# Exercise as it relates to Disease/the effects/benefits of Physical Therapy on the symptoms of Parkinson's Disease
### What is Parkinson's Disease?

Parkinson's disease (PD) is a neurodegenerative disease causing the death of brain cells in parts of the substantia nigra which produces dopamine. Dopamine is a chemical that is responsible communicating between the substantia nigra and other parts of the brain to control movement, it helps have smooth, fluid and coordinated movements. Once the brain is no longer able to produce enough dopamine, this is when the motor symptoms of PD begin to appear. This can begin to effect the quality of life that the individual can experience due to the influence PD can have on their ability to perform everyday tasks as PD progresses.

### Symptoms

Some signs and symptoms may include
* Tremor - which often starts in a limb, often the fingers and hand.
* Slowed movement - overtime and the progression of PD can cause the individual to slow
* Impaired Posture - beginning to hunch over and not stand as straight as you used to
* Speech Changes - Like having a low of softer voice than you once did
* Writing Changes - writing can become small and difficult to do

## Physical Therapy and Parkinsons Disease

There have been many studies looking at various exercise interventions and their effects on those with PD whether it be in a strength, aerobic, Mobility/flexibility or even a focus on walking gait. As at this time PD can not be cured the studies look to see which intervention could improve the ability of those living with PD. The different intervention show improvement in their main areas of focus, such as participants showed an improvement in strength if strength was the main area and so on for each of them. It is looking as if there is positivity in physical therapy intervention for individuals with PD. Whilst not a lot look at the effect it has on the quality of living for those that they have studied, the improvement shown in their ability to get around could be seen as a improvement in quality of life as a mean of getting around the house is made easier.

## Recommendations

Of the different interventions made across the different studies, the main recommendation would have to be a focus on aerobic exercise as it also showed they had an improvement in their walking gait as well as a improved ability to get around easier. But it wouldn't hurt to add strength and flexibility components as an overall regime would be best. But there still needs to be a study with a greater focus on the impact that these interventions have on the quality of life of the individual.

## Further reading

* National Parkinsons Foundation, http://www.parkinson.org
* National Institute of Neurological Disorders and Stroke, http://www.ninds.nih.gov/disorders/parkinsons_disease/parkinsons_disease.htm
* The Michael Stern Parkinson Research Foundation, http://www.parkinsoninfo.org/
* American Parkinson Disease Association, http://www.apdaparkinson.org/

## References

1. Van nimwegen M, Speelman AD, Overeem S, et al. Promotion of physical activity and fitness in sedentary patients with Parkinson’s disease: randomised controlled trial. BMJ. 2013;346:f576.
2. Schenkman M, Hall DA, Barón AE, Schwartz RS, Mettler P, Kohrt WM. Exercise for people in early- or mid-stage Parkinson disease: a 16-month randomized controlled trial. Phys Ther. 2012;92(11):1395-410
3. Shulman LM, Katzel LI, Ivey FM, et al. Randomized clinical trial of 3 types of physical exercise for patients with Parkinson disease. JAMA Neurol. 2013;70(2):183-90
4. Fisher BE, Wu AD, Salem GJ, et al. The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson’s disease. Arch Phys Med Rehabil. 2008;89(7):1221-9.
5. Mehrholz J, Friis R, Kugler J, Twork S, Storch A, Pohl M. Treadmill training for patients with Parkinson’s disease. Cochrane Database Syst Rev. 2010;(1):CD007830.
6. Herman T, Giladi N, Hausdorff JM. Treadmill training for the treatment of gait disturbances in people with Parkinson’s disease: a mini-review. J Neural Transm. 2009;116(3):307-18.
7. Van der kolk NM, King LA. Effects of exercise on mobility in people with Parkinson’s disease. Mov Disord. 2013;28(11):1587-96
8. Allen NE, Sherrington C, Suriyarachchi GD, Paul SS, Song J, Canning CG. Exercise and motor training in people with Parkinson’s disease: a systematic review of participant characteristics, intervention delivery, retention rates, adherence, and adverse events in clinical trials. Parkinsons Dis. 2012;2012:854328