# Exercise as it relates to Disease/Exercise to improve mobility in Parkinson's disease
## Background Information: What is Parkinson's Disease?

Parkinson’s Disease is a degenerative disorder which affects the brain. It occurs due to the death of cells which produce a type of hormone known as dopamine: the cause of this cell death remains unknown. Dopamine is associated with transmission of signals for voluntary movement, motivation, sleep, mood and attention. In some cases Parkinson’s disease is accompanied by dementia.
Symptoms of Parkinson’s Disease include:
* Diminished facial expression
* Stooped posture
* Slowness of voluntary movement
* Accelerated steps and shortening step length
* Tremor (known as a pill rolling tremor)
* Some mental impairment
* Poor balance
There are forms of Parkinson’s Disease which are genetic; however this only makes up a limited number of cases. In the majority of Parkinson’s patients the cause is unknown with no genetic component. Exercise is known to greatly benefit individuals with Parkinson’s Disease. One of the most important benefits of exercise for Parkinson’s Disease patients is increased mobility and this is seen through an increase in patients step length, increase leg strength and improved posture, significantly improving several symptoms of the disease. Mobility is a major issue for people suffering from Parkinson’s Disease and as the research shows it is important for people to undertake regular exercise maintain or improve mobility. As Parkinson’s Disease affects the area of the brain which is associated motivation it can be difficult for individuals suffering from the disease to motivate themselves to exercise however the benefits of exercise are clear.

## Recommendations for Exercise

Patients that are suffering from Parkinson's Disease can follow standard exercise guidelines when exercising and should try to include the following types of training;
* Aerobic exercise, such as treadmill training, swimming or cycling, for a minimum of 20 minutes at least 3 days per week
* Strengthening/weight-bearing or resistance training exercises to help maintain muscle strength should be performed 2- 3 times per week
* Balance and flexibility exercises such as stretching to assist in mobility can be performed daily
The hardest part with starting to exercise is being consistent and not losing motivation so try the following out to see what works best for you;
* Start simple and gradually build up, if your not sure where to start contact your Dr/Physical Therapist for guidance
* Make it fun, ensure that the exercise you are completing is something you enjoy e.g dancing, aerobics, walking
* Set yourself goals that you want to achieve e.g. climbing the stairs with out any help
* Work within your own limitations, find a level of exercise that is challenging but not 'too hard'
* Mix things up, try doing a little bit each day and add a touch of variety
* Exercise with a friend or participate in community exercise classes
At any stage if you are unsure what is safe/appropriate for you to be participating in please ensure that you seek professional advice.

## Further reading

* National Parkinson Foundation. Parkinson's Disease: Fitness Counts
* Parkinson's Disease Foundation. Physical Therapy in Parkinson's Disease: What you need to know

## Useful Links

* Parkinson's Australia
* World Parkinson's Disease Association.Org
* American Parkinson Disease Association Inc.

## References

* 1 2 3 4 Kuman, V., Abbas, A.K., Fausto, N. & Aster, J.C., 2010, Robbins and Cotran Pathologic Basis of Disease, 8th Eddition, Elsevier, United States.
* 1 2 Allen, N.E., Sherrington, C., Paul, S.S. & Canning, C.G., 2011, “Balance and Falls in Parkinson’s
* 1 2 Goodwin, V.A., Richards, S.H, Taylor, R.S., Taylor A.H. & Campbell, J.L., 2008, “The Effectiveness of Exercise Interventions for People with Parkinson’s Disease: A Systematic Review and Meta-Analysis”, Movement Disorders, vol. 23, no.5, pp. 631 – 640.
* 1 2 Morris, M.E., Iansek, R., Matyas, T.A. & Summers, J.J., 1994, “Ability to modulate walking cadence remains intact in Parkinson's disease”, Journal of Neurology, Neurosurgery and Psychiatry, vol. 57, pp. 1532 – 1534.
* 1 2 3 Speelman, A.D., van de Warrenburg, B.P., van Nimwegen, M., Petzinger, G.M., Munneke, M. & Bloem, R.B., 2011, “How might physical activity benefit patients with Parkinson disease?”, Nature – Advanced Online Publication, pp. 1- 7.
* ↑ Fitness and Flexibility: The Role of Exercise in PD Managment. National Parkinson Foundation. Retrieved from www.parkinson.org
* ↑ Cianci, H. Parkinson's Disease: Fitness Counts. National Parkinson Foundation. Retrieved from www.parkinson.org