Large-Movement Exercise Helpful for People with Parkinson’s & Other Neurological Disorders

Bigger is better… yes, it’s a cliché, but for people with Parkinson’s disease, it’s a valuable one. In a recent study of Parkinson’s patients, every participant improved by doing exercise that involved big movements.

The research had roots in another therapeutic program for people with Parkinson’s, called the Lee Silverman Voice Treatment, in which patients are urged to constantly think “loud” to counteract losing voice volume. Study leader Air Force Major Maria Alvarez, MD, and her colleagues at Wilford Hall Medical Center at the Lackland Air Force Base in San Antonio built on that concept, applying it to movement and muscle power to encourage patients to “think big” about exercise, since their movements tend to diminish as the disease progresses. The study, called ThinkBIG, included 20 randomly selected Parkinson’s patients (mean age 71) who were examined at the start and again at the end, 12 weeks later. There were no medication changes for any of the participants, and each engaged in three 45-minute exercise sessions each week.

For the first eight weeks, participants engaged in “large range” movements, such as taking giant steps while swinging their arms vigorously. Then, once they had met the initial goal to improve range of motion and balance, they spent the last four weeks using the Nintendo Wii yoga and bowling systems, both of which involve arm swings and forceful movements. The program proved helpful in improving the typical ambulation of Parkinson’s patients — shuffling gait, arms hanging at their sides. After 12 weeks, participants showed an average improvement of 58% in muscular function and coordination and they walked more normally. These results suggest that the exercises not only are beneficial in relieving Parkinson’s symptoms but may even slow or reverse progression of the disease, said Dr. Alvarez.

Why Do Big Exercises Work?

Dr. Alvarez attributes the program’s success to several factors. First, earlier studies had already demonstrated that exercise produces brain chemicals that protect against the disease’s signature destruction of dopamine cells. This particular form of large-movement exercise is fun, so participants enjoyed being involved and were happy to participate — they even organized their own Nintendo Wii bowling tournament! Also, Dr. Alvarez told me that she believes that focusing on one goal — “big” — is achievable for people with neurological disorders, who often have trouble practicing and repeating complex tasks. Dr. Alvarez believes that the ThinkBIG approach would benefit patients with other neurodegenerative conditions, such as multiple sclerosis, brain injury and stroke.

If you are interested in trying this, the first step should always be to seek an evaluation by a physical therapist who can advise you on what large-movement exercises you can safely do at home. (For instance, the Nintendo Wii system uses an elevated platform that can pose a falling risk.) Where most healthy adults are urged to engage in at least 2.5 hours of exercise each week, Dr. Alvarez suggests that people with Parkinson’s should do more — aiming for 30 minutes of exercise at least six days a week. If that seems overwhelming, you can try breaking it into increments of five or 10 minutes over the day.

The important thing, Dr. Alvarez said, is to keep moving — becoming sedentary makes matters much worse, exacerbating such symptoms as shaking and muscular contraction and also making it harder to move around. It’s another cliché, but people with Parkinson’s must remember that “if you don’t use it, you’ll lose it.”