# Exercise as it relates to Disease/Exercise effects on Parkinson's Disease
## What is Parkinson's diease?

Parkinson’s disease is a degenerative disorder that affects the neural cells and makes body movements difficult. Typically, these cells produce a chemical known as dopamine. Dopamine allows for the smooth, coordinated movement of the body's muscles. Symptoms of Parkinson's disease will appear when roughly 70% of these neural cells are damaged.

## Symptoms

There are various symptoms that may occur, although different symptoms will appear for each individual. The main symptom that is identified with Parkinson’s is a tremor or shaking of the limbs, this usually starts in one hand and moves down to the legs. It is interesting to note that one third of Parkinson’s patients will not experience these tremors. Other symptoms include:
* Rigidity or stiffness of the muscles (will feel like the muscles, even when relaxed, are tight)
* Slowness in movement (results in a reduction of fine motor control and periods of immobilization)
* Pain in arms or legs
* Cognitive and memory problems
* Anxiety
* Depression
* Disturbed sleep
* Constipation

## How can exercise help?

Exercise in Parkinson’s patients, will stimulate the synthesis of dopamine in the non-damaged cells and therefore reduce the symptoms associated with the disease. It is suggested that there are five key points to enhance positive affects on Parkinson's symptoms:
* Intensive activity will maximize synaptic plasticity
* Complex exercises will enhance structural developments
* If the patient feels rewarded, dopamine will increase even more
* Dopaminergic cells are highly responsive to exercise
* Progression of the disease can be decreased (slower rates if caught and started earlier)

## Recommendations

The studies that have been conducted have shown many different exercise duration's and frequencies in their interventions. Typically research has found that exercise programs for people with Parkinson's disease span over 4–12 weeks. The type of exercise that works best for the patient depends on their symptoms, fitness level and overall health. Generally, exercises that promote the stretching of the limbs through the full range of motion are encouraged. Some tips that people with Parkinson's are encouraged to follow are:
* Warm-up before beginning exercise and cooling down at the end
* If for example, the person plans to workout for 30 minutes, they should start with 10-minute sessions and work their way up
* Exercise facial muscles, jaw, and voice when possible: Sing or read aloud, exaggerating the lip movements, make faces in the mirror, chew food vigorously etc.
* Water exercises such as swimming and aerobics are helpful as they are easier on the joints and require less balance
* The person should always exercise with a partner or supervisor

## Treatment

Parkinson's disease is incurable, however drug therapy can be used to reduce the progression of the disease and reduce the nature and severity of the symptoms.The drugs used will supplement or help with the production of more dopamine. Unfortunately, long term use of these drugs will cause side-effects that can affect the patient even more so than the disease itself.

## Further reading

Body and soul: Parkinson's disease
Parkinson's Australia
Neuroscience Australia: Parkinson's disease

## References

* VICTORIA A. GOODWIN, S. H. R., ROD S. TAYLOR, ADRIAN H. TAYLOR, AND JOHN L. CAMPBELL. 2008. The Effectiveness of Exercise Interventions for People with Parkinson’s Disease: A Systematic Review and Meta-Analysis. Movement Disorders, 23, 631-640.
* 2012. What is Parkinson's [Online]. Available: http://www.parkinsons.org.au/about-ps/whatps.html
* D. SUTOO, K. Akiyama. 2003. Regulation of brain function by exercise. Neurobiol Dis, 13, 1-14.
* FOX CM, R. L., CIUCCI MR, SAPIR S, MCFARLAND DH, FARLEY BG. 2006. The science and practice of LSVT/LOUD: neural plasticity- principled approach to treating individuals with Parkinson’s disease and other neurological disorders. Semin Speech Lang, 27, 283-299.
* CRIZZLE, A., NEWHOUSE, I 2006. Is Physical Exercise Beneficial for Persons with Parkinson’s Disease? Clin J Sport Med, 16, 422–425.
* ABC’s HEALTH & WELLBEING, 2011. Fact File: Parkinson's Disease [Online]. Available: http://www.abc.net.au/health/library/stories/2002/08/22/1830960.htm#c
* Safe Exercise and Parkinson’s Disease: Types, Intensity, Warming Up, and More. 2012. Safe Exercise and Parkinson’s Disease: Types, Intensity, Warming Up, and More. [ONLINE] Available at: http://www.webmd.com/parkinsons-disease/guide/parkinsons-exercise.