You might assume that anyone who moves slowly, isn’t sure-footed and has hand or arm tremors should shy away from exercise. But when these symptoms are caused by Parkinson’s disease (PD), nothing could be further from the truth.

What you need to know about exercise if you or a loved one has PD…

Rx FOR HEART AND BRAIN

After Alzheimer’s disease, PD is the most common neurodegenerative disease in the US. It causes serious motor changes—such as rigid muscles, tremors and balance problems—along with non-motor symptoms such as fatigue, depression and constipation…and it almost always worsens over time.

Drug treatments, such as carbidopa-levodopa (Sinemet) and ropinirole (Requip), can ease some of the symptoms, but the effectiveness of medications tends to wane over time. That’s why researchers have looked for other treatments that can both improve symptoms and prevent the disease from worsening.

Aerobic workouts that tax the cardiovascular system appear to be the ticket. While weight training can improve balance and muscle strength (both important for PD), it doesn’t seem to confer the wide-ranging benefits that accrue from fast biking, treadmill training, challenging dance sessions or other cardiovascular workouts.

HARDER IS BETTER

Until recently, doctors routinely advised patients with PD, particularly those who weren’t regular exercisers, to take it slow and easy. It seemed unrealistic—and possibly unsafe—to encourage physically impaired patients to go all-out.

New thinking: An increasing body of evidence now shows that intense workouts are more effective for patients with PD than slow walks, easy bike rides and other light physical activity.

COMPLEX BEATS SIMPLE

Intense exercise is believed to offer such significant benefits because it increases blood flow to the brain. But additional research suggests that intensity is just part of the picture. Learning-based workouts—things that require close attention and involve frequent changes of direction, tempo, balance, etc.—are better than merely moving at a fast clip because they incorporate a cognitive component.

Physical therapists who specialize in PD also have developed workouts that draw from tai chi, kayaking, boxing, Pilates and other exercises that involve challenging combinations of movements. The workouts are more effective than repetitive types of exercise, such as straight-ahead walking or weight lifting.

A good example is a boxing-style workout known as Rock Steady Boxing. Designed for patients with PD, it emphasizes full-body movements that challenge gait, speed, hand-eye coordination and balance. During a session, participants (depending on their physical abilities/limitations) will do a myriad of boxing maneuvers, heel-walks, skipping, jumping rope, etc.

The workouts require participants to constantly monitor what their bodies are doing and to make adjustments—in balance, tempo, etc.—on the fly. A study in Physical Therapy, the journal of the American Physical Therapy Association, found that patients with PD who attended two to three boxing sessions a week for nine months had both short- and long-term improvements in balance and other physical parameters. They also reported having a better quality of life.

EXERCISE FOR LIFE

If you’ve been diagnosed with PD, your neurologist will probably refer you to a physical therapist. If he/she doesn’t, insist on it. Insurance usually covers a certain number of visits.

Most large cities will have dozens of therapist-led exercise programs for PD. (Search online for “Parkinson’s disease physical therapy centers” to find one near you. Or contact the American Parkinson Disease Association, 800-223-2732, APDAparkinson.org. Click on “APDA in your community” to locate your local chapter for resources, including exercise programs, in your area.) The key is to find something you like…that addresses all of the body’s systems affected by the disease…and that you think you’ll keep doing. My advice…

• Start at your level. Avoid overdoing it when you first start working out—but don’t stay at a beginner level any longer than you have to. If you’re new to exercise and/or have advanced symptoms, you might start out by, say, holding weighted poles while sitting and performing kayaking movements or doing slow Nordic walking (using walking poles). However, don’t waste too much time on “baby steps.” Push yourself to the next level as soon as you can.

• Go for intensity. As discussed earlier, intense workouts are more effective than easygoing exercises. An intense workout is one that increases your heart rate to 70% to 85% of your maximum capacity. If you don’t use a heart-rate monitor, you can gauge intensity by how you feel—your breathing will be rapid…you’ll be sweating within a few minutes…and you’ll only be able to speak a few words.

• Keep it interesting. You want a program that not only challenges your body but also forces you to master (and memorize) complex routines and movements.

Examples: Forward and backward walking on a treadmill…tai chi…dance movements with frequent changes of tempo and direction…and boxing-style workouts.

• Make a commitment. While patients with PD can work out on their own, many enjoy the dynamics of a group exercise program, which also helps them to push themselves harder. The key is to find a high-intensity workout that fits one’s lifestyle and allows for a long-term commitment to enhance well-being and functional ability.