Parkinson’s Disease

What is Parkinson’s disease?

PD affects one person in every 500 which is about 127,000 people in the UK. Most who have it are over 50 but it can affect younger people, famously Michael J Fox who was diagnosed at the age of 30.

Each person with PD has different symptoms but the main ones are:

Tremor– uncontrolled shaking, usually the hand or arm and more likely at rest

Bradykinesisa- slowness of movement. This can make everyday tasks difficult

Shuffling- slow walk with small steps

Muscle stiffness- stiffness and tension in muscles making movement difficult and the possibility of painful cramps

Mask-like expression- Muscle stiffness makes smiling difficult.

Balance problems- making falls more likely.

If you have any of these symptoms, don’t panic! Speak to your GP. Diagnosis is not made by a blood test; you will need to see a specialist to confirm if it is PD.

What causes it?

It really isn’t fully understood. PD occurs when there is a loss of nerve cells in the brain. It isn’t until 70% of these nerve cells have been lost that symptoms show. It’s not known why they die.

The nerve cells are responsible for producing a chemical called Dopamine. This allows messages to be sent to parts of the brain that coordinate movement. Lack of dopamine results in PD symptoms. Dopamine levels then continue to fall slowly over many years causing more symptoms to develop.

Treatment

Drugs-The main treatment is through drugs. The medication increases the levels of dopamine to relieve symptoms. There are lots of different drugs available and they are improving all the time.

Surgery- This option is suitable for some but not all PD patients

The future

The clever scientists out there are developing drugs which mimic dopamine and prevent the remaining nerve cells from being damaged.

Exercise – the way forward!

Over the years I have met several people with PD who have come through the GP referral scheme. I have witnessed a fantastic improvement in their quality of life through taking their medication and being  physical activite. This is the great part of an Exercise Referral’s job; when you see first-hand how medical conditions can be improved or at the very least the progression slowed down.

One man was referred to me with PD in his early 40’s.  He had a very bad tremor in both hands which he kept tucked into his trouser pockets so that people didn’t notice his tremor. We worked on a programme of strength and balance, posture and CV. He found that after exercising his tremors were reduced for hours afterwards. This in its self was giving his confidence such a boost and the improvement in his mood was really noticeable. He has since moved away from the area but he promised me he would keep up his exercise routines.

Another man was referred who had no tremor but had trouble with muscle stiffness and a fixed expression on his face making him look very serious, even miserable. He has told me how the exercise has helped his balance problems, helped with muscle cramps and has improved his already perfect body by losing weight! His facial expressions belied his very dry sense of humour!

How does it help?

Research on animals has shown that physical activity seems to protect dopamine producing cells that are lost due to PD helping them to work better and survive for longer. This has the potential to slow down the progression of PD which is something that current treatment can’t so.

Studies have also shown that moderate/high levels of physical activity lower the risk of developing PD. Being physically active can delay the onset of symptoms in patients who already have been diagnosed with PD.

PD patients who regularly exercise compared with those who are only medicated or who have had surgery have increased benefits of functional performance and a lower risk of developing other health problems associated with being inactive.

Exercise programmes should be designed to incorporate the following;

• Aim to exercise 3-5 times a week, 30-60 minutes
• Cardio-vascular exercise- swimming, walking, rowing, cycling.
• Maintain and improve good posture and balance to decrease the risk of falls
• Maintain and improve trunk mobility by rotation and extension. Roman twists on an exercise ball are ideal
• Maintain and improve neck mobility especially rotation
• Encourage walking through the whole foot, heel strike first to toe
• Increase thoracic mobility with deep breathing exercises and using ‘breathing muscles’ on the lat pull down and fly machine for example in the gym
• Avoid a kyphotic posture (rounded upper back) seated row exercise to shorten upper back muscles and keep the shoulders back
• Agility exercises
• Make sure the limbs are being taken through their full range of movement
• Functional movements; squat – sit to stand, Lunge – walking, twist- rotation Push and pull
• If you would like to exercise but don’t know what to do, contact your nearest leisure centre and see if they have an Exercise Referral scheme.
• PD patients tell me that when they are diagnosed their initial reaction is game over. I’m really happy to say that this hasn’t been the case with the people I have met. Everyone is different with PD, symptoms vary considerably but, keeping physically fit is suitable for all from chair based exercise to a more challenging level of activity.

If you would like to exercise but you’re not sure what you can do, contact your local leisure centre and see if they have an Exercise Referral scheme.

For more information visit www.parkinsons.org.uk

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