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Dr. Okun

Post of the Week: What are the Barriers to Getting People With Parkinson's Disease to Exercise

35 posts in this topic

Dear forum members,

 

This is an interesting study that explored the barriers as to why people do not exercise with PD. Exercise seems to be very important so understanding the problem will be critical.

 

 

Phys Ther. 2013 Jan 3. [Epub ahead of print]

Barriers to Exercise in People With Parkinson Disease.

 

Source

 

T. Ellis, PhD, PT, NCS, Department of Physical Therapy & Athletic Training, College of Health & Rehabilitation Sciences: Sargent, Boston University, 635 Commonwealth Ave, Boston, MA 02215 (USA).

Abstract

 

BACKGROUND:

 

Exercise is known to reduce disability and improve quality of life in persons with Parkinson disease (PD). Although barriers to exercise have been studied in older adults, barriers are not well defined in persons with chronic progressive neurological diseases, such as PD.

OBJECTIVE:

 

The purpose of this study was to identify perceived barriers to exercise among persons with PD.

DESIGN:

 

Cross-sectional METHODS: Community-dwelling individuals with PD (N= 260), mean age = 67.7 years, and Hoehn & Yahr = 2.4, participated in a cross-sectional study. Participants were categorized as exercisers (N= 164) or non-exercisers (N= 96). Subjects self-administered the barriers subscale of the Physical Fitness and Exercise Activity Levels of Older Adults Scale endorsing or denying specific barriers to exercise participation. Multivariate logistic regression analysis was used to examine the contribution of each barrier to exercise behavior and odds ratios were reported.

RESULTS:

 

Three barriers were retained in the multivariate regression model. Non-exercisers had significantly greater odds of endorsing low outcome expectation (OR= 3.93, 95% CI 2.08-7.42), lack of time (OR= 3.36, 95% CI 1.55-7.29) and fear of falling (OR= 2.35, 95% CI 1.17-4.71) compared to exercisers (p < 0.05).

LIMITATIONS:

 

The cross-sectional nature of the study limited our ability to make causal inferences.

CONCLUSIONS:

 

Low outcome expectation of exercise, lack of time to exercise, and fear of falling appear to be important perceived barriers to engaging in exercise among ambulatory, community-dwelling persons with PD. These may be important issues for physical therapists to target among patients with PD who are not regularly exercising. The efficacy of intervention strategies to facilitate exercise adherence in persons with PD requires further investigation.

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I have had PD for 19 years and am doing ok with DBS. I recently began exercising with a physical therapist twice a week and exercise everyday on my own. My question is does exercise slow the progression of PD? Or is it inevitable that I will be less capable tomorrow than I am today? Can improvements in functioning be gained or is it a losing battle?

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This is unknown. Exercise has many positive health benefits and one thing that happens are trophic factors get released from the brain. Some groups are researching the potentially protective effects in cells loss in PD of exercise. We recommend exercise to all of our patients (if they can participate).

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Being diagnosed 2 yrs ago at 44, I am still working full time doing 12 hrs shifts at very busy hospital. Between being tired all the time, sore muscles and insomnia, I can't even think about an exercise routine! I know its important but sometimes on my days off its very hard to get motivated yo get off couch.

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I completely understand. Sometimes it is best to cut down hours if you can and try to work in some exercise. Great to hear you are working!

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Great question. I think education is the key. If we can help people to understand how it will help and also give them resources and support it will be of benefit.

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Dr. Okun, I'm one of six who participate in a weekly movement for PD class. We have tried every avenue to get more people to join, front page newspaper write up, fliers in doctors ofc., presentation for Brown U. medical students, even lowering the fee...it's like hitting a stone wall. Yes doctors say exercise so people think you need to lift weights. Our one hr. class gets every part of the body moving to music. People just don't understand there are all forms of exercise but they need to take that first step...search them out maybe instead of popping another pill. Sure there are days I would rather sit home but I know how it helps my body.

 

Patricia

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Patricia thanks for the great post, and keep up the enthusiasm!

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The greatest barrier to getting people with Parkinson's disease to exercise is Parkinson's...The disease itself. We need much more than motivation. We need more effective drugs with fewer side effects. We need effective treatment for dysautonomic symptoms and drug-resistant dystonia....We need to get rid of this body-numbing fatigue. We need more patient-oriented research to identify and address the limitations of current treatment options for patients with PD.

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Fortunately for me, I had already been a regular exerciser. As my disease progressed (before I was diagnosed) I had less and less energy, and was able to exercise less and less. Since I had exercised - before getting Parkinson's - to relieve stress, have more energy, and in general feel better, I knew of the positive benefits of exercise and couldn't wait to start getting them again. Once I was diagnosed and medicated, I did feel better and was able to exercise more. And the more I exercised, the better I felt. So I went from a downward spiral of feeling tired, exercising less, feeling more tired, exercising even less ... to an upward spiral. Although I still don't feel as good as when I was "normal", I feel far better than when I was first diagnosed six years ago.

 

So, it seems to me, the key to getting Parkinson's patients to exercise - if they haven't been regular exercisers before - would be to somehow show them how much better they can feel if they exercise regularly. As it is now, they can hear it, but they probably don't believe it.

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exercise has heped me alot.before i started sinemet agai i exercised more but i still had ridgity and balence issues.i fell better on meds now but i cut back on my nordic trac and weights.i still do alot of gardening but have to be careful now i dont overdo.now i have a bad shoulder injury that could have been prevented if i toned down my ambition some.Weights seem to help and probaly would prevent alot of injuries for a benefit.exercise along with my Recovery training keeps me peaceful and productive.More should look into Recovery Inc.especialy for stress.

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I am newly diagnosed with PD and have walked off and on for the past year. After falling twice while walking recently, I quit. I have three young sons who love to swim and I recently began swimming with them at a local natatorium. I noticed that I feel better while in the water. The muscle aches aren't as pronounced while I am in the pool (maybe I am not as focused on me and more on my kids?? :) I am also interested in Tai Chi and am waiting on a video from the library. I live in a relatively small town and there is only one Tai Chi class available and it's held at a time when I work. I also see a massage therapist to help with my muscle aches between my shoulder blades. Is there any solution to helping with posture problems. I am a psychotherapist and sit most of the day with my shoulders rolled forward. Stretching helps but the aching between my shoulder blades persist. I read the study on barriers to exercice and agree that education is critical in addition to trying new things and see how effective/non-effective they are. For now, I will continue to swim!

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STretching, exercise, swimming and Tai Chi are all excellent. Focus on the stretching routine. Most people with these issues may be slightly undermedicated with sinemet or dopaminergics and you may ask you doc if you need a higher dose. Massage is excellent and can be relaxing. In severe cases the neck and surrounding muscles can be injected with botox. Occassionally a muscle relaxer helps.

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Hi,

 

I am a personal trainer and I've been asked to work with a person with Parkinson's Disease.  I want to understand it more completely before accepting, in order to make sure that I can offer a program that will benefit the individual's needs.  What types of exercises are recommended for a person with PD?  I am under the assumption that due to the variablility of how the disease affects people differently as well as progresses differently and at different rates, that the aforementioned question may be difficult to answer without specifics to the individual. 

 

Thanks for any advice you can offer.

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Hello,

 

My mom has had PD for about 15 years.  Up until about 2011, she was doing well.  In December 2011 she was in the hospital (dehydration/fall - in FLA), and I went to advocate for her (I'm her health care proxy) for the 100 days (rehab) afterward.  Once that was over, she couldn't live alone so she moved in with us April 2012 (in NY).  She was pretty capable of walking on her own and with a walker, but would lose her footing from time to time.  There were no signs of mental confusion or dementia until the Fall of 2012 and much more apparent this past Spring.  In April 2013 I placed her in a local nursing home as the dementia (hastened from the long term PD meds per her neurologist) was affecting her sleep to where she was not safe in our home anymore and I was overstressed and exhausted. 

 

The nursing home physical therapist only offered her therapy (PT, OT, ST) for about 2 weeks, then said they wouldn't continue as she was not rehabilitating as they wished (yet her mood was high and she looked forward to it).  Within a few more weeks they had her in a wheelchair (easier on staff due to her wandering around) and her swallowing worsened, so I complained, they restarted for a few weeks and then stopped. 

 

My question is this : Isn't there something that was passed higher up (government)  re: not being able to deny PT services due to a nonrehabilitative reason?  Some of the CNAs have been walking her for a few minutes every other day or so, but nothing official from any therapy.  Help - there are days where she knows what's happening and days where she doesn't, but she would benefit with therapy on the days where she feels better than others?

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There was a decision that favored the Parkinson's disease patient not being denied therapy.  The implementation has been spotty and complex, and the best place to look for answers is by calling the Parkinson Action Network, also known as PAN.  They are the advocacy arm of the PD community that is supported by all the PD organizations.

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I am finding it more and more painful to stand for more than a few minutes, much less exercise. I also have balance problems. As a retired educator I know there have been a lot of studies showing a connection between exercise and improving academic test scores. The theory is exercise oxygenates the brain. Since exercise gets more oxygen to the brain and helps intellectually, then I figure it might help Parkinson's.

 

So, this is what I did: I had a small indoor pool with an adjustable current installed inside my home. I keep it at just the temperature I like. I chose a 51" water depth which is shallow enough that at any point I can stand up, but deep enough that it provides resistance against the current when I'm jogging. I usually alternate between jogging and swimming against the current. There is no worry of falling when I'm in my pool as the water supports me and jogging in water is very low impact compared to jogging on land (I also have osteoarthritis). When I'm jogging in the water I practice arm swinging (left arm forward with right leg, right arm forward with left leg) --- trying to create those brain connections. The pool is so relaxing; it is a real de-stressor physically and emotionally. I find my muscles are so much more relaxed and willing to move in the water. The pool was completed October 4, so it is a little early to tell how much it is helping, but it does seem like my walking (on land) has improved a little (maybe placebo effect?). One other note --- I did not opt for the treadmill that is optional with these pools because when I previously used a treadmill (on land) my muscles would sometimes freeze up, but the treadmill would keep on going, which was both painful and hazardous.

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This sounds great,  

 

In addition to increasing oxygenation in Parkinson's disease exercise leads to release of neurotrophic factors (miracle grow) for the brain.

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