I honestly could talk for days about my good and not so good experiences with treating individuals with Parkinson’s disease (PD). Parkinson’s is complex and although it has its’ specific signs each individual presents sightly different when factoring in co-morbidities. So what exactly is Parkinson’s?
Parkinson’s disease (PD) is a progressive neurodegenerative disorder that affects 60,000 Americans each year and 10 million individuals worldwide. (1) Men are also 1.5 times more likely to have PD than women. (1) PD directly affects the dopamine-producing brain cells in the substantia nigra resulting in dysfunction of movement and difficultly with procedural motor learning, including acquiring and retaining automaticity. The classic motor symptoms of PD are resting tremor (pill-rolling movement of upper extremity or shaking of lower extremity), bradykinesia (slowness of movement), rigidity (involuntary increase in muscle tone to passive range of motion), and postural instability (balance dysfunction, which leads to falls). Parkinson’s begins on one side of the body and eventually progresses to the other side.
However, the GREAT news is that there is mounting research that shows regular physical exercise to be highly beneficial for individuals with PD. Exercise plays an integral role in the overall management of PD because it ultimately helps improve mobility and prolongs functional independence by slowing down, halting, or reversing the progression of PD. One study compared group, individual, and home exercise for individuals with PD and found that individual exercise yields the most improvement in functional mobility via Physical Performance Test (PPT). (3) Bottom line is that individuals with Parkinson’s NEED continuous monitoring and intervention over the course of their disease.
Individuals with PD are unable to use their own internal feedback to recognize and regulate the size and speed of their movement, or the volume or speed of their voice due to the motor/sensory disconnect associated with the disorder. Pilates is specifically a “MIND-BODY” method of exercise that integrates both the musculoskeletal system and nervous system with varying external feedback (verbal, tactile, and visual cues) from an instructor, which is KEY for optimal functional outcomes when working with an individual with Parkinson’s.
Here are three Pilates exercises that help fight multiple impairments associated with Parkinson’s disease: (listed below are targeted goals of each exercise directly addressing impairments)
1. Jump Board: Alternating Push-Off (top video)
- weight shifting
- inter-limb coordination
- plyometric push-off
- hip extensor strengthening with eccentric training of quadriceps
- addition of dual task: counting up/down by certain number
2. Stomach Massage Series: Hands Back (no video)
- opens front of chest
- elbow extension, wrist extension with open hands
- sitting posture/axial elongation
- knee extension/quad strength
- dynamic calf stretching/strengthening
3. Scooter with bi-lateral arm support OR uni-lateral with opposite arm reach (bottom video)
- dynamic single limb stance
- inter-limb coordination of upper and low extremities
- hip extensor strengthening
- core stability in functional position
- *Research found Pilates to be an effective intervention to improve functional balance and decrease fall risk, especially with individuals with postural control impairments. (2)
Personal experience: During a Pilates session with a client who has PD I had to provide varying min-max assist with sit to/from supine transfers getting on/off Reformer, sit to/from stand transfers getting on/off Reformer, and with certain exercises such as the arm series providing assistance at his legs (specifically heels with legs in “table-top” position) due to poor core strength and endurance. “Blair is encouraging and accommodating with people of all levels of ability. She is patient and explains things clearly. Great pilates experience!” - Client with PD.
Word of advice: Be creative, but safe! Understand that an individual with PD may need assistance with transitioning on and off the apparatus aka transfer training in physical therapy. Remember that with PD the ability to move is not lost, there is an activation problem. Therefore be respectful and allow them ample time to perform transitions/transfers with as little assistance as possible, unless it is unsafe. Who knew that there was so much transfer training in Pilates? As a physical therapist this makes me very happy because transfer training is essential when working with individuals with Parkinson’s.
Yes, Pilates can help fight Parkinson’s! However, individuals with Parkinson’s should receive medical clearance from their doctor or physical therapist before engaging in Pilates at a studio. For additional information on Parkinson’s disease check out www.parkinson.org. And people with Parkinson’s… make exercise a DAILY part of your life, continue fighting, and never give up!
References:
(2018). Parkinson’s Foundation. Retrieved from http://www.parkinson.org.
Daneshmandi H, Sayyar S, Bakhshayesh B. The Effect of a Selective Pilates Program on Functional Balance and Falling Risk in Patients with Parkinson’s Disease, Zahedan J Res Med Sci. 2017 ; 19(4):e7886. doi: 10.5812/zjrms.7886.
LA King, J Wilhelm, Y Chen, R Blehm, J Nutt, Z Chen, A Serdar, FB Horak. Does Group, Individual or Home Exercise Best Improve Mobility for People with Parkinson’s Disease? J Neurol Phys Ther. Author manuscript; available in PMC 2016 Oct 1. Published in final edited form as: J Neurol Phys Ther. 2015 Oct; 39(4): 204–212. doi: 10.1097/NPT.0000000000000101.
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With Love, Scrubs, and Sidekicks,
