New Exercise Recommendations Issued for Patients

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by Steve Bryson, PhD |

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New exercise recommendations have been released by the Parkinson’s Foundation and the American College of Sports Medicine (ACSM) to provide effective and safe guidelines about physical activity for people with Parkinson’s disease and certified exercise professionals.

The recommendations followed a recent meeting convened by the Parkinson’s Foundation, which included experts in exercise programs and research, physical therapy, exercise certification, medicine, and Parkinson’s community-based exercise programs. 

The exercise guidelines are built upon science-based standards for exercise testing and prescription by the ACSM, which is an organization dedicated to advancing and integrating research to improve practical applications of exercise science and sports medicine.

“As a leader in driving better health outcomes and quality of life for people with Parkinson’s, these exercise recommendations are an important framework to ensure the [Parkinson’s] community is receiving safe and effective exercise programs and instruction,” John Lehr, president and CEO of the Parkinson’s Foundation, said in a press release. “We are pleased to partner with ACSM to provide people with Parkinson’s important guidance on staying active and living well with the disease.”

People with Parkinson’s experience a progressive loss of motor control, with symptoms such as tremors or difficulties walking (gait) and movement. The condition is caused by the death of nerve cells in the brain that release dopamine, a chemical messenger molecule that passes signals between nerve cells. Dopamine is necessary for sending messages to instruct muscle movement and coordination. 

Research studies, including the Parkinson’s Outcomes Project — the largest clinical study of Parkinson’s including more than 13,000 participants in five countries — have revealed that those who exercise experience a better quality of life and decreased symptoms compared to those who do not. Such symptoms include balance and mobility difficulties, as well as depression, constipation, and thinking skills.

“Living with Parkinson’s is an active sport in and of itself. Parkinson’s can be complicated because my symptoms are constantly changing. I can’t live well on medication alone,” said Scott Rider, Aware in Care Ambassador who has been living with Parkinson’s for 15 years. “Sometimes, it is challenging to know how I should be exercising. I am excited to utilize the new recommendations so I can be active today and in the future.” 

The new exercise guidelines recommend 150 minutes (2.5 hours) of moderate to vigorous exercise per week across four domains: aerobic activity; strength training; balance/agility/multitasking; and stretching. They also suggest that individuals meet a physical therapist specializing in Parkinson’s for an evaluation and patient-specific direction.

The guidelines recommend three days per week for at least 30 minutes per session of continuous or intermittent aerobic exercise at moderate-to-vigorous intensity. This includes rhythmic activities such as fast-walking, running, cycling, swimming, or aerobics class. Supervision may be required due to safety concerns such as the risk of freezing gait, blunted heart rate, or low blood pressure. 

Two to three non-consecutive days per week for at least 30 minutes per session are recommended for strength training. Each session should include 10 to 15 repetitions focusing on major muscle groups, resistance, and speed and power. Using weight machines, resistance bands, handheld weights, or bodyweight to exercise the upper and lower extremities is suggested. Muscle stiffness and posture instability should be considered. 

For balance, agility, and multitasking, the guidelines recommend two to three days per week of multi-directional stepping, weight-shifting, balance activities, large movements, and activities such as yoga, tai chi, dance, or boxing. Supervision may be required due to safety regarding cognitive and balance problems. 

Finally, the recommendations include two to three days per week of sustained stretching with deep breathing or stretching before exercise. Adaptations for flexed posture, osteoporosis (bone loss), and pain needs to be considered. 

“Research clearly shows that regular physical activity yields numerous health benefits for everyone, and it can be especially beneficial for people living with chronic medical conditions like Parkinson’s,” said Francis Neric of the ACSM. “ACSM works to equip certified exercise professionals with evidence-based guidelines, so they can help all clients exercise safely and effectively. 

“We are proud to partner with the Parkinson’s Foundation and help even more people benefit from an active lifestyle,” he added. 

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