a suggested exercise program for people with parkinson’s ... · a suggested exercise program for...

Be Active!

A Suggested

Exercise Program

for People With

Parkinson’s Disease

THE AMERICAN PARKINSON DISEASE ASSOCIATION, INC

Be Active.qxd 10/17/00 9:57 AM

The American Parkinson Disease Association, Inc

Honorary Chairman of Research Development President EmeritusMuhammad Ali Hon Mario J. Esposito, Sr

Honorary Board MembersCliff Robertson OfficersBrooke Shields John Pillarella, PresidentMs Michael Learned Vincent Gattullo, 1st Vice PresidentDavid Soul Hon Joel A. Miele, Sr, 2nd Vice PresidentLarry Bauer J. Patrick Wagner, 3rd Vice PresidentIstavan F. Elek Salvatore J. Esposito, Jr, SecretaryDave Debusschere Hon Nicholas Corrado, TreasurerRichard A. Grasso

Board of Directors John Z. Marangos, EsqDan Allis, Esq John B. MartinElizabeth Braun James MaurerFred Cafasso Robert MeekerThomas Collins Hon Gregory MeeksHon Nicholas Corrado* Michael MelnickeAva Crowder Hon Joel A. Miele, Sr*John D’Amato Theresa E. Molloy, EsqJoel A. Dolci, CAE Gregory PerilloMaxine Dust Robert Pessolano*Hon Mario J. Esposito, Sr* Lisa Esposito Pidoriano, DVMMario J. Esposito, Jr Michael A. Pietrangelo, EsqSally Ann Esposito John A. Pillarella, Sr*Salvatore J. Esposito, Jr* Robert PirrelloMichael Florentino Carmine Ragucci, SrHon Vito Fossella, Sr Dorothy ReimersDonna Marie Foti Richard A. RussoGreg Fowler Joseph SauerhoffJames Gartenberg Scott SchefrinVincent Gattullo* Ray SerraHon Norman Goodman Jay A. Springer, EsqFred A. Greene* Bill StilwellMichael Halkias Max Ralph Tarbox, EsqJames Hansen Meyer Temkin, CPAJohn Haugen Hon. Vito TitoneElena Imperato Martin TuchmanJay Kessler J. Patrick Wagner*Charles Klasky Jerry Wells, EsqJohn Lagana, JrRev Dougald L. MacLean *Executive Committee MemberSophia Maestrone

Scientific Advisory Board Thomas B. Freeman, MDG. Frederick Wooten, MD, Chairman Marry Maral Mouradian, MDJames Bennett, Jr, MD, PhD Erwin Montgomery, Jr, MDMarie-Francoise Chesselet, MD, PhD Richard Myers, PhDMahlon R. Delong, MD William J. Nicklas, PhDDennis Dickerson, MD Jacob I. Sage, MDRoger C. Duvoisin, MD, FACP Teepu Siddique, MDDavid Eidelberg, MD Ray L. Watts, MD


This booklet was originally written and compiled for The American Parkinson DiseaseAssociation, Inc, by Rose Wichman, RPT, The Institute for Rehabilitation Services,Methodist Hospital, Minneapolis Minnesota, ©1990. It was redesigned and reprinted in2000 through an unrestricted educational grant from Pharmacia & Upjohn Company andBoehringer Ingelheim Pharmaceuticals, Inc.

THE AMERICAN PARKINSON DISEASE ASSOCIATION, INC

Be Active!

A Suggested

Exercise Program

for People With

Parkinson’s Disease


2

A SuggestedExercise Programfor People WithParkinson’s Disease

Parkinson’s disease causes slowness of movement, muscle rigidity, and joint stiffness. Itcan also create changes in one’s posture, walking, and endurance. Daily tasks such as rising from a chair or turning in bed can become difficult to perform. Many individualshave been encouraged to perform regular exercise to help improve mobility. This bookletcontains suggested activities to help build needed exercise into your daily routine. Thesuggestions may also make everyday tasks easier to perform.

You should obtain medical clearance from your personal physician before beginning this,or any, exercise program. Most of the exercises can be done lying down or sitting, butyou may need to modify the program for your personal needs. A physical therapist in your area can help to create a more individualized program, if needed.

The following suggestions will help you gain the most benefit from your exercise program:

• Choose a time to exercise when you are well rested and moving most freely.

• Wear loose, comfortable clothing and shoes with good support.

• Structure your program to include adequate rest periods, or divide your program into severalshorter sessions.

• Move slowly through each exercise. Avoid “bouncing” motions.

• Maintain normal breathing throughout exercises.

In addition to the exercises suggested in this booklet, regular conditioning exercises suchas walking, riding a stationary bicycle, swimming, and other types of water exercise canhelp to improve cardiovascular endurance.

Exercise promotes relaxation and can help reduce stress. So join in; be active! It’s justone way of taking steps to better cope with Parkinson’s disease.


Sitting

3

Deep BreathingPurpose: To promote relaxation and awareness of using the diaphragm in respi-ration.

Place hands on abdomen. Breathe in slowly through your nose, feeling your diaphragmexpand as you inhale. Then exhale slowly through your mouth as if you were trying toblow out a candle. Repeat 10 times.

Head TurnsPurpose: To promote neck flexibility.

Turn head slowly side to side, looking overeach shoulder. Feel a gentle stretch in neckmuscles. Repeat 10 times.

Head TiltsPurpose: To promote neck flexibility.

Look straight ahead. Move head sideways,bringing ear toward shoulder. Feel a gentlestretch in neck muscles. Repeat each side10 times.


Sitting

4

Chin TucksPurpose: To promote goodposture and help decrease“forward head” position.

Jut chin forward (think of aturtle’s head as it pushes outof its shell). Then pull chin in asfar as possible. Repeat 10 times.

Shoulder ShrugsPurpose: To promote mobilityin neck, shoulders, and upper back.

Shrug shoulders upward, bringingshoulders up toward ears. Hold toa count of 5. Relax. Repeat 10times. If this exercise feels difficult,try one shoulder at a time.

Shoulder SqueezesPurpose: To promote mobility in neck,shoulders, and upper back.

Squeeze shoulder blades together, bringingelbows behind you. Hold to a count of 5.Relax. Repeat 10 times.


Sitting

5

Trunk TwistsPurpose: To promote mobility in neck, shoulders, and trunk muscles.

Place hands on shoulders. Twist head, neck, and trunk from side to side as far as possi-ble, feeling stretch in trunk muscles. Repeat 10 times.


Sitting

6

Slouch/ArchPurpose: To promote awareness of good sitting posture and assist in trunk flexibility

Slouch forward in a flexed posture. Then arch backward to create a curve in the small ofyour back. Repeat 10 times.


Sitting

7

“Wand” ExercisePurpose: To promote shoulder flexibility.

Grasp cane or yardstick with both hands and lift overhead. Then try to bring cane behindhead. Lift overhead and lower it back to your lap. Repeat 10 times.


Standing

8

Arm StretchPurpose: To promote shoulder flexibility.

Hold arms straight out in front of you. Slowly push arms out to sides, keeping elbowsstraight. Return arms to original position. Repeat 10 times.


Sitting

9

Wrist CirclesPurpose: To promote wrist flexibility.

Make slow circles with your wrists. Circle wrists five times in each direction. Stabilizeforearm to get better wrist motion, if needed.

Finger/Thumb CirclesPurpose: To promote finger dexterity.

Slowly bring each finger to your thumb, making round circles between thumb and finger.Begin slowly, then increase speed. Repeat 10 times.


Sitting

10

KicksPurpose: To promote knee mobility and leg strength.

Kick leg straight out in front of you, making sure knee is completely straight. Repeat witheach leg 10 times.


Sitting

11

Hamstring StretchPurpose: To promote knee flexibility and good standing posture.

Place one leg up on a small stool with the other foot flat on the floor. Place hands on kneeand lean forward, feeling stretch in back of knee. Hold for a count of 20. Relax. Repeatwith each leg five times.


Sitting

12

Gluteal SetsPurpose: To strengthen muscles in back of hips

Squeeze buttocks together. Hold contraction for a count of 5. Relax. Repeat 10 times.

Ankle CirclesPurpose: To promote ankle flexibility.

Raise a leg off the floor. Make slow circles with ankle. Circle ankle 10 times in each direc-tion. Repeat with other ankle.


Supine

13

Knee to ChestPurpose: To promote flexibility in lower back and hips.

Raise knee up toward chest as far as possible, bending at hip. Repeat with each leg 10times.


Supine

14

BridgingPurpose: To strengthen hip muscles.

Place feel flat on bed or floor with knees bent. Raise hips off surface as high as possible.Repeat 10 times.


Supine

15

Hip RollsPurpose: To promote hip and trunk flexibility.

Lay on flat surface. Place feet flat on surface with knees bent. Roll knees side to side asfar as possible. Repeat 10 times in each direction.


Supine

16

Straight Leg RaisePurpose: To strengthen hip and knee muscles.

Lay on flat surface with one knee bent and other leg straight. Raise straight leg entirely offsurface, keeping knee straight. Return slowly to original position. Repeat with each leg 10times.


Prone

17

Prone Lying on ElbowsPurpose: To stretch hip muscles and promote flexibility in lower back.

Lay flat on stomach for 3 to 5 minutes. Then try to prop yourself up on your elbows tocreate a curve in small of your back. Maintain this position for 3 to 5 minutes. Relax.


Standing

18

Toe RaisesPurpose: To strengthen calf muscles.

Hold on to back of chair or counter for support. Raise up on tiptoes 10 times.


Standing

19

Calf StretchPurpose: To stretch calf muscles.

Hold on to back of chair or counter for support. Place one foot forward. Bend forward atknee, keeping back heel flat on floor. Feel stretch in back calf muscles. Hold for a count of20. Repeat with each leg five times.


Standing

20

Wall Push-upsPurpose: To stretch shoulders and promote good posture.

Standing toward a corner, place one hand on each wall. Now lower yourself toward wall,feeling stretch in shoulders. Keep feet flat on floor. Then push yourself away from thewall. Repeat 10 times.


Posture

21

Parkinson’s disease, combined with adecreased activity level, can createchanges in posture. Individuals maydevelop “forward head,” rounded upperback, forward trunk lean, or flexion con-tractures of the hips and knees. Thesechanges can produce neck and back painor tendency for increased balance loss. Itis important to evaluate your own postureand make necessary changes.

Sitting Posture

Choose a chair that offers a stable baseand good support. Place a small towel orroll a pillow in the small of your back tomaintain lumbar curve. Sit up straight,maintaining eye contact with thosearound you. Avoid sleeping in a chair,which promotes flexed posture.

Standing Posture

Keep shoulders back, avoiding forwardtrunk lean. Avoid standing with hips orknees bent.

Sleeping Posture

Avoid too many pillows under your head.Consider using a towel roll or cervical pil-low to support neck when sleeping. Placepillow between knees when sleeping onside to decrease lower back pain.


Transfers

22

Rising From a Chair1. Slide out to edge of chair.

2. Place hands on chair armrests.

3. Lean forward far enough to get your nose over your knees.

4. Place feet under you.

5. Push on armrests and boost up, leaning forward until you are on your feet.

6. Rocking back and forth several times may help boost yourself up more easily.

Elevated toilet seats with grab bars and “electric lift” chairs may be good options forthose with significant transfer limitations.


Transfers

23

Getting Up From Bed1. Bend knees up, placing feet flat on bed.

2. Turn on to side, reaching arm across body to assist rolling. (See illustration).

3. Move feet off edge of bed.

4. Use arms to push self into sitting position. (See illustration). A half side rail or chairfastened to the side of the bed may help.

Lying Down in Bed1. Sit on edge of bed.

2. Lift legs into bed(one at a time may be easier).

3. Lie down with head on pillow.

4. Slide legs into center of bed(moving one leg at a time may be easier).


Walking

24

Walking is an excellent activity for condition-ing and endurance. Parkinson’s disease maycause changes in your walking pattern andcontribute to balance loss and falls.

There are several things you can do to helpcompensate for these changes:

• Maintain space between feet to promotebetter balance support.

• Take a longer stride, allowing heel to strikefloor first with each step.

• Allow arms to swing freely at sides. Avoidputting hands in pockets or behind theback.

• Turn corners in a wide arc. Avoid crossingone foot over the other when turning.

• Try to make your first step a long one. Ifshort, shuffling steps occur, STOP! Startover, making your first step long enough tostrike heel down first.

• If you experience a “freezing” episode, tryto relax. Imagine you are stepping oversomething or marching in place to helpbreak the freeze.

• Wear good support shoes. Avoid open-toed, high-heeled, or crepe-soled shoes.

Assistive devices such as wheeled walkers or canes may improve your stability. Contactyour physician or physical therapist for specific recommendations, fitting, and gaittraining.


APDA Information and Referral Centers

Alabama, BirminghamUniversity of Alabama atBirmingham205-934-9100Arizona, TucsonUniversity of Arizona520-326-5400Arkansas, Hot SpringsSt. Joseph’s RegionalHealth Center800-407-9295501-518-1690California, Los AngelesCedars-Sinai Health System310-855-7933California, San DiegoInformation & Referral Center619-273-6763California, San FranciscoSeton Medical Center650-991-6391Connecticut, New HavenHospital of Saint Raphael203-789-3936Florida, JacksonvilleMayo Clinic, Jacksonville904-953-7030Florida, Pompano BeachNorth Broward Medical Center800-825-2732Florida, St. PetersburgColumbia Edward White Hospital813-898-2732Georgia, AtlantaEmory University School ofMedicine404-778-5120Idaho, BoiseSt. Alphonsus Medical Center208-367-6570Illinois, ChicagoGlenbrook Hospital847-657-5787The Arlette JohnsonYoung Parkinson Information& Referral CenterGlenbrook Hospital847-657-5787800-223-9776 - (Out of IL)Louisiana, New OrleansSchool of Medicine, LSU504-568-6554Maryland, BaltimoreJohns Hopkins Outpatient Center410-955-8795Massachusetts, BostonBoston University School ofMedicine617-638-8466Minnesota, MinneapolisAbbott Northwestern HospitalMinneapolis Neuroscience Inst.612-863-5850

Missouri, St. LouisWashington UniversityMedical Center314-362-3299Montana, Great FallsBenefit Health Care800-233-9040406-455-2964Nebraska, OmahaInformation & Referral Center402-551-9311Nevada, Las VegasMedical AssociatesUNLV School of Medicine702-671-2356Nevada, RenoV.A. Hospital702-328-1715New Jersey, New BrunswickRobert Wood JohnsonUniversity Hospital732-745-7520New Mexico, AlbuquerqueHEALTHSOUTHRehabilitation Hospital800-278-5386New York, AlbanyThe Albany Medical College518-452-2749New York, Far RockawayPeninsula Hospital718-945-7079New York, ManhattanNew York University212-983-1379New York, Old WestburyNew York College ofOsteopathic Medicine516-626-6114New York, SmithtownSt. John’s Episcopal Hospital516-862-3560New York, Staten IslandStaten Island University Hospital718-226-6129North Carolina, DurhamDuke University Medical Center919-681-2033Ohio, CincinnatiUniversity of CincinnatiMedical Center513-558-6770800-840-2732Oklahoma, TulsaHillcrest Medical Center 918-747-3747800-364-4450Pennsylvania, PhiladelphiaCrozer-Chester Medical Center610-447-2911Pennsylvania, PittsburghAllegheny General Hospital412-441-4100

Rhode Island, PawtucketMemorial Hospital of RI401-729-3165Tennessee, MemphisMethodist Hospital901-726-8141Tennessee, NashvilleCentennial Medical Center615-342-4635800-493-2842Texas, BryanSt. Joseph Regional Rehabilitation Center409-821-7523Texas, DallasPresbyterian Hospital of Dallas214-345-4224800-725-2732Texas, LubbockMethodist Hospital806-785-2732800-687-5498Texas, San AntonioThe University of Texas HSC210-567-6688Utah, Salt Lake CityUniversity of Utah, School of Medicine801-585-2354Vermont, BurlingtonUniversity of Vermont Medical Center804-982-4482Virginia, CharlottesvilleUniversity of Virginia Medical Center804-982-4482Washington, SeattleUniversity of Washington206-543-5369Wisconsin, AppletonAppleton Medical Center920-831-1844888-797-2732

Dedicated Centers

Armed Forces VeteransReno, NV702-328-1715The Arlette Johnson Young ParkinsonInformation & Referral CenterGlenbrook Hospital800-223-9776 (outside IL)847-657-5787

Please contact the nearest I&R Center or the National Office for information regardingSupport Groups and Chapters, or call the National Office at 1-800-223-2732.

You can also dial the toll free number 1-888-400-2732 to contact the I&R Center closest to you.


The American Parkinson Disease Association, Inc1250 Hylan Boulevard, Suite 4BStaten Island, NY 103051-800-223-2732 (toll free)

APDA West Coast Office10850 Wilshire Boulevard, Suite 730Los Angeles, CA 900241-800-908-2732

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Reprinted with permission by


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