The Importance of Exercise and Understanding and Building the Most Effective Program for you

Often people tell me they know exercise is important but do not know what exercises they should be doing. Others tell me they know it is important but do not have the motivation to exercise.  
Exercise should change what you are able to do each day.

Key: Make a Plan That Fits Your Goals

Having more energy to do the things that are meaningful to you should be a part of your goal setting. This will increase your motivation to exercise and may also result in changes such as a faster walking speed and increased safety on stairs. Individual goals such as hiking, traveling and/or a better golf game will be enhanced by consistent exercise.


You may have read or heard certain types of exercise such as Tai Chi, yoga, tango, cycling or boxing are beneficial for people with Parkinson’s disease.  Research shows they are beneficial  but for various reasons.  Interest and benefit depend on what you need to improve to reach your personal goal. For example:
  • Skiing: if you want to improve your turning while skiing, then you may need to find an exercise that incorporates weight shifting, such as, Tai Chi or dance
  • Walking: If you want to improve your walking, tango is one style of dance most similar to walking. It challenges the balance systems with stepping in multiple directions, turning, and being aware of your partner’s movements and other dancers on the dance floor. It also improves postural awareness and coordination.
  • Mobility: If you want to be loose and stiffness limits your mobility, yoga and/or Tai Chi may benefit you with stretching and reciprocal movements. They both may also improve your posture and balance with various positions and weight shifting.
  • Aerobic: If you want to improve your aerobic capacity, boxing and/or cycling could help you. Boxing can also help with your speed of movement, reaction time and balance.
The secret is to find ones that you enjoy! There are so many ways to exercise. Finding something you enjoy will automatically increase regular performance.  You will not reap the benefits of exercise if you are not enjoying it and thus avoid doing it.  You can also modify almost any exercise so you can continue what you like to do. The fun of dancing, cycling or boxing may surprise you and become your new passion.

Getting Started

  • High-intensity endurance training can help decrease the progression of the disease and improve cognition.  In the Sparx trial, over a 6-month period, patients who were assigned to the high-intensity (80-85% max heart rate) treadmill exercise group had lower mean changes in their Unified Parkinson’s Disease Rating Scale motor score, signifying less progression of motor symptoms as compared to the moderate-intensity (80-85% max heart rate) and no-exercise control group. You can dose your exercise prescription similar to medicine; the higher the intensity the greater the benefits.
  • It is beneficial to stretch every day especially if you experience bradykinesia (slowing of movement) and rigidity (stiffness).  This may help you feel loose and ease movement.  Forward flexed posture associated with Parkinson’s disease decreases the flexibility of the muscles on the anterior (front) side of the body including areas of the chest, shoulders, neck and hips.  Stretches that focus on opening of the chest, neck, back and hips will promote correction of the forward flexed posture. After stretching, try to use that movement in function to maintain your range of motion.
  • It is important to work on your posture, as greater flexed truncal posture was associated with poorer performance on balance, mobility tasks and risk for falls.
  • Improving the strength of your back muscles will help keep you upright for a longer period. Since the anterior (front) body muscles decrease in flexibility, the opposing back muscles are unable to perform their jobs maintaining a straight back and tend to become overstretched which can lead to weakness.

  • Trunk, hip and ankle/foot strength all have been identified as a key parameters related to fall-risk.
  • Including unstable surfaces within a training regime seems to have functional advantages over traditional stable resistance training.
  • Make sure you use cues or attend to your technique.  Cues are prompts that give information on when and how an action should be carried out. In relation to walking this information can be about the timing of movement or the size of movements. With PD you may not fully complete your movements.  The smaller motion limits strengthening the muscles to their full capacity and full range of motion.  You may also use one side more than the other and may need to work the less used side harder to make the movements equal.
  • Use of auditory cues using music or metronome combined with visual cues will immediately enhance the size and timing of your movement and therefore maximize your overall performance.
  • Add a cognitive dual task exercise to your routine to improve motor performance.
  • Always remember to consult your MD prior to starting any new program and a physical therapist can help provide a comprehensive evaluation, assessment and exercise plan to help you reach your goals.  Consultation with someone with the knowledge of the options is time well spent.
  • Join a class, meet new friends, and get expert advice on your program.

Music and Metronomes

There is also extensive research on the benefits of music and movement.  So, put on your favorite tunes while exercising to help motivate and get you moving!  One of the main movement problems due to basal ganglia disorder is the failure to automatically maintain an appropriate amplitude and timing of sequential movements.  Cueing tackles this problem.  The use of auditory cues using music, a metronome or feedback such as the auditory footpads from our Balance Matters system, along with visual cues will immediately enhance the size and timing of your movement and therefore maximize your overall performance.  Cueing from a therapist, trainer or external cues and feedback will help you improve your quality of movement in both speed and size of movement.

The Test

Start assessing if your exercise program helps you reach your goals. 
Does it improve your posture, flexibility, strength, movement speed, walking, balance, and/or coordination?  Or do you need a combination of different types of exercises to reach your goals?

What Neuroscience Tells Us

You may already be aware of the benefits of exercise to improve your heart, strength, endurance and mood but are you aware of the benefits it can make on the brain and your everyday function and quality of life?  Exciting neuroscience research is showing the benefits of exercise that can delay degeneration, reorganize your brain map, and recover some of your lost function.
The neuroprotective effect preserves nerve cells that are at risk for damage by slowing degeneration. If there is damage in one area of the brain, neuroplasticity drives rewiring of pathways; increases use of other parts of the brain; and makes new connections to improve function.  The neurotransmitter dopamine becomes more efficient by modifying the areas of the brain where the dopamine signals are received. High intensive aerobic exercise shows the most promise of neuroprotection.  Higher intensity, higher duration and task specific paradigms that are continually challenging and complex may be required to accomplish the changes in the brain.

Write it down. 

Goals work if you write them Down.

So, start now with three.

My goals are:

  1. ----------------------------------

  2. ----------------------------------

  3. ----------------------------------


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