# Mobility and Postural Effects of Exercise in Parkinson's Disease Suffers
## What is Parkinson's Disease?

Parkinson's Disease (PD) is a progressively degenerative neurological disorder that affects control of body movement. Parkinson’s is caused by progressive degeneration of nerve cells in part of the middle of the brain known as substantia nigra. This causes a reduction in levels of the chemical transmitter dopamine, which is used for smooth controlled movements.

## Effects of Parkinson's
### Symptoms

Symptoms of Parkinson’s disease may be the same in every case. The number, type and severity of symptoms can be vastly different, however, there are several different symptoms that are commonly found in PD suffers.
* Tremors (shaking)
* Muscle Stiffness (can be through whole range of movement or just part)
* Bradykinesia (slowing of movement)
* Freezing/immobility
* Stooped posture
* Shuffling gait
* Mircographia (small handwriting)
* Lethargy

## Treatment

Parkinson’s disease is incurable, however, there are a number of different treatments that can help reduce symptoms and improve quality of life.

### Medication

Medication is the main form of treatment used for Parkinson’s, with the aim to restore dopamine levels. This is done by medication being able to be transferred into dopamine or the medication stimulating the dopamine receptors in the brain. Medication will initially improve symptoms, however over time, the progression of the symptoms may worsen, with medication not having the same effect. As a result, different medication regimes may be needed.

### Exercise

Although medication is used as the main treatment for Parkinson’s, exercise has proven to help improve quality of life and reduce symptoms especially related to gait and posture.

#### Gait And Posture

Gait is an area that can be largely affected by Parkinson’s disease. Many suffers will experience Hypokinesia, which refers to gait becoming substantially slower. Commonly described as shuffling gait, hypokinesia can be characterised by short step length and decreased ground clearance. It is believed this may also be increased due to a fear of falling
Postural decline is also extremely common with PD and can be a major factor in falls within PD sufferers. PD effects balance and can be attributed to the shuffling gait as it aims to improve stability.
Exercise has been proven to improve both postural and gait abilities in PD sufferers, by improving motor control, strengthening muscle and improving flexibility. Exercise that includes slow, controlled movements, such a stretching, walking, general range of movement exercises for limbs and even light weighted exercise can all help improve quality of life.

## Exercise Recommendations

* Start with easiest exercises and once fitness increases introduce more complex exercises
* Warm up and cool down
* Exercise promoting use of full range of movement
* Make exercising fun (exercise with others, dancing, boxing)

### General aerobic fitness

* Walking, using treadmill or on even surface
* Stationary cycling
* Swimming, water aerobics

### Flexibility and Balance

* Active and passive stretching
* Basic Hand-eye coordination exercises

### Strength

* Resistance exercises (body weight or theraband)
* Lightly weighted

## Safety

Safety is extremely important whilst exercising with PD, due to the high risk of falls and freezing. If the sufferer is at risk of falls or freezing, these simple precautions can be made to help alleviate the likelihood of an accident.
* Perform exercises sitting down
* Exercise with others
* Ask for assistance

## References

* 1 2 3 4 5 6 7 8 9 1. "What is Parkinson's." What is Parkinson's. N.p., n.d. Web. 20 Sept. 2014. <http://www.parkinsons.org.au/about-ps/whatps.html#treatment>.
* 1 2 3 4 5 2. Parkinson's disease - Better Health Channel." Better Health Channel. N.p., n.d. Web. 20 Sept. 2014. <http://www.betterhealth.vic.gov.au/bhcv2/
* 1 2 3 3. "Exercise." National Parkinson Foundation -. N.p., n.d. Web. 25 Sept. 2014. <http://www.parkinson.org/Parkinson-s-Disease/Treatment/Exercise>.
* 1 2 4. "Exercise and Parkinson's Disease | The Michael J. Fox Foundation." The Michael J. Fox Foundation. N.p., n.d. Web. 25 Sept. 2014. <https://www.michaeljfox.org/understanding-parkinsons/living-with-pd/topic.php?exercise>.
* ↑ Fisher, Beth E., et al. "The effect of exercise training in improving motor performance and corticomotor excitability in people with early Parkinson's disease." Archives of physical medicine and rehabilitation 89.7 (2008): 1221-1229
* 1 2 3 Trail, Marilyn, Elizabeth Protas, and Eugene C. Lai. Neurorehabilitation in Parkinson's disease: an evidence-based treatment model. Thorofare, NJ: SLACK Inc., 2008. Print.
* 1 2 3 Morris, Meg E, and Robert Iansek. Parkinson's Disease: A Team Approach. Cheltenham: Southern Health, 1997. Print.
* ↑ Canning, Colleen G., et al. "Parkinson's disease: an investigation of exercise capacity, respiratory function, and gait." Archives of physical medicine and rehabilitation 78.2 (1997): 199-207.
* 1 2 Dibble, Leland E., Odessa Addison, and Evan Papa. "The effects of exercise on balance in persons with Parkinson's disease: a systematic review across the disability spectrum." Journal of Neurologic Physical Therapy 33.1 (2009): 14-26.
* 1 2 Ashburn, Ann, et al. "A randomised controlled trial of a home based exercise programme to reduce the risk of falling among people with Parkinson’s disease." Journal of Neurology, Neurosurgery & Psychiatry 78.7 (2007): 678-684.