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Senior-and-Trainer

How Feedback Can Improve Sit to Stand Performance

Sit -to -stand transfers are important movements that physical therapists, occupational therapists, trainers, and coaches use every day with their clients. With professional guidance clients can successfully learn the symmetry of weight distribution and other mechanics required to correctly perform sit-to-stand. Without such guidance clients may not learn the safe and correct way to get up from a seated position or to use the movement as exercise. The result can be pain, falls and other injuries.

Feedback

Feedback regarding proper motor patterns is an important tool that can lead to greater movement efficiency, increased activity, and lower risk of injury. After analyzing the different phases of sit to stand (preparatory/ starting alignment, transitional movements, and the final standing posture), clinicians can use feedback to address both the spatial and temporal parameters of movement that is needed to improve overall performance.

Why We Need Feedback

A natural part of performing a skill is to use intrinsic feedback, the sensory perceptual information caused by-the movement. Vision, proprioception, touch, pressure, and audition help formulate a person’s internal representation of a movement goal.

When performing sit- to- stand, proprioceptors indicate the muscle length and tension of the position of the ankles and feet, as well as the amount of pressure through the limbs; visual information orients the individual to the environment; and vestibular inputs, contribute to sense of verticality. If your clients are not receiving the proper intrinsic feedback, they may not be aware of their movements. For example, an individual with impaired ankle proprioception may need extrinsic or augmented feedback to increase the weight and symmetry through their legs.

Augmented feedback enriches/enhances intrinsic feedback. It provides information to clients who are unaware of their body position. Augmented feedback can help engage the patient during all phases of sit -to- stand and with different modalities: visual, auditory or tactile.

What type of Feedback to Use? Auditory, Tactile, or Visual?

When training sit<>stand, what type of feedback and verbal cues would you provide to achieve forward weight shift, symmetry of weight distribution versus increasing speed of transfer?

Think about your clients who have trouble getting up from sitting and are not sure why they cannot rise on their first attempt. Often patients think the problem is lack of strength.

Sometimes using the cue “nose over toes” works for these patients. Other times, it is the size and timing of their forward weight shift that needs to be cued?

Auditory feedback provides an engaging solution in this situation. For example, the Step and Connect’s Balance Matters System features auditory feedback about the timing and amount of weight the client shifts forward. The system’s innovative foot pads make a clicking sound when the move is done correctly. The click is nonjudgmental and motivating. The client learns a new way to move without verbal instruction.  With practice the correct move becomes automatic.

During sit to stand transfers auditory feedback can improve: 

  • Starting alignment
  • Forward weight shift
  • Timing of weight shift
  • Symmetry of weight distribution
  • Postural control (decrease sway at the ankles)

Example using the Balance Matters system:

Sit to stand: Activate back clicker, activate front clicker while you stand, keep all clickers quiet during standing.

Stand to sit: Keep all clickers quiet until bottom is on the seat.

Progressions and Intervention Ideas

Part Practice (only one phase of the transfer).

  • Preparatory phase: Work on good starting posture, activating back clicker to promote anterior pelvic tilt and increased weight bearing through the legs.
  • Transitional phase: Reach forward with arms and activate front clicker to promote anterior weight shift.
  • Transitional phase for stand to sit: partial squats to sit down keeping clickers quiet to improve the timing of weight shift and decrease a “plop”.

Symmetry of movement and weight-bearing

  • Does one side activate sooner than another or do you not activate one clicker on one side since you are weight bearing more on the opposite side.
  • Verbal cue: Hear the clicker go off at the same time standing up and sitting down.

Activate the vestibular system standing on foam footpads

  • Add head turns with sit to stand on foam

Changing the Stance Position

  • Staggered stance and step to work on step initiation.

Eyes closed to improve balance in dimly lit environments.

  • This is important when standing up from bed to walk in order to go to the bathroom at night. An article “Effect of Sitting Pause Times on Balance After Supine to Standing Transfer in Dim Light” mentions that the risk of falling for older adults increases in dimly lit environments.
  • The results of the study suggest that longer sitting pause times may improve adaptability to dimly lit environments, contributing to improved postural stability and reduced risk of fall in older adult women when getting out of bed at night.
  • This is an important topic on how the speed or timing to adapt in different environments (dim lit or uneven surfaces) can change our overall balance and postural control and should be integrated into balance exercises and goals.

Using multi-sensory feedback with the Balance Matters system will:

  • Improve an individual’s awareness of their starting posture and transitional postures.
  • The auditory feedback in the footpads helps promote improved timing, sequence of the task, weight distribution for symmetry and weight shift.

Remember, there are influential factors when designing programs using feedback. Fading the feedback for retention is highly recommended. In the Balance Matters courses, we review more in-depth these influential factors and clinical applications.


Originally printed on stepandconnect.com. Reprinted with permission.

Balance Matters is a unique balance training sensory tool developed by recognized Physical Therapist Erica Demarch, intended initially for Parkinson’s patients and others suffering from balance issues. Now has become a popular sensory balance training tool for people looking to “train their brain” for improved balance. The Balance Matters system is the foundation of Erica’s company, Step and Connect, stepandconnect.com

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How A Thought Becomes An Action: A Guide To Movement And The Disconnect In Parkinson’s Disease | PART 2

In Part 1, we discussed how a thought becomes an action, and the disconnect in Parkinson’s Disease, as well as how a Fitness Professional do to improve brain and body connection.

For those living with Parkinson’s, the three Activities of Daily Living (ADLs) considered to be most difficult to perform are:

  • Rolling over in bed
  • Getting out of a vehicle
  • Working through a freeze episode while crossing over a threshold between rooms.

I have provided a list of exercises to complement these ADLs as well as a “Practice Option” that combines the exercises listed.

Considerations

  1. Remember to begin with the most basic of movements until the client can properly and safely execute the exercise.
  2. Care partners of wheelchair-bound clients need to be instructed on how to safely assist loved ones without causing injury to either person. Please refer the client to an Occupational Therapist if needed.

Activity of Daily Living: Rolling over in bed                                         

Exercises

  • Bridges
  • Push-ups or chest press
  • Tricep extension
  • Rows
  • Glute squeezes (for chair bound)
  • Lateral Step with torso rotation using a tube
  • Side Planks/ Prone Plank
  • Clamshells

Advanced Practice Option: Have the client lay on his or her back. Take the right leg and swing the leg over the left leg and move into the side plank position and hold for 5 counts. From there roll to a prone plane OR bird dog position. Reverse the exercise to practice returning to the supine position.

Assisted Practice Option: If lying down is not an option, have the client sit in a chair.  Have the client hold a tube with both hands in front of them. Trainer provides tension from the side and the client maintains the isometric hold while picking up one leg and moving it out to the side and bringing it back in like a seated jumping jack.

Activity of Daily Living: Getting in/out of vehicle

Exercises

  • Rows (add a diagonal step/lunge)
  • Squats/Lunges
  • Sit to Stand drill (include single leg version)
  • Bridges
  • Clamshells (or any abduction work)
  • ½ Warrior step / ½ Gong arms
  • “Step over the Fence” ( lift left knee and step laterally over the “fence” followed by the right knee and then reverse the movement)
  • “Jazz Hands” (improves ability to reach)
  • Hip circles
  • Bob-n-weave (or lean left/right if needed)
  • Side planks or oblique bend
  • Tricep/Biceps (add lower body exercise)

Advanced Practice Option: (Stand with chair next to left leg). Place a hurdle next to chair to act as the “floorboard” of the car. Client will stand alongside the “car”.  Client will then lift the left knee and hold for 3-5 counts then step “over the fence”/bob-n-weave” to get into the car. Reverse the motion to practice getting out of the car. Repeat on the other side.

Assisted Practice Option: (Begin in a chair and with a short hurdle or object for them to “step” over). Client is in the chair and reaches right arm out as if opening the car door (jazz hands). Client then comes back to center and picks up the right knee and steps over the hurdle and turns foot to the right (½ warrior/ ½ gong) as the entire body turns to the right. Left foot follows the right foot and steps over the hurdle. Once the feet are facing the right, have the client do a full or partial Sit-to Stand drill. Reverse the motion to practice getting into the car.

Activity of Daily Living: Working through a “freeze” episode 

Exercises

  • Obstacle courses
  • Stop and start gait drills
    • Walk and turn head right and left
    • Walk slow then fast then slow etc
    • Walk and at cue, stop and turn
  • Visual drills
  • Lateral steps 5x then walk forward
  • Walk to a song with a strong beat
  • Criss-Cross Applesauce

*If client freezes at room threshold, emphasize that they want to look straight ahead and not down.

These three ADLs are just a few of the frustrating tasks people living with Parkinson’s Disease deal with each and every day.  Fitness Professionals can make a real difference in someone’s life if they will take the time to consider how movement works, where it can go wrong, and what to do to help it go right again. Imagine the success your client will experience during a session and throughout the day as they tackle ADLs with minimal effort! I can tell you this, their level of confidence will soar and the future will be something they look forward to.


Work with Parkinson’s Clients and Change Lives!

Working with Parkinson’s clients is an extremely rewarding experience. Check out Colleen’s course, Parkinson’s Disease Fitness Specialist to get started.


Colleen Bridges has worked for nearly 17 years as an NSCA Certified personal trainer, group exercise instructor and fitness consultant and as an independent contractor for Nashville’s first personal training center, STEPS Fitness. Her passion for understanding the body in sickness and in health, and how it moves, as fed her interest in and enhanced her talent for working with senior adults, especially those living with a neurological disorder such as Parkinson’s Disease.

Renee Rouleau is a Clinical Research Coordinator for the Department of Neurology at Vanderbilt Movement Disorder. Her research primarily focuses on the glymphatic system, a proposed waste-clearance system in the central nervous system in different neurodegenerative disorders such as Parkinson’s Disease (PD) and Alzheimer’s Disease (AD).

parkinsons-graphic

How A Thought Becomes An Action: A Guide To Movement And The Disconnect In Parkinson’s Disease | PART 1

It’s 2am and Robert needs to use the restroom but can’t gather enough strength to roll to a seated position to get out of bed without his wife’s help.

Gus decides to go to the kitchen for a snack but “freezes” when he reaches the doorway. His feet feel like they are stuck in mud.

Mary would like to attend her exercise class but the process of getting in and out of the car leaves her exhausted.

What do all of these people have in common? They have a progressive neurological disease called Parkinson’s Disease (PD). Parkinson’s Disease affects the dopamine-producing neurons in the substantia nigra (Latin for “Black Substance”, due to its darkened pigment in the brain).  The substantia nigra contains the highest concentration of dopamine neurons.  It is a part of the Basal Ganglia, an area that is responsible for motor control, motor learning, and procedural memory such as learning how to tie your shoes.

In PD, the onset of dopaminergic neuronal death in the substantia nigra manifests itself in the form of motor and non-motor symptoms that occur over a long period of time and in a progressive fashion.  Most people are not aware they are presenting symptoms of PD until a loved one brings their attention to a tremor, lack of arm swing, or notices a series of falls.

People living with Parkinson’s Disease want to take larger steps, smile more, swallow food without fear of choking, dress and bathe themselves, drive and participate in social activities.

However, for some, when they have a thought such as “I want to walk to the kitchen for a snack”, getting the thought to become an action, is almost impossible due to the lack of dopamine neurons in the Substantia Nigra. But wait a minute! HOW does a thought even become an action and WHAT can a Fitness Professional do to improve brain and body connection?

How a thought becomes an action

The brain is constantly multitasking as it takes in stimuli from your surroundings, interprets what’s going on around you and causes you to take action.  When your mind creates a conscious thought, such as “I want to get a snack”, a chain reaction takes place in the brain involving several areas. This starts in the frontal areas of your brain after processing the stimuli leading to the thought. For example, if you have your eyes set on the kitchen to get a snack, your prefrontal cortex initiates plans to make the movement, sending signals to your premotor cortex to organize those plans, and then sends those signals to the motor cortex to carry out the movement.

Once the movement has been planned and the best course of action has been “decided” by these neurons, the movement can commence. This creates the surge of neuronal firing from the motor cortex through the spinal cord to motor neurons that communicate with muscles and finally manifests the movement.

The above seems straightforward. The tricky part is regulating all of those different areas. Once the gross movement is executed, sensory information ( i.e. touch, temperature, or force) travels back up to the brain through sensory neurons in the spinal cord. The sensory cortex receives and carries the message to other parts of the brain that fine-tune the movement. This is one of the functions of the basal ganglia and other areas in the midbrain.

Because you’ve most likely done these types of movements before, those patterns are all stored in the basal ganglia so it doesn’t take up valuable space in the motor cortex. This area talks back and forth to the frontal areas to figure out what specific pattern should be used to achieve the best result. There are a hundred different ways to get out of a chair and go to the kitchen, but the basal ganglia works together to choose the most efficient option out of all of them and keeps the movements from getting out of control so you’re not high knee-ing to the kitchen when a simple walk will do (unless you want to high-knee to the kitchen). Once everything is adjusted and looks correct, new sensory information goes to the sensory cortex and back to those frontal areas to then signal that the movement has been fully executed.

Now, although that looked like a lot of steps just to complete one movement, this all happens within a fraction of a second, and is constantly going as you move to correct and adjust. The process is fluid, but works as a chain. If one link is broken, the rest of the process is going to fall apart. So how is the link broken in a disease like Parkinson’s?

Because the basal ganglia gets a lot of communication from the substantia nigra, if there is a loss of any sort of dopamine neurons, the relay of information gets discombobulated and, in the case of Parkinson’s, causes the motor system to stop the movement mid-way as there is not enough information from the neurons firing. Instead of creating the controlled movements and fine motor adjustments like you would see in a regular motor response, you have freeze-ups where the frontal areas are telling the midbrain to do one thing, and the basal ganglia just can’t do what it’s being told to do. Thus, the chain of movement is broken and the body cannot execute the action properly. To most, it looks like people with PD can’t seem to execute an action because of cognitive reasons. However, from their perspective, they want to be able to execute it and are consciously telling themselves to do it, but part of their brain isn’t “listening” and it causes the brain and body to be disconnected, resulting in incomplete movements and motor symptoms such as resting tremor, freezing of gait, and rigidity. This is why when PD patients take their medications, which help the brain to produce dopamine, they have “on” periods where these areas are able to have clearer communication with each other, their movements are better and their symptoms are better managed.

This is critical information for Fitness Professionals working with people living with Parkinson’s Disease. Once the information is understood, Fitness Professionals can focus on the second question which is “What can a Fitness Professional do to improve the brain-body connection for those living with Parkinson’s Disease?”

First, remind them that Exercise is Medicine! They need to take a dose each and every day! And the good news is that exercise provides outcomes such as:

  • Improved neuro-protection for at-risk dopamine neurons
  • Neuro-repair for areas of the brain affected by Parkinson’s Disease, and
  • Adaptation by retraining areas of the brain to pick up where the damaged parts can no longer execute commands.

Second, determine the activities of daily living (ADLs) that are most difficult for them. Identifying the ADLs and providing an exercise program that includes the seven functional movement patterns (push, pull, carry, hinge, lunge, squat and rotation) to improve their ability may save their lives. Repetition will be the key to create a spirit of confidence!

In Part 2, I discuss the three ADLs considered by most people living with Parkinson’s Disease to be most difficult, and exercises to complement them.


Colleen Bridges has worked for nearly 17 years as an NSCA Certified personal trainer, group exercise instructor and fitness consultant and as an independent contractor for Nashville’s first personal training center, STEPS Fitness. Her passion for understanding the body in sickness and in health, and how it moves, as fed her interest in and enhanced her talent for working with senior adults, especially those living with a neurological disorder such as Parkinson’s Disease.

Renee Rouleau is a Clinical Research Coordinator for the Department of Neurology at Vanderbilt Movement Disorder. Her research primarily focuses on the glymphatic system, a proposed waste-clearance system in the central nervous system in different neurodegenerative disorders such as Parkinson’s Disease (PD) and Alzheimer’s Disease (AD).

Senior-doctor-throat-open-wide

Parkinson’s Symptoms: “OPEN WIDE” – A Trip Down Our Throat

Our throat muscles, through which we speak, sing and scream, give us our signature sound. In many situations, people affected by Parkinsons disease (PD) have diminished voice control. According to Wikipedia, Parkinsons disease can cause changes in speech. The voice may get softer, breathy or hoarse, causing others difficulty hearing what we say. Speech may be slurred. Speech changes can interfere with communication, which can be isolating and harmful.

Other causes of voice disorders include infections, stomach acids that move upward in the throat, growths due to a virus, cancer and diseases that paralyze the vocal cords. Here is a brief understanding of what, how and ways to care for your precious voice.

What Are Your Vocal Cords?

Your voice box sits between the base of your tongue and the top of your windpipe, which is where your Adams apple likes to hang out. (The Adams apple is more pronounced in men than in women.) The vocal cords are two bands of smooth muscle membrane tissue, each covered in a mucous membrane, that stretch across the voice box like the strings on a guitar.

How They Work

When youre quiet: listening, observing, perhaps meditating your vocal cords sit apart, creating a tunnel through which you breathe in. But the moment you begin speaking, they clap together as the diaphragm pushes air up from the lungs. This air causes a buzz sound or vibration and sends sound waves through your throat, nose and mouth, which amplify them. As these humspass through, they are transformed into song or sentences.

Your Sound

Vocal cords vary in thickness and length, which is why each person has his or her unique tune. Think of the singer Barry Whites voice. Deep and strong. Those who have booming voices, such as Barbra Streisand have larger resonating cavities (throat, nose and mouth).

Take Care of Your Cords

Yelling, or screaming can cause inflammation and lesions on your vocal cords. Even a long-lasting cough can do damage. If you are hoarse, rest your voice. Speak softly and try to avoid throat clearing, even if your throat is congested. Drink lots of water to thin excess mucus and lubricate. Menthol and eucalyptus can be irritating.

For those with Parkinsons disease, if you notice your voice is diminished, see a speech-language pathologist (SLPs) specializing in voice therapy. They can assist with diagnosis, assessment, planning and treatment of voice disorders including difficulty with swallowing. Some exercises include moving your tongue up and down, moving it from corner to corner, placing your tongue at the tip of your mouth or smiling and saying EEEloudly. Repeat 10 times, at least twice a day.


Reprinted with permission from Lori Michiel. 

Lori Michiel, NASM, has been assisting seniors in their homes since 2006 with customized exercise programs including those designed to address Parkinson’s, metabolic disorders, arthritis and diabetes. These adaptive programs are specifically designed to improve balance, circulation, flexibility, mobility and promote independence. Lori Michiel Fitness has over 40 certified trainers who are matched with clients in Los Angeles, Ventura and Orange Counties. Connect with Lori at www.LoriMichielFitness.com.

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Fight Back Stronger! Working with Clients with Parkinson’s Disease

Determined, consistent and tenacious are just a few words I like to use to describe my Parkinson’s Disease “fighters”. I call them “fighters” because instead of lying down and giving up, they have chosen to take charge of their future. They commit to FIGHT BACK against Parkinson’s Disease, and that is a “fight” I want to join!

It is critical that you observe how the “fighter” moves, processes information and responds to challenges. We utilize that information and create fitness programs to address the motor symptoms those living with Parkinson’s Disease (PD) struggle with each and every day.

And the best place to start is with “Foundational Movements”  that will broaden a fighter’s Activities of Daily Living (ADL). People living with PD require a unique fitness program to address the impact that PD has on their ADLs.

Foundational Movements

Squats
Lunges
Hinge
Push
Pull
Carry
Rotation

I encourage Fitness Professionals to start with the most basic form of each Foundational Movement before progressing to a more challenging version. Neurologically, progressive and regressive movements make an impact on people living with PD. I have learned that repetition and exercise phases are a necessary part of any fitness program, similar to the human development process.

Consider how humans learn how to move from birth to 3 years of age. First, we learn a skill such as rolling over and we repeat it until we succeed. Then, we move on to unsupported sitting, followed by crawling until one day we are up and running!

And just in case you are wondering, the best place to start with foundational movements is in the warm-up. The repetition of the drills enables the fighters to improve their form, prepare for the work phase and create new neural patterns that will improve their functionality.

Let’s briefly discuss the movement patterns and how each movement can improve ADLs.

Squat

This movement pattern is used daily and assists in maintaining the ability to use synergistic muscular tension, stability and mobility through the torso, hips, knees and ankles. However, every fighter is different which means they will need to start at different levels.

EXERCISE ADL
Seated knee extension Toileting
Wall Squat Showering
Squat Dressing
Squat/stand and lift heels Cleaning
Squat-jump Care-giving

Lunge

Falling or the fear of falling is a significant issue for people living with Parkinson’s Disease.  The ability to stand on one leg, shift weight back and forth, maintain an asymmetrical split stance, bend down or get up off the floor is crucial for fall prevention. Lunging, in its various stages, provides Fitness Professionals a way to identify weak links.

NOTE: Some overlap will occur with the lunge and hinge movement.

EXERCISE ADL
Tap one foot behind Vacuuming
Reverse Lunge Stepping in/out of shower
Step one foot forward Tying shoelaces
Forward lunge Walking up/down stairs

Hinge

We ALL need to strengthen our posterior chain but it seems to be the one area many Fitness Professionals shy away from including in their program. When you consider how many times a day someone bends over, they must have the strength and basic knowledge of how to hinge so they don’t fall or hurt themselves.

This is even more important for people living with Parkinson’s Disease. If they fall, it could take months for them to recover and by that time, the disease has progressed. Make it a goal to include a hinge movement in every routine.

EXERCISE ADL
Basic Deadlift with arms crossed Getting in/out of car
Supported Deadlift with one foot behind Toileting/Showering
Traditional Deadlift with weights Dressing
Single Leg Deadlift

Cross-over Deadlift

House and Pet Management

Push

The push-up is one the most popular exercises of all time! Mastering the “push” is a different challenge. The “push” (not always push-ups) requires core stability, upper back and shoulder strength. Once mastered, people living with PD will notice an increase in power and strength.

Word of caution: Parkinson’s Disease typically affects a person’s posture. Please remember that anything overhead will alter the center of gravity which means some fighters need to perform a “push” exercise that keeps the arms closer to the body.

EXERCISE ADL
Wall Push-up Rising from the floor
Push-up on Smith Machine Bar House cleaning
Push-up on knees Showering
Push-up on hands/toes Pushing large door open

Pull

With so many postural issues due to weak muscles, developing a stronger “pull” will help people living with PD strengthen their back muscles which will decrease falls, improve posture and relieve back pain.

EXERCISE ADL
Shoulder retraction only Opening refrigerator
Shoulder retraction and hold Vacuuming/sweeping
“Row” arms (no weights) Showering
“Row” with tubes Pulling up pants
“Row” with one arm Picking a child or pet up

Carry

People living with PD want the ability to carry a grocery bag, walk and pull out keys all at the same time. But if they do not know how to use their body correctly, multitasking can be scary. Carry exercises focus on leverage and load. The good thing is we can always make adjustments depending on other variables. For example, bad shoulders mitigate against the overhead version of the carry while weak hands prevent one from carrying heavy loads. Carry exercises don’t necessarily help prevent falling other than the benefits they provide by strengthening the core. However, Fitness Professionals need to remember that carry exercises will serve your fighters in the early pre-kyphosis stage as a posture exercise. Carry exercises also provide a challenging asymmetrical exercise if performed unilaterally.

TIP: The carry movement is a great way to challenge the core without doing crunches!

However, before beginning a gait/carry movement with your fighters, make sure they have been thoroughly assessed.

EXERCISE ADL
Walking Carrying groceries
Bird dog walk Carrying laundry basket
Farmer’s walk with two weights Child care
Farmer’s walk with one weight Pet Care
Farmer’s walk with one weight overhead House Management

Rotation

The core maintains the stability and strength of the torso and acts as a conduit for energy. The movement patterns listed above encourage core strength which means rotational exercises are not so much a movement pattern as a powerful supplement to the above foundational movements.

Rotational exercises for people living with PD help improve gait and posture, reduce falls, improve coordination and mobility,  increase overall strength and, most importantly, enable them to independently perform ADLs.

Rotation Reminders for Fitness Professionals:

  • Torso stabilizes the spine and allows movement by coordinating with the pelvic muscles.
  • Flex, extend, bend and rotate
  • Anti-Rotational Exercises best for beginners. People living with Parkinson’s DIsease often deal with Processing Information issues. Begin with basic exercises in order for fighters to learn proper form and technique.
  • Muscles – Rectus Abdominis, obliques, rhomboids, deltoids, glutes, abductors, quads and adductors

Caution! Be sure to include the hips and the lower portion of the spine when rotating.

EXERCISE ADL
Isometric tube hold Enter/exit tub or shower
Isometric tube hold and step laterally Enter/exit vehicle
Circles with tube Emptying dishwasher
Circles with tube/squat Laundry related activities
Torso rotation with tube All ADL categories

In closing, when Fitness Professionals learn the art of organizing movement patterns and creating a program that uses these foundational movements, their fighters living with Parkinson’s Disease experience physical gains such as standing without support, joint mobility, active core stabilization, integrated joint action, cognitive improvement and most importantly the ability to handle a challenging moment with confidence.

Having acquired these foundational skills with the help of you, their Fitness Professional, build trust and credibility for supporting a fighter’s long-term commitment to HOPE. As noted at the beginning of this article, our fighters are determined, consistent and tenacious. They have chosen to take charge of their future and FIGHT BACK against Parkinson’s Disease — a “fight” I hope you, as a Fitness Professional, join!

Become a Parkinson’s Fitness Specialist

You can acquire the tools and resources necessary to integrate foundational movements with ADLs within the Parkinson’s community. Sign up for Colleen’s 12.5-hour online course on MedFit Classroom, Parkinson’s Disease Fitness Specialist.


Colleen Bridges has worked for nearly 17 years as an NSCA Certified personal trainer, group exercise instructor and fitness consultant and as an independent contractor for Nashville’s first personal training center, STEPS Fitness. Her passion for understanding the body in sickness and in health, and how it moves, as fed her interest in and enhanced her talent for working with senior adults, especially those living with a neurological disorder such as Parkinson’s Disease.

brain-neurons

Parkinson’s Disease and Exercise

Parkinson’s disease is the second most common neurodegenerative disorder after Alzheimer’s disease.  Unfortunately, the incidence of Parkinson’s disease has not declined, and its impact is seen in all races.  This is due in part to the fact that the population of the world is greater than ever before and increasing. In addition, people are living longer than in previous generations, and the baby boomer generation, one of the largest generations in history, has reached old age.

Risk factors for Parkinson’s disease include:

Age: Risk of Parkinson’s disease increases with age.  The average age of onset for this disease is 55 years and the rate of incidence increases steadily until the age of 90.

Gender: Men have a higher risk for Parkinson’s disease than women.

Family history: Individuals with a family history of Parkinson’s disease are at a higher risk for Parkinson’s disease. Moreover, it is said that those with affected first-degree relatives double their risk of Parkinson’s disease.

Agricultural work: Individuals exposed to pesticides and herbicides have a greater risk of developing Parkinson’s disease symptoms. Drinking well-water and living in rural areas have also been associated with an increased incidence of Parkinson’s disease.

Head Trauma: Head trauma can be a risk factor for Parkinson’s disease as is seen in the case of boxers. One study showed that trauma to the upper cervical region, head, and neck was a risk factor for Parkinson’s disease. However, in some cases it took years for these symptoms to appear.

The exact cause of Parkinson’s disease is unknown.  Regarding the molecular events that lead to the development of this disease, there is still some uncertainty in terms of what causes the neurodegeneration seen in Parkinson’s disease. The current hypothesis is that Parkinson’s disease may result from the interaction between environmental factors and genetic susceptibility.

The primary symptoms for PD are deficiencies in motor performance due to the loss of the dopamine pathways in the brain. Decreased dopamine production in the substantia nigra in the brain causes the 4 primary motor symptoms:

  • Bradykinesia: described as slowness in the execution of movements while performing daily activities.
  • Rigidity or Stiffness: caused by an involuntary increase in tone of the limbs and axial musculature.
  • Resting Tremor: Found primarily in the arms and hands and can be socially bothersome. Resting tremors are less disabling since they often vanish with the initiation of activity (especially in the early stages of Parkinson’s disease).
  • Postural Instability: manifested in a slow speed of walking, shortened stride length, narrowing of base of support, and leaning towards one side.

Exercise should be targeted for the primary motor symptoms with exercise and occupational therapy to improve quality of life. Recommended program components include:

  • Posture, gait, mobility
  • Fall risk reduction
  • Cardiorespiratory health
  • Strength and function
  • Depression and Anxiety
  • Joint health

Exercise prescription for clients with PD includes: (ACSM)

  • An individualized program
  • Cardiorespiratory: use guidelines for healthy adults
  • Muscular Fitness: use guidelines for healthy adults
  • Flexibility: slow, static exercises for all major and minor joints in the body including the upper torso, spine, and neck.
  • Neuromotor Exercises: help with balance, gait, and postural instability. Clinicians use a gait belt or parallel bars to ensure safety depending on the severity of the symptoms.  Include functional exercises to improve ADLs and quality of life.

PD exercise therapy includes intervention with many kinds of exercise modes. Both personal training and group fitness have been successful in helping to manage the disease and reduce the symptoms. There is not strong evidence at this point to show that exercise prevents PD, but it is believed that exercise may play a role.  Exercise is however the mainstay for symptom management and slowing disease development.

 


June M. Chewning BS, MA has been in the fitness industry since 1978 serving as a physical education teacher, group fitness instructor, personal trainer, gym owner, master trainer, adjunct college professor, curriculum formatter and developer, and education consultant. She is the education specialist at Fitness Learning Systems, a continuing education company.

References and Resources:

brain

Neuroplasticity and the Aging Brain

One of the greatest concerns for the aging population is cognitive decline which leads to loss of independence as well as an extreme burden on the caretakers.  Individuals worldwide are fearful of being diagnosed with any of the various cognitive issues: Dementia, Parkinson’s, Alzheimer’s, and other forms of cognitive debilities.  In 2015 there was an estimated 47 million people living with dementia and this number is expected to triple by 2050.  In 2014, the Alzheimer’s Association reported that they believe there is sufficient evidence to support the link between several modifiable risk factors and a reduced risk for cognitive decline and sufficient evidence to suggest that some modifiable risk factors may be associated with reduced risk of dementia. Specifically, that regular physical activity and management of cardiovascular risk factors (diabetes, obesity, smoking, and hypertension) reduce the risk of cognitive decline and may reduce the risk of dementia. The Association also believes there is sufficiently strong evidence to conclude that a healthy diet and lifelong learning/cognitive training may also reduce the risk of cognitive decline.

Positive association between aerobic exercise or CV fitness and executive functions is highly consistent but cannot determine causality.  Aerobic exercise (AE) has shown moderate to medium sized effects on executive function and memory. Resistance Training (RT) has improved executive function and memory. Combined AE and RT has the biggest (potentially synergistic) effect. It has been proposed that the physical and cognitive exercise might interact to induce larger functional benefits.  Larger benefits on cognitive test performance were noted for combined physical and cognitive activity than for each activity alone.  “Claims promoting brain games are frequently exaggerated and at times misleading. … To date, there is little evidence that playing brain games improves underlying broad cognitive abilities, or that it enables one to better navigate a complex realm of everyday life (Consensus statement, 2014).

Neuroplasticity is the brain’s ability to reorganize and rebuild itself by forming new neural connections. The more neural pathways you have, the more resilient your brain is. Neurogenesis is the process of creating new neurons (brain cells).

Contrary to popular belief, neurogenesis continuously occurs in the adult brain under the right conditions such as with exercise.  Substantial benefits on cognitive test performance were noted for combined physical and cognitive activity than for each activity alone. It was also noted that the physical and cognitive exercise together might interact to induce larger functional benefits.  “We assume, that physical exercise increases the potential for neurogenesis and synaptogenesis while cognitive exercise guides it to induce positive plastic change” (Bamidis, 2014).  To maximize cognitive improvement, combine physical exercise with cognitive challenges in a rich sensorimotor environment that includes social interaction and a heaping dose of fun.

Brain health is becoming extremely important as individuals live longer.  Today there is much more information available on how to train the aging brain.

Some great resources are:


Dianne McCaughey Ph.D. is an award winning fitness specialist with more than 35 years experience in personal training, group exercise, coaching, and post-rehabilitation. She is a master trainer for multiple companies and practices and teaches optimal wellness emphasizing the mind, body and spirit. She works with special populations and focuses on posture, gait, balance and corrective exercise programs for better function and health.

Cody Sipe, PhD, has an extensive background in the fitness industry with 20 years of experience as a personal trainer, fitness instructor, program director, exercise physiologist and club owner. He is currently an Associate Professor and Director of Clinical Research in the physical therapy program at Harding University. He is the co-founder and vice president of the Functional Aging Institute (FAI).

 

arrow road

The Power of Purpose

I have Parkinson’s. I call it “accelerated aging” because it is a progressive neurologic disorder that simulates aging. On my bad days, I feel ten to twenty years older than I am.

For your information, a bad day, for me, has me struggle to get out of bed specifically having to focus all my energy on one arm and then the other arm to just move enough to get my bed cover off my body in hopes of coming up with a strategy to get out of bed and to the bathroom in time. I stressfully drive to the gym and at least show up to the one-hour fitness class. I put on boxing gloves to hit the bag and my arms don’t respond to what my mind is commanding that they do. But I show up. I then go home and walk around my house because I cannot find a comfortable place to sit. Medical marijuana allows me to sit, but makes work, household chores (if fact, almost everything) impossible. The term of art for this phenomenon is “off periods.”

What I can say is that, when I am doing something purposeful, I somehow am able to muster the strength and, yes, courage to get up on stage and provide inspiration to my audience. I love standing in front of a group and provide words of wisdom that help others to change their behavior. It is how I “make a difference.”



For example, I just traveled from Sarasota, Florida to Las Vegas, Nevada on Tuesday, attended a reception Tuesday night, attended breakfast with the Medical Science Liaison Society on Wednesday, did a 45 minute inspirational talk, attended much of the conference, enjoyed the Awards banquet, went out late with a group of attendees, went to be late, got up early on Thursday and travelled back to Florida. The thing is that I was on the whole time. I had my slower moments, but was able to summon the energy to stay engaged the whole time. I call it the “power of purpose.” It happens to me every time that I have an engagement. I also call it “staying engaged.”

By way of a second real-life example, last Tuesday, I flew to New York City, On Wednesday, I attended my father’s induction into the High School Athletics Hall of Fame. On Thursday, I was in the audience of the Wendy Williams Show, talk about the power of positivity waiting in line with some pumped up people at 7:00 am. On Friday, I took a train 2 hours each way to inspire about 100 individuals at the Mid-Hudson Parkinson’s Association. Finally, on Sunday, my wife and I threw her mother an 80th surprise birthday party. We flew back Tuesday and I was useless for several days. My point is that you can summon the energy to overcome anything for a finite period of time if it is in line with your purpose.

Stay Engaged. Fulfill your Purpose. Make a Difference. Have Faith.


John Baumann is a 17 year veteran of Parkinson’s who has demonstrated the desire and discipline to continue to have an amazing life. He exemplifies the word “resilience” starting out as an attorney, then, after getting the news that he has Parkinson’s, continuing to practice for ten more years while getting prepared to fulfill his lifelong dreams of teaching at a University, writing a book on success, and finding his life’s purpose as an inspirational speaker. John graduated from the University of Massachusetts and Cornell Law School. He worked for Exxon for 10 years before accepting the position of General Counsel of Steel Technologies. John was diagnosed with Parkinson’s in 2002 when he was 41 years old. Since being diagnosed, he has taught law at the University of Louisville, College of Business, written a book entitled, Decide Success: You Ain’t Dead Yet, and delivered over 100 keynote presentations.

blueberries-closeup

Tailoring Nutrition to Help Fight Parkinson’s Disease

Good nutritional practices are the groundwork for a healthy and productive life. People with Parkinson’s and their Care Partners have extra challenges to face as they navigate life with this progressive disease that causes tremors, slowness of movement, muscle stiffness and impaired balance. For people with Parkinson’s, healthy eating is another strategy to fight the effects of Parkinson’s.

Like all of us, people with Parkinson’s should strive to eat a balanced diet of carbohydrates, fats, and protein. Carbohydrates are the body’s preferred energy source. Fats – especially healthy unsaturated fats – are also used for energy. Protein contributes to cell growth, repair and maintenance. It is also important to get necessary vitamins and minerals from fruits and vegetables to truly feel your best. Drinking water throughout the day keeps us from becoming dehydrated and helps the entire body to function optimally.

Because People with Parkinson’s already have a progressive disease to manage – it is important to try to keep other chronic diseases at bay. Vitamin E and C are antioxidants that combat free radicals (compounds that injure healthy cells) in the body. It is important that people with Parkinson’s eat plenty of antioxidant containing foods such as blueberries and spinach.

People with Parkinson’s are at a greater risk for osteoporosis and falls – which is why adequate amounts of Vitamin D and Calcium are essential to keep bones strong. The body can create its own Vitamin D from 15 minutes a day of sunlight exposure – or it can be found in foods such as salmon, pork and eggs. Vitamin D is essential for helping calcium be absorbed in the body – calcium being the primary component of bones. Good sources of calcium include yogurt, cheese, kale and spinach.

Protein serves many vital functions in the body, and it is important for People with Parkinson’s to get adequate amounts. Protein rich foods can diminish the effects of some Parkinson’s medications when they are taken together, so taking medications an hour prior to eating can help them to work most efficiently.

Fiber is the bulky, indigestible part of plants that passes through the digestive tract. Fiber absorbs water in the body and helps with regularity. People with Parkinson’s have higher instances of constipation – so eating high fiber foods such as bran cereals, whole wheat bread, beans and broccoli can help relieve this condition.

Sometimes diseases of the eye can occur in People with Parkinson’s. Beta-Carotene is a type of Vitamin A that helps maintain retina function and is found in carrots and sweet potatoes. Leafy green vegetables and egg yolks contain lutein and antioxidants that may lower the risk of cataracts and macular degeneration.

Finally, People with Parkinson’s should always be sure to drink enough water. Adequate water consumption helps relieve constipation, prevents dehydration, aids in vitamin absorption in the body, and rids the body of waste.

Always consult your physician if you notice any undesired weight loss, and before you make any changes to your regular eating habits.


Carisa Campanella, BA, AS, is an ACE Health Coach and ACSM Personal Trainer. She is the Program Manager at the Neuro Challenge Foundation for Parkinson’s. Neuro Challenge provides ongoing monthly support groups and educational programs, individualized care advising and community resource referrals to help empower people with Parkinson’s and their caregivers.