complex movements that are otherwise automatic for healthy people.  Try teaching them to break down complex
sequences of movements into smaller parts, which can be memorized and then rehearsed mentally so that the overall
movement becomes, in fact, a multi-stepped task.

With time, Parkinsonian residents will learn this skill and will be able to perform simple sequences of movements.  Here
are a few examples of exercises you can begin with, which are important to loosen the tightness of necks, arms, legs, and

•        Ask patients to lift their arms as far as possible and then slowly lower them back to their lap.

•        Encourage them to turn their head to the left, look over their left shoulder and turn head to the front.  Then, turn head to
the right and look over their right shoulder, and back to the front.

•        While residents are sitting on a chair, ask them to straighten their legs and move their feet in a large circle.

•        Again while sitting, keeping knees bent, patients swing their feet into the middle and then out to the side.

However, you will soon realize that, no matter how hard they try; parkinsonian residents cannot initiate any movement if you
do not provide them with some visual clue.  Putting white strips of tape on the floor provides that clue and gives a prompt to
initiate movements in the confined space of the room where the exercise program is taking place.  

Walking always represents an excellent way of improving fitness and general well-being.  Make sure that your residents
walk on a flat surface with no obstacles and encourage them to swing their arms.  Count to help them to keep the rhythm if
slowness becomes a problem.  Alternatively, make residents march lifting their knees as high as possible.

On the other hand, as researchers from Loyola University, Chicago, have found recently, Pole Striding - walking with
modified ski poles using a movement pattern similar to skiing - improves parkinsonian residents’ cognitive skills, motor
function and overall quality of life, But, you must keep in mind that this activity should include at least eight weekly sessions
in order to achieve significant results.

If you are going to organize cycling, bowls, gym or dancing sessions, as part of an aerobic exercise program, you need to
plan these activities for at least 16 weeks.  This, according to another study from the US’s University of West Florida, will
improve your residents’ ability to initiate and perform appropriate movements.

You may also want to develop an activity where music and physical exercise are combined together, which – according to
new studies - will benefit parkinsonian residents who struggle with one of the most debilitating symptoms of the disease:
muscle rigidity.  

Remember that you must take some important precautions when working with Parkinson’s patients.
•        Any complicating factors, like cardiovascular diseases must be checked before starting any exercise program.

•        Since residents suffering from Parkinson’s disease have a predisposition to fatigue, the best time to exercise is in the

•        Allow patients to rest at any time if they become tired because excessive physical activity results in the worsening of
tremor, the most characteristic sign of Parkinson’s disease.

•        Be sure that you know how to cope with freezing episodes, during which residents remain still for seconds and
sometimes minutes.  Taking a step back before starting to walk and rocking gently from side to side helps patients to
overcome freezing almost immediately and, if you can organize brief sessions of these rotations on a daily basis, you will
be able to observe a long-term effect characterized by a reduction of freezing episodes by approximately 50%.

•        Always supervise residents properly while exercising, and if they become dizzy, or faint, or have chest pain, stop the
activity immediately and call the doctor.                                                                                                                         

Overall, consider that you have a key role in encouraging motivation and will-power in your parkinsonian residents, who
continually struggle with feelings of isolation and apathy, and that exercise will become for them a daily routine that
contributes to a better quality of life trough enjoyment.
Article Sources:

Baatile J., Langbein W.E., Weaver F.,
Maloney C., Jost M.B. “Effect of
exercise on perceived quality of life of
individuals with Parkinson’s
disease”, Journal of Rehabil Res
Dev, 2000, Sept-Oct, Vol 37,
pp 529-34.

Garber C.E., Friedman J.H. “Effects of
fatigue on physical activity and
function in patients with Parkinson’s
disease,” Neurology, 2003, April, Vol
60, Issue 7, pp 119-24.

Pacchetti C., Mancini F., Aglieri R.,
Fundaro’ C., Martignoni E., Nappi G.
“Active music therapy in Parkinson’s
disease: an integrative method for
motor and emotional rehabilitation”,
Psychosom Med, 2000, May-June, Vol
62, Issue 3, pp 386-93.

University of Northumbria, Newcastle,
UK “Guidelines for physiotherapy
practice n Parkinson’s disease,”

VanVaerenbergh J., Vranken R., Baro
F. “The influence of rotational
exercises on freezing in Parkinson’s
disease,” Functional Neurology,
2003, January-February, Vol 18,
Issue 1, pp 11-16.

Bergen JL, Toole T., Elliot R.G.,
Wallace B., Robinson K., Maitland C.
G. “Aerobic exercise intervention
improves aerobic capacity and
movement initiation in Parkinson’s
disease patients”,
NeuroRehabilitation, 2002, Vol 17,
Issue 2, pp 161-8.
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