Parkinson's Disease (PD) is a chronic, degenerative, neurologic disease. Meaning that the disease will increase in severity over time due to the degeneration of the nervous system and is not reversible. It is classed as a neurodegenerative disorder.
PD most often occurs to people over the age of 50 and is one of the most common nervous system disorders of the elderly. It is most common in those in their 60’s, with a 2-4% risk of developing PD around this age. Other neurodegenerative disorders include Alzheimer’s disease, Huntington’s disease, and amyotrophic lateral sclerosis, or Lou Gehrig’s disease.
This article will look at PD as a condition and the exercise benefits and considerations.
What are the signs and symptoms of PD?
One of the earliest signs of the onset of Parkinson’s disease is a person losing some or all of their sense of smell. In some cases anosmia can occur many years before a person develops PD.
Once a person develops PD the symptom most often associated with PD are the affected motor symptoms. However PD is a very individual condition and each person with the condition can experience very different symptoms. Some of these symptoms include pain and mental health problems, classified as non-motor symptoms.
Below is a list of the common motor and non-motor symptoms that a person with PD can experience. These symptoms will vary from person to person.
- Tremor (shaking/dyskinesia)
- Slowness of movement (hypokinesia/bradykinesia)
- Rigidity (stiffness)
- Akinesia (lack of movement or loss of spontaneous movement)
Non motor symptoms:-
- Bladder and bowel problems
- Eye problems
- Falls and dizziness
- Restless legs syndrome
- Skin, scalp and sweating problems
- Sleep problems
- Speech and communication problems
- Swallowing problems
- Parkinson's Anxiety Dementia Depression
- Hallucinations and delusions
- Memory problems
Someone with PD who has these motor symptoms is said to have Parkinsonism.
What is the pathology of PD?
PD is caused by a slow deterioration and death of the nerve cells in the pars compacta region of the substantia nigra area of the brain. These nerve cells create dopamine. Dopamine is a natural substance found in the brain that helps control muscle movement throughout the body. Therefore as the nerve cells die, dopamine levels reduce and muscle movement is affected.
As dopamine levels reduce, those with PD will show signs of hypokinesia (slowed/decreased movement) and akinesia (lack of movement). Medications used to treat PD can produce excessive dopamine activity, which can allow the affected motor systems to be activated when not required and thereby produce uncontrollable, involuntary movements such as tremors and shaking (dyskinesia).
What causes PD?
Despite the research, PD is still considered idiopathic. However it has been suggested that the cause is largely to do with environmental factors (illness, toxins), with a small percentage of cases linking to genetic factors. Ageing is also seen as an important risk factor.
As with the severity and speed of degeneration the causes of the condition may also vary from person to person.
The vast majority of PD cases are not directly inherited, with around only 15 to 25 percent of people with PD having a relative with the disease. Research suggests that if a person’s parent has PD, his or her chances of developing the disease are slightly higher than the risk among the general population.
Because genetic forms of a disease can be studied in great detail by scientists, and because understanding the rare genetic forms of PD may help us to understand more common forms of the disease, genetics is currently the subject of intense research.
It has been suggested that PD may result from exposure to an environmental toxin or injury. Epidemiological research has identified several factors that may be linked to PD, including living in rural areas, well water, manganese and pesticides.
Some studies have demonstrated that prolonged occupational exposure to certain chemicals is associated with an elevated risk of PD. To add to this there is a known synthetic neurotoxin agent which research shows can cause immediate and permanent Parkinsonism.
Research does highlight that simple exposure to an environmental toxin is never enough to cause PD. Most people exposed to a toxin never develop the disease. There is still no conclusive evidence that any environmental factor, alone, can be considered a cause of the disease. However, as environmental factors have been helpful in studying laboratory models of PD, scientists continue to use the gathered evidence to help understand why PD occurs.
The environmental (chemical) or genetic trigger that starts the cell death process in dopamine neurons is the subject of large scientific study. It is believed that by understanding the sequence of events that leads to the loss of dopamine cells, scientists will be able to develop treatments to stop or even reverse the disease
Why is the condition called Parkinson’s Disease?
PD is named after the English physician James Parkinson (1755-1824). James first described the condition as ‘paralysis agitans’. The condition was later renamed by Jean-Martin Charcot.
What is the recommended exercise prescription for a client with PD?
It is recommended that PD sufferers are initially prescribed exercise that appeals to them, as they are more likely to adhere to it early on. In addition to this, exercise which promotes social interaction and can fit into to their lifestyle is also recommended for those with PD.
Example activities include:-
- Use of the Nintendo Wii or similar
- Walking groups
- Dance classes
- Non-contact boxing
The FITT principle for PD
I – 60-75%MHR
T – 30 minutes
T – walking, rowing, swimming
F – 2-3
I – 8-12 reps
T – 1 set
T – major muscle groups, postural muscles
F – 1-3
I – Mild discomfort
T - 30 seconds during cool down
Whatever activity/exercise is prescribed, PD sufferers should be encouraged to start exercising as soon as they can as this will help build and maintain connections in the brain
Which medications are prescribed or offered OTC for a person with PD?
There are a number of medications and supplements available to treat the symptoms of PD, although none reverse the effects of the disease
Development in the late 1960s, Levadopa is a Dopamine replacement remains the most effective drug for treating PD.. On its own Levodopa produces nausea and vomiting. Therefore in recent years Carbidopa is also taken to prevent this side effect and allow more Levadopa to get to the brain.
Unfortunately, with increased dosage and prolonged use of levodopa (as the condition progresses), those with PD experience other side effects including dyskinesia and freezing as well as the “on-off effect" when the medication will suddenly and unpredictably start or stop working.
Coenzyme Q10 (CoQ10)
Believed to play an important role in mitochondria health and some scientists think that abnormalities of mitochondrial function may play a role in PD.
Vitamin E, Vitamin C and health foods
Vitamin E can fight damage in the brain caused by free radicals, and has been suggested to lower the risk of PD. However, research has failed to find any evidence that Vitamin E slows the progression of Parkinson's or manages symptoms. Since Vitamin E has very few side effects, many PD patients continue to take it in high doses. Health foods, such as fermented papaya and blueberries, are also being researched to determine their role in slowing nerve cell death. Scientists are optimistic about the research but do not have enough conclusive data to recommend these supplements to treat Parkinson's disease.
It increases levels of phosphocreatine (an energy source in muscle and the brain). Research is being carried out on the product as a supplement for PD sufferers, but the appropriate dosing is unclear, as are the most effective method of administration, side effects and long-term dosing risks.
What are the benefits of exercise for a client with PD?
- Offers routine
- Research supports that exercise can be neuro-protective and reverse some symptoms of PD by helping protect the dopamine producing nerve cells
- Provides a sense of achievement
- It helps increase muscular strength
- It strengthens bones and improves bone health
- It increases joint mobility
- It can improve your balance, walking and posture
- It can provide you with an improved quality of life
- Aerobic activity may help improve mental function and memory
- Aerobic activities like biking, walking, using a treadmill or rowing machine can help improve your cardio-respiratory (heart and lung) fitness
- Reduces fatigue
- Exercise increases self-confidence and sense of accomplishment
- Stretching can help decrease stiffness in joints
- Promotes independence
- Improves balance and reduces the risks of falls
What are the exercise considerations when prescribing exercise for a client with PD?
- Always get consent and clearance from your GP to ensure you are able to exercise prior to starting a program
- Exercise when you are feeling your best
- Try to do your exercises with someone. This will help to motivate you and is a safe way to exercise
- Know when you are tired and learn to pace yourself
- Do activities and exercises that interest you
- Be aware of medication cycle (on/off effect)
- Monitor freezing episodes and avoid certain activities if it is occurring regularly
- Focus on functional activities to promote independence
- Ensure activities only require short, simple instructions
- Ensure exercise space is free of trip/fall hazards
- Ensure manual handling of equipment is correct
- Drink plenty of water and monitor swallowing ability