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Michigan Parkinson Foundation: Exercise for Parkinson’s Disease, Focusing on Intensity

Swingle is co-CEO, lead physical therapist and certified LSVT®BIG clinician of Livonia-based The Recovery Project.


For Parkinson’s patients, the benefits of moderate-to-high intensity exercise are increasingly well understood. The right exercise program can improve virtually all of the symptoms of Parkinson’s, boosting mobility, increasing fluidity of movement, and improving overall function. Patients who participate in a quality program, in conjunction with the right mix of medications, will frequently be able to walk and stand better, as well as dress and feed themselves more easily. Moderate and high intensity exercise can also improve overall cardio fitness. Exercise is neuro-protective, and the increased oxygen intake while exercising can improve cognitive function and slow the onset and progression of dementia we often see with PD.


The key—for patients and healthcare and therapeutic professionals alike—is to understand what “moderate- to-high intensity” means. Program participants should be working anywhere from 60 to 80 percent of maximal ability for both strength training and aerobic exercise. Patients who are exercising at the correct intensity will find themselves sweating and somewhat short of breath (and will typically only be able to say about eight syllables per breath)— it should feel like hard work. Strength and resistance train- ing should also be performed at a much higher intensity—in order to yield results, you need to place some stress on muscles. At the proper intensity, patients should not be able to do more than 12 repetitions of a strength exercise before reaching muscle fatigue.


Today, research indicates that exercises that involve coordi- nation and big (large amplitude) explosive movements and coordinated, rhythmic exercise are particularly beneficial. Boxing techniques and kayaking/rowing exercises—which integrate lots of quick, fluid, coordinated movements, and require sequencing and repetition to perform—show a great deal of promise in that regard. Consequently, it is important to integrate coordination and balancing activities alongside cardio and strength exercises when designing an exercise program for Parkinson’s patients.


Most programs and exercises can be modified to suit the needs and circumstances of individual patients. For example, more complex or challenging balancing activities can be made more accessible by allowing patients to use a cane, chair, or other external support. Typically, the exercise is modified until the patient is able to perform it quickly, safely, and with better balance. Although the exercises themselves can be performed in a community or fitness center, or even in the home, it is important to consult a therapist experienced in designing programs specifically for Parkinson’s patients to ensure that each program meets the needs and abilities of the patient.


Many patients, and even some therapists, might think that patients who are particularly frail or who are suffering from severe or advanced symptoms might not be able to work at the same intensity level. This is not the case. Exercising with sufficient intensity is not something a patient should “work up to”: every patient, no matter what kind of strength or conditioning, should aim work at 60-80 percent of their maximum output.


As important as intensity is, however, you don’t want to overdo it. At least 24 hours between exercise sessions is an essential part of allowing the body to recover and derive maximum benefit. As mentioned, you also want to be sure you are designing your exercise regimen with a trained professional to ensure you are learning how to safely perform and combine the right moves for you.


It is important to note that research emphasizes that exercise, no matter how beneficial, is not a cure for Parkinson’s or a replacement for medication. But as a critical therapeutic tool that should be used in conjunction with medication, exercise offers patients an exciting opportunity to substantially improve their overall quality of life.