Start today – Be Proactive – No Excuses.

• Daily physical exercise has been shown to increase survival rate in people with Parkinson’s disease.
• Animal studies suggest that there is a window of opportunity beginning at diagnosis, when exercise may be able to slow disease progression and have the greatest impact on brain repair mechanisms.
• Even if you think your meds are optimal and keeping your symptoms at bay - Even if you don’t think you have movement problems – you need to exercise to fight PD!
• Studies show that at the time of diagnosis, people have already greatly reduced their overall level of physical activity and often withdrawn from sports/recreational and leisure activities, despite minimal reports of disability. This reduced activity is further perpetuated by sensory deficits that interfere with body and spatial awareness making it less likely that you are going to accurately self-monitor and then self-correct your small/slow movements.

Failure to drive brain circuits can lead to their degradation.

• This is the concept of “forced use.” For people with PD, this means practice those skills that you don’t want to lose (i.e., practice bigger/faster sequential daily movements).
• Increase participation in your favorite activities; start new ones that challenge you.
• Remind yourself daily what normal bigger/faster everyday movement feels like so you continue to use your full capacity daily and to recognize when you are not.

Training a specific brain function can lead to an enhancement of that function.

• This is the concept the people with PD can get BETTER with training (practice)!
• Research suggests that the benefits of training will deteriorate without continuous practice/use. There may be a minimum use requirement to maintain new skills. This may be especially important in a neurodegenerative disease.
• Consider that regular bouts of practice will be necessary to maintain benefits gained!

Greater intensity of practice (dosage) is associated with greater improvement (response).

• Intensity of practice can be described by total time of practice (i.e., 1-hour/day; 5X/week for 6 weeks); number of repetitions of a desired movement; and the amount of external work performed (rate of energy expenditure).
• Learn to monitor (and increase) your intensity. Rate your perceived exertion on rating scales (1-10 with higher numbers representing higher effort) or by monitoring heart rate (60-85 % Max). Count the number of repetitions you do for the duration of your practice and how long it takes. You can also monitor your movement speed (on a treadmill or with a stop watch) or cadence (on a bike or by counting steps).
• Another way to increase your intensity of practice is to incorporate bouts of high effort (intervals). The duration of your intervals can be increased gradually over time as you increase endurance.

You will most likely get better at what you practice.

• Spend time practicing those behaviors that are most difficult (and important to you!). Even if you already have a general activity program, you need to implement a Parkinson-specific training approach by learning how to challenge the impaired system –Train the deficits!
• What does that mean?
  1. Learn to activate your muscles completely with maximal effort during everyday whole body movements.
  2. Focus on activities that require extension of the trunk and limbs, trunk rotation, and that reinforce good postural alignment.
  3. Practice large weight shifts in side to side and especially backward directions.
  4. Retrain body awareness (kinesthetia). Relearn how it “feels” to move normal (bigger/faster) so you learn to recognize when you aren’t and to self-correct your movements.
  5. Practice sequential coordination and quick changes in direction.
  6. Challenge yourself cognitively to pay attention to movement and sensory feedback!

Practice how to move in an environment and under similar level of challenge as “real life.”

• It is not enough to learn how to walk and balance better in the safety of the rehab clinic, but you need to practice your improved skills in progressively more challenging environments (small spaces, limited vision, unstable surfaces) that require sequences of actions, secondary motor and cognitive tasks (speaking, visual distractions, carrying objects).

Active and positive emotional engagement in practice affects how fast and well you learn.

• Find ways to strongly engage the brain and keep attentional focus high while staying highly motivated.
• Group exercise programs, seeking positive feedback from others, and setting goals to reengage in your favorite activities (e.g., dance with wife, hiking, gardening, playing with grandkids, tennis, walking) can give you positive feedback and empowerment about what you CAN do.
• Track your own progress in a diary, develop your own rewards use technology or games to generally track your progress or keep your motivation high.