pakinson's disease fitness counts

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Parkinson Disease:

Fitness

Counts

Parkinson Disease:

Fitness

Counts

3rd Edition

Heather Cianci, PT, MS, GCSThe Dan Aaron Parkinsons Rehab CenterParkinson's Disease and Movement Disorders Center at

Pennsylvania HospitalPhiladelphia, PA


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PAR KI NS ON D I S E A S E : FI T N E S S CO U N TS

ii

DISCLAIMER

The information contained in this publication is provided for informational and educational purposes only

and should not be construed to be a diagnosis, treatment, regimen, or any other health-care advice orinstruction. The reader should seek his or her own medical or other professional advice, which this publi-

cation is not intended to replace or supplement. NPF disclaims any responsibility and liability of any kind

in connection with the readers use of the information contained herein.


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Contents

Chapter 1 Foundation for Fitness .................................................... 1

Chapter 2 Putting It All Together .................................................... 9

Chapter 3 Balance, Falls and Posture .............................................. 19

Chapter 4 Helpful Therapies ............................................................ 26

Chapter 5 Carepartner Assisted Exercise ........................................ 28

Appendix A Resources........................................................................... 30

Appendix B A Note for Therapists...................................................... 32

About the Author ...................................................................................... 33

Acknowledgements .................................................................................... 35


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This manual is intended to be a resource for increasing your fitness level, and forimproving your ability to do everyday activities. Read Chapter 1 for an overview ofstretching, strengthening and conditioningthe foundation for fitness. For thehow to of exercises, see Chapter 2. Chapter 3 explains how fitness counts for goodbalance, posture, and preventing falls. Other therapies that are complementary to anexercise program are explained in Chapter 4. The appendices provides resources forcaregivers.

This booklet is part of a literature series addressing topics including nutrition,medications, speech and swallowing. The bookletActivities of Daily Living: Practical

Pointers for Parkinson Disease is particularly complementary to Fitness Counts. Thisfree booklet provides more information about activities of dailyliving and adaptive aids for PD. Contact the National Parkinson Foundation at(800) 327-4545, orwww.parkinson.orgto request a copy.

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About this booklet


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WHY EXERCISE?Some people turn away from exercise because they think that it will be too difficult,

or that they cant fit it into their busy schedules. Others simply do not understandhow exercise can help them. Exercise is important for everyone. It is the foundationfor fitness, and it also helps us fight the effects of aging.

If you have Parkinson disease (PD), exercise is even more important. Recentresearch shows that regular exercise can help people with PD stay more flexible,improve posture, and make overall movement easier.

While medication has long been the most promising treatment available, a regularexercise program should always be part of managing PD. Exercise is one of the fewtreatments available that is free, has no bad side effects, and can actually be enjoyable!Though exercise is not a cure, it can help you to stay ahead of the changes that takeplace in your body and can help you feel more in control of your condition.

PHYSICAL AND OCCUPATIONAL THERAPYThis manual is designed to provide general information and suggestions regarding

exercise to all people living with PD. Specific questions or problems should be dealtwith by a licensed physical therapist (PT) or occupational therapist (OT).

Physical or occupational therapists can:

Design or modify an exercise program to meet your particular needs. Evaluate and treat mobility and walking problems. Evaluate and treat joint or muscle pain which interferes with the activities

of daily living. Help with poor balance or frequent falling. Teach carepartners proper body mechanics and techniques for

assisting someone with PD.

Refer to movement and exercise programs in the community. Treat difficulties performing activities of daily living (ADL) such as eating,dressing, bathing and handwriting.

Recommend and teach the use of appropriate adaptive equipment.

Your doctor or other health care professional should be able to refer you to a thera-pist in your area. When possible, it is best to see a therapist that has special trainingand/or experience with PD. Visits to a physical or occupational therapist are usuallycovered by medical insurance with referral by a physician.

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Introduction


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To build a foundation for fitness you will need three main components:stretching, strengthening, and aerobic conditioning. Each component on its ownis important, but together they can help you remain as active as possible and bet-ter equipped to deal with the changes that PD can bring. After learning moreabout each of these components, you may follow along with examples of each inSection 2.

StretchingRegular s-t-r-e-t-c-h-i-n-gis the first step in your exercise program, and it can

be one of the most enjoyable. Stretching helps you combat the muscle rigiditywhich comes with PD. It also helps your muscles and joints stay flexible.People who are more flexible tend to have an easier time with everyday move-ment.

Why should I stretch?

You should stretch because it:

Increases range of motion of joints. Helps with good posture. Protects against muscle strains or sprains. Improves circulation . Releases muscle tension.

Dos and Donts of Stretching

DO stretch until you feel a gentle pull. DONT stretch to the point of pain. DONT bounce while you stretch. Bouncing can cause small tears in muscle

fibers. This can actually lead to less flexibility. DONT hold your breath while you stretch. Breathe evenly in-and-out

during each stretch. DONT compare yourself to others. Everybody varies in how far they

can stretch.

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Chapter 1:Foundation for Fitness


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When Should I Stretch?

A good thing about stretching is that you can do it at any time. Get yourday off to a good start by stretching before getting out of bed. Try to stretchthroughout the day. For example, you can stretch while you watch television or

ride in a car.

Choose a time for exercise when you are well-rested and your

PD medications are working.

How often should I stretch? Everyday!

How many times should I do each stretch?

Each stretch should be done 3 times. If you cant do the entire series of stretches

at one time, select a few stretches to do at different times throughout the day.

How long should I hold each stretch?

For at least 3-5 breath counts. 1 breath count = 1 full breath in and out.

A note about deep breathing

Learning how to breathe deeply will not only help you get more oxygen, butwill help you relax. Often times, people with PD take shallow breaths. Taking ashallow breath means we are not fully using our lungs or diaphragm. Shallowbreaths only use the upper part of the lungs and overwork the upper chest mus-cles. This can lead to tension and fatigue. It can also affect the quality of yourspeech. Full, deep breaths allow the diaphragm to lower and the lungs to expandmore deeply, ensuring more oxygen is taken in with each breath.

This simple exercise can help you practice breathing deeply:1. In a lying or sitting position, gently place your palms over your lower

abdomen2. Take in a full breath through your nose, allowing the diaphragm to expand.

You will feel your abdomen lift out if you are doing this correctly.3. Slowly breathe out through the mouth. Your out breath should last longer

than your in breath.4. Perform this exercise for 5 minutes a day, or at any time you need help to

feel relaxed.


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Breathing exercise

1. Stand tall with feet hip width apart.

2. Cross arms over one another.

3. Take in a deep breath and begin lifting arms up and open.

4. Breathe out and lower hands to starting pose.

5. Perform for 5 deep breaths.

Strengthening

Strengthening is another important part of a PD exercise program.Strengthening certain muscles can help you stand up straighter and can maketasks like getting up from a chair easier. Strengthening exercises also helps to

make bones stronger, so if you fall, you are less likely to get a fracture.Strength training is more than just lifting weights. If you have access to hand

held weights or a gym with weight machines, by all means, use them. However,you can build strength by using your own body weight as resistance. Likestretching, you can do strengthening exercises in the privacy of your home.The trick is to find out what kind of strengthening exercises work best for you.

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What tools do I need to do strengthening exercises at home?

There are many tools available that you can use to build strong muscles andbones. Choose the one that best suits your situation and surroundings.Here are some examples:

Small hand weights (commonly available in sporting goods departments). Wrist and ankle weights with Velcro closures. Elastic resistance bands, such as TheraBands. Common household items:

Soup cans Plastic shampoo or milk bottles filled with water or sand Laundry detergent bottles

Some exercises use your body weight as resistance. A few examples aresquats and prone on elbows.

Dos and Donts for strengthening

DO work one muscle group at a time. DO stop any exercise that causes pain. DO perform the movements slowly. DO concentrate on standing up straight while doing the exercises. DO breathe in while performing the movement, breathe outwhile relaxing

the movement.

DONT grip hand weights too tightly. DONT do rapid or "jerky" movements. DONT hold your breath. Breathe evenly throughout each exercise.

How much weight should I use?

Use a technique known as the 10 Rep Max. This means that you use themaximum amount of weight you can lift for 10 repetitions. For example, if youcan lift 3 pounds 10 times with no difficulty, the weight is too light for you. Youcould try 5 pounds. If you can only do 10 repetitions with 5 pound weights

before getting too tired to continue, 5 pounds is a good weight for you to use.

How often should I perform strengthening exercises?

You shouldnt perform strengthening exercises on the same muscles two daysin a row. So, you could strengthen your arms one day, and your legs the next,but you shouldnt strengthen your arms on both days.


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How many repetitions should I perform?

Begin by performing 1 set of 10 repetitions of the exercise. Slowly increaseto 3 sets of 10 repetitions.

Increase the amount of weight once you can perform 2-3 sets

with no difficulty. If you are unable to perform the entire series of strengthening exercises at

one time, select a few to perform at different times throughout the day.

Aerobic Conditioning Exercise

Aerobic, or conditioning exercise includes any nonstop activity that uses theentire body, working the heart and lungs as well as muscles. Examples of aero-bic activities include:

WalkingSwimmingWater aerobicsBikingDancing

Even some regular daily activities have an aerobic, or conditioning benefit,including:

Household chores such as mopping or vacuuming. Walking the dog. Gardening and yard work.

A program of regular aerobic exercise performed 3 or more times per week can:

Strengthen the heart and lungs. Improve stamina and endurance. Reduce stress.

Improve mood and combat depression. Help control high blood pressure, high cholesterol, and diabetes.

Aerobic, or conditioning may also be done from a seated position. "Armchairaerobics exercise videos can be found at many sporting goods stores or videoareas of department stores.


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How often should I perform aerobic exercise?

Your goal should be at least 20 minutes of aerobic exercise 3 times per week.Start slowly and gradually increase the time until you reach 20 minutes or more.

Begin by performing a 3-5 minute warm-up. This does not necessarily haveto be the same as the activity you are going to perform.Example: Walk around the block or march in place for 3-5 minutes beforeswimming or biking.

Finish your routine with a 3-5 minute cool-down. This can be done bycontinuing your activity for an additional 3-5 minutes at a lesser intensity, orswitching to a different activity.Example: If you were biking, either take a gentle walk or sit and perform legkicks.

You should get approval from your doctor before beginning an aerobic, or condi-

tioning program. This is especially important if you are over 50 years of age, or

have a history of cardiovascular disease.

How hard should I work when performing aerobic exercise?

There are two methods to rate how hard you are working.

The first is the Target Heart Rate method. This method helps you keep track

of your heart rate while exercising. For the best benefit, you should keep yourheart rate between 60-and-80% of your maximum heart rate. For beginners, it isgood to start out at 60%.

To calculate your Target Heart Rate, subtract your age from 220. This is themaximum number of times your heart can beat in a minute. This number is thenmultiplied by the percentage of your maximum heart rate that you want toexercise. If you are just starting you aerobic program, your target heart rateshould be between 60 to 75% of your maximum heart rate. Generally, after 6months at this rate, you may increase to 85%.

For example, if you are 65 years old:220-65=155: This is your maximum heart rate.If you want to exercise at 60% of your maximum heart rate:155 x .60= 93: This is your target heart rate.If you want to exercise at 80% of your maximum heart rate:155 x .80=124: This is your target heart rate if you want to exercise at 80% ofyour maximum heart rate.


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You can periodically check your heart rate by counting your pulse for 6 secondsand multiplying by 10. If the total is lower than your target heart rate, you canincrease how hard you are working. If the total is higher, you should work lesshard.

CAUTION - Do not use the target heart rate method if you: Take any medications that change your heart rate. Have a pacemaker. Have atrial fibrillation.

The following chart can give you a quick gauge of your target heart rate at 60%and 85% of your maximum heart rate.


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Age Target Heart Rate

60% 85%

30 114 16140 108 15350 102 14460 96 13670 90 12780 84 119


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The second method is the Borg Rating Scale. This scale assigns a number todescribe how hard you feel you are working. For your aerboic program, youshould gradually work up to level 13.

Least Effort

67 Very, Very Light89 Very Light

1011 Fairly Light1213 Somewhat Hard

1415 Hard1617 Very Hard1819 Very, Very Hard20 Maximum Effort


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Stretches

STANDING CHEST STRETCH

1. Stand facing a corner,placing forearms and palms on each wall.

2. Lean forward into the corner.

3. Keep head up and feet flat on floor.

SEATED NECK ANDCHEST STRETCH

1. Sit tall in a chair with hands claspedbehind back of chair.

2. Allow neck to gently fall back.

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Chapter 2:Putting it all together


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SEATED ROTATIONSTRETCH

1. Sit tall in a chair with one arm behindback of chair.

2. Reach around in front of you withother arm to grab the back of chair.

3. Turn your neck and look back overyour shoulder.

OVERHEAD STRETCH

1. Sit tall in a chair and interlock fingers together.

2. Turn palms facing out and slowly lift armsoverhead.

3. Gently allow neck to fall back andlook up at hands.

STANDING BACK STRETCH

1. Stand with feet hip width apart.

2. Place palms on low back.

3. Gently lean trunk and neck back.


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HAMSTRINGSTRETCH

1. Sit tall in chair and place one legstraight out on another chair.

2. Keep toes pointed up, kneesflat, and back straight.

3. Gently reach for toes.

4. Only reach as far forward asyou can without your kneebending.

LYING SHOULDERSTRETCH

1. Lie flat on your back.

2. If you are using a pillow, do notplace it under your shoulders.

3. Slowly lift arms straight up and allowthem to fall back overhead.

SEATED SIDE STRETCH

1. Sit to one side of a chair with arm rests.

2. Reach one arm down toward floor.

3. Reach other arm up and over to side.

4. Keep feet flat on floor.


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STANDING SHOULDERSTRETCH

1. Stand tall with feet hip width apart.

2. Clasp hands behind back.

3. Gently lift arms up and awayfrom the back, keeping head up.

ROTATION STRETCH

1. Lie on your back, with knees bent and feet flat. Arms should beoutstretched at your side.

2. Rotate both knees to one side, keeping arms and upper torso flat.

Turn head in opposite direction.

3. Repeat, rotating knees in the opposite direction.


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CALF STRETCH

1. Support upper body on wall. Stand atarms length from wall.

2. Step one foot back.

3. Lean weight forward onto front foot.

4. Press back foot down, keeping heels flaton floor and toes pointed forward

ANKLE CIRCLES

1. Kick foot in front of you.

2. Move foot in slow, complete circles.

3. Repeat in both directions.


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StrengtheningREMEMBER:

Begin by performing 1 set of 10 repetitions of theexercise. Slowly increase to 3 sets of 10 repetitions.

If you are unable to perform the entire series ofstrengthening exercises at one time, select a few toperform at different times throughout the day.

WALL SLIDES

1. Stand with feet about 6-8 inches from

the wall.

2. Rest your back and hands on the wall.

3. Slowly bend your knees and slide downthe wall.

4. Do not let your knees move past your feet.

5. Hold this pose for a count of 5.


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BRIDGING

1. Lie on back withknees bent and feetflat.

2. Raise hips up andsqueeze buttocks.

3. Hold this pose fora count of 5.

SHOULDER BLADE SQUEEZE

NOTE: A physical or occupationaltherapist can supply you with aTheraband or you can buy them atmost sporting goods stores.

1. Hook middle of Theraband arounddoorknob of closed door.

2. Hold ends of Theraband in each hand.

3. Slowly pull on TheraBand by pullingelbows back and squeezing shoulderblades together.

4. Hold this pose for a count of 5.

NOTE: You can also perform theshoulder blade squeeze without aTheraband.


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SHOULDER BLADE SQUEEZES

1. Place hands in front of chest.

2. Pull elbows back.

3. Avoid shrugging shoulders.

QUAD STRENGTHENING

1. Sit tall in chair.

2. Kick leg straight out, toes pointing up.

3. Hold leg for a count of 10.

QUADRAPED TRUNK

1. Begin on hands and knees,keep back level.

2. Reach one arm straightforward.

3. Extend opposite legstraight back.

4. Hold for a count of 3-5.


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PRONE ON ELBOWS

1. Lie on stomach.

2. Lift upper body off surface, supporting body weight on forearms.

3. Hold position for 5 to 10 counts.

NOTE: Remember, this is not a push up. Your back muscles should be doingthe work, not your arms.


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Aerobic exerciseSee the section on aerobic exercise on page 5.Perform aerobic exercise at least 3 times per week.


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Daily Exercise RecordWeek of ____________

Use this form to help keep track of your progress.

Day Aerobic/Conditioning Stretching Strengthening Other

Example Walked 15 minutes Performed 5 Performed all Performedexercises in leg exercises breathing

AM & 3 in PM exercisesand planted

in garden

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday


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How Can I Improve Balance?

Balance exercises can help improve balance and decrease the chance of falling.If you are having trouble with balance, or are falling, you should see a physical

therapist. Your doctor of or other health care professional can refer you to one.

A physical therapist can recommend specific exercises, equipment and tech-niques to improve balance and reduce falls.

BALANCE EXERCISES

1. Stand with feet hip width apart and onefoot ahead of the other.

2. Slowly shift weight forward onto frontleg and reach hands out in front of you.

3. Slowly shift weight backward onto theback leg and pull elbows back.

4. Move back and forth between the twomoves 10-20 times.

NOTE: Have someone near you for safety.

For safety, stand in front of a bed with achair in front of you, or have someone standnearby to guard you.

1. Stand tall with feet apart.

2. Slowly lift one leg and try to balance onthe other leg.

3. Try to balance for 5-10 seconds.


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legs are touching the chair. Reach back with both arms to slowly loweryourself. NEVER reach forward for the chair first and then turn to sit. Thiscan lead to landing sideways on the end of the chair, landing too hard in thechair, or missing the chair and falling to the floor.

What Should I Do if I Fall?

First, remain calm. Determine any pain or possible injuries before you try to

get up. Plan your strategy carefully. Use a heavy piece of furniture to assist in

getting up. If you doubt your ability to safely get up alone, crawl or scoot toa phone and call for help.

Persons who fall frequently should enroll in some emergency signalingsystem, and may need to use protective equipment such as knee and elbowpads to avoid repeated injuries.

Getting Up from the Floor1. Crawl to a sturdy piece of furniture, such as chair, bed, or sofa.

2. Hold on to the furniture as you raise one knee up so the foot is flat onthe floor.

3. Slowly push up on the bent knee so you straighten to stand.4. Keep holding for balance as long as needed.

A physical or occupational therapist can teach you the best techniques for getting

up from the floor.


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INCORRECT CORRECT


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Posture

PD can cause many changes in the body. One easily recognizable change isposture. The characteristic changes in posture can include:

A forward head position. Rounding of the shoulders and upper back. A forward trunk position with increased bending of the hips and knees.

Exercise and proper body positioning can help to limit or correct these changes.

Even without PD, it is very easy for anyone to fall into the habit of bad pos-ture. Some typical positions we place ourselves into contribute to bad posture.These include:

Sitting on the couch watching TV. Leaning over to work on the computer. Driving/riding in the car. Looking downward while reading, or propping your head against the

headboard while reading.

Fortunately, there are some easy ways we can break bad habits.

The following tips are helpful for maintaining good posture in all positions:

Sitting

Avoid sitting in chairs without back support or arm rests. Avoid recliners. They promote rounding of the neck, shoulders and

head, and also tightness in the hips. Avoid low, soft couches and chairs. The height of the chair should allow for your hips and knees to be level

with one another. Keep your chin parallel to the floor. Avoid crossing your legs. Keep your head, shoulders and hips in line with one another. Sit so that

your back is fully in contact with the chair back and seat. Use a lumbar roll along your low back, especially for long car rides,

plane rides and in the theater it will help you to sit tall. Your computer screen and TV should be at eye level to minimize

neck and eye strain.


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While reading, use a book stand or rest your elbows on a pillow or a table.This allows you to look directly ahead at the pages. When reading in bed, sitwith your entire back resting on the head board, not just your head andneck.

DO NOT sit for long periods at a time. After about 20-30 minutes, get up andmove around.

Example of poor sitting posture.

Standing and Walking

Keep your chin parallel to the floor. DO NOT look straight down while walking. Instead, look out in front

you and down. Keep a broad base of support by keeping feet at shoulder width. Keep your tummy in, your shoulders rolled back and your head and

chest up.


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Example of good sitting posture using

cushion and lumbar roll.


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Keep your thumbs facing forward with your palms facing in at your sides. Keep your hands free carry light loads in fanny packs or small back packs. Have walkers and canes adjusted to proper heights. A physical or

occupational therapist can help you with this.

Lying Down

Avoid using too many pillows, or too thin of a pillow under the head. The best postures for sleeping include lying on your back with a soft

pillow under the knees or lying on your side with a soft pillowbetween the knees.

Other Posture Hints

Perform frequent neck and shoulder stretches to relieve muscle tension. Maintain eye contact during conversation. This holds the head erect. Avoid sleeping in a chair - lie down to nap with the head and neck

supported. Practice these techniques every day. Place written reminders on commonly used items like the bathroom mirror,

computer screen, dashboard, television. Stand tall...Shoulders back...Sitstraight...Chin up

See a physical or occupational therapist for specific posture exercises.


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Massage Therapy

Massage therapy has been shown to increase circulation, stimulate lymphaticdrainage, reduce muscle tension, and promote relaxation. It can be particularlyhelpful to the person with PD who experiences problems with rigidity.

Massage is not a substitute for regular movement and exercise, but may be a

useful part in your overall exercise program. Select a massage therapist who iscertified by the American Massage Therapy Association, and interview thepotential therapist regarding the techniques they prefer to use. It is also impor-tant to provide feedback to the therapist throughout the massage regarding thelevel of pressure being used and any discomfort you experience.

Self-massage and care partner-assisted massage is possible. Using itemssuch as wooden rollers or hand-held electric massagers will allow you or yourcare partner to apply gentle pressure to tight areas of the body. These items canbe purchased at most drug or department stores. It is important to note that

massage services are often not covered by health insurance.

Tai Chi

Tai chi, an ancient form of Chinese exercise, is a slow, flowing form of move-ment which has been shown to aid in flexibility, balance, and relaxation. Manypeople with Parkinson's disease have reported benefits from learning and prac-ticing tai chi principles.

There are several forms of tai chi that can be done by anyone regardless of

age or physical condition. Classes are often offered at fitness centers, senior cen-ters, and community recreation centers. It is important to first speak with the taichi instructor to learn if the type of tai chi they teach is best for you. Videotapesteaching basic principles and moves of tai chi can also be purchased or rented ata variety of retail stores.

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Chapter 4:Complementary Therapies


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Yoga

Yoga is a form of exercise which can be very helpful for persons with PD.Yoga has been shown to increase flexibility, increase breathing and postureawareness, and help with relaxation and stress reduction. Yoga is a self-paced

activity, which means that not everyone has to perform a pose in the same wayor hold it for the same amount of time. Most poses can be modified dependingon your needs. Yoga can even be performed in a chair.

Since there are many types of yoga, it is important to contact the instructorprior to beginning a class. Generally, a beginner class or a class for those withspecial needs is a good place to start for those with PD.

Pet Therapy

"Lap" pets, such as dogs and cats, can provide great satisfaction in the lives oftheir human companions. Numerous studies have shown that having animals inthe home improves both mental and emotional health of their owners, not tomention ample opportunities for movement and exercise. Research has demon-strated that pets can:

Lower blood pressure and heart rate. Improve mobility and flexibility (through stroking, grooming, and

walking the pet).

Satisfy the human need for touch and nurturing.

Creative Expression

Creative expression, unique to each person, may also stimulate movementand physical activity. Painting on an easel with large, forceful strokes stretchesthe arms and shoulders. "Conducting" the music of a favorite symphony oropera has shown to have a strengthening and aerobic benefit.

Ceramics, woodworking (using extreme caution with power tools), and othercreative endeavors stimulate fine motor skills and improves manual dexterity andstrength. Singing alone or in a choral group promotes deep breathing needed forlouder speech and increased endurance.

Persons with PD are encouraged to research and identify the creative outletsthat best fit their talents and abilities.


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Persons with advanced Parkinson symptoms may not be able to follow com-mon exercise programs due to changes in physical or thinking abilities. It maybe better to work exercises and stretching into the daily routine. Here are somesuggestions for doing this:

Sitting and reaching in different directions can stretch the arms and trunk.

Household chores such as folding laundry, dusting, wiping dishes or assistingin food preparation take on added value as gentle exercise.

Simple games such as balloon volleyball, playing catch with a large, soft ballor blowing soap bubbles are fun alternatives to structured exercise.

Music stimulates movement such as marching or dancing. If balance is aproblem, try chair dancing. "Conducting" to the beat of up tempo music

provides both upper body exercise and good emotional therapy!

Perform a few extra arm and leg motions during dressing tasks.

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Chapter 5:Carepartner Assisted Exercise


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An example of partner-assisted hamstring stretching is demonstrated below:

1. Have the person with PD lie flat on their back.2. Kneel beside one leg.

3. Gently lift the leg by supporting itunder the ankle and above the kneeon the thigh.

4. Place the ankle on your shoulder (youcan place a folded towel here for

cushioning).

5. Place both hands on the thigh, justabove the knee.

6. Slowly lean forward to lift the legstraight up.

7. Push the leg until you meet withresistance.

8. Hold for 30 seconds, then lower theleg and relax.

9. Repeat on the other leg.


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National Parkinson Foundation, Inc. (NPF)

Telephone: (800) 327-4545Website: www.parkinson.org

American Physical Therapy Association (APTA)

Telephone: (800) 999-2782

Website: www.apta.org

American Occupational Therapy Association (AOTA)

Telephone: (301) 652-2682Website: www.aota.org

American Massage Therapy Association (AMTA)

Telephone: (847) 864-0123

Website: www.amtamassage.org

Yoga Journal's Teacher Directory

Telephone: (800) 359-9642Website: www.yogajournal.com/directory/

Exercise: A Guide from the National Institute on Aging

A 48-minute video shows you how to start and stick with a safe, effective pro-gram of stretching, balance, and strength-training exercises. You can order thevideo and 80-page companion booklet by mailing a check or money order for$7.00 to:NIAIC, Dept. WP.O. Box 8057Gaithersburg, MD 20898-8057Or visit the the website www.nia.nih.gov/exercisebook/

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Appendix A:Resources


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Gentle Fitness

A videotape of gentle stretches and exercise, guided by recreational therapistCatherine MacRae.Telephone: (800) 566-7780

Website: www.gentlefitness.com

Sit and Be Fit

The Parkinson's disease special edition patterned after the popular public televi-sion series hosted by Mary Ann Wilson, RN.Telephone: (509) 448-9438Website: www.sitandbefit.com

Parkinsons Disease & the Art of Moving

Written by John Argue, a movement & voice teacher, this book teaches exercisesand movement methods for coping with everything from balance to freezing.Available at most local or on-line book sellers. The video companion to thebook can be ordered by phone: (510) 985.2645 or on-line at www.parkinsonsex-ercise.com


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It is important that the therapist have a clear understanding of the purpose,side effects, and dosage of antiparkinson medications. Many patients areon multiple medications; therapy is most effective when the dopaminergicmedications are working at "peak dose" and the patient's motor function isgood. This may vary from day to day and even hour to hour. Detailededucational publications about Parkinson's disease and drug therapy are

available at no charge from the National Parkinson Foundation.

Recommended Readings

Here is an abbreviated reference list to help in your treatment ofpeople with PD:

Morris, ME. Movement Disorders in People with Parkinson Disease: AModel for Physical Therapy. Physical Therapy, 2000; 80(6): 578-595.

Schenkman, M, et al. (1998). Exercise to Improve Spinal Flexibility andFunction for People with Parkinson Disease: A Randomized, ControlledTrial. J Am Geriatr Soc., 46: 1207-1216.

Turnbull, GI., editor. (1992). Physical Therapy Management of ParkinsonsDisease. New York: Churchill Livingston.

Argue, J. (2000). Parkinsons Disease and the Art of Moving. California:

New Harbinger Publications.

Guidelines for Physiotherapy Practice in Parkinsons Disease link from theUniversity of Northumbria in England, website:http://online.northumbria.ac.uk/faculties/hswe/research/Rehab/Rehab.htm

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Appendix B:A Word to Rehabilitation Therapists


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Author, 2nd EditionHeather Cianci, PT, MS, GCS

Heather Cianci has been a physical therapist for over 10 years at Pennsylvania

Hospital in Philadelphia, Pennsylvania. For 6 years she has specialized in treat-

ing people with Parkinsons disease. Since 2000, Heather has been the senior

therapist at the Dan Aaron Parkinsons Rehabilitation Center at Pennsylvania

Hospital. Heather received her degree in physical therapy from the University

of Scranton in Scranton, Pennsylvania, and her Masters degree in gerontology

from Saint Josephs University in Philadelphia, Pennsylvania. She became a

Board Certified Geriatric Clinical Specialist in 1999. Heather frequently lectures

on Parkinsons disease to local college physical therapy programs, support

groups, and patient and caregiver symposiums. She is a consultant to the NPFs

Allied Team Training for Parkinson (ATTP) Program and is actively involved in

research on Parkinsons disease.

33

About the Author


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NPF Literature Feedback Form

Wed like to know what you think of our literature. Your answers will benefitboth patients and caregivers. Thank you for taking a moment to help.

Title of publication: Parkinson Disease: Fitness Count

Are you: A person with Parkinsons? Caregiver/family member?On a scale of 1 to 5, how easy was the material to understand?

(1 = not easy at all; 5 = very easy)

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On a scale of 1 to 5, how helpful was the information presented in the brochure?(1 = not helpful at all; 5 = very helpful)

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What would be the most important thing that we could do to improve thispublication?

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Please return this form to: National Parkinson FoundationAttn: Publications1501 NW 9th Ave.

Miami, FL 33136


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National Parkinson Foundation Centers of Excellence

Alexian Neurosciences InstituteHoffman Estates, Illinois

Aurora Sinai Medical CenterMilwaukee, Wisconsin

Beijing Institute of Pharmacology andToxicology, Academy of MilitaryMedical Sciences

Beijing, China

Betty and Morton Yarmon Center forParkinson's Disease at Beth IsraelMedical Center, The

New York, New York

California Neuroscience Institute at St.John's Regional Medical Center,The

Oxnard, California

Center for Neurological Restoration,Cleveland Clinic FoundationCleveland, Ohio

Centre for Movement DisordersMarkham, Ontario Canada

Centro Neurlogico Hospital FrancsBuenos Aires, Argentina

Chang Gung Medical CollegeTapei, Taiwan

Clinica Universitaria, University ofNavarraPamplona, Spain

Clinical Neuroscience CenterWilliam Beaumont Hospital Research

Institute Southfield, Michigan

Colorado Neurological InstituteMovement Disorders Center

Englewood, Colorado

Johns Hopkins Hospital Departmentof Neurology

Johns Hopkins HospitalBaltimore, Maryland

Juntendo University School ofMedicine - Dept. of NeurologyTokyo, Japan

Kings College LondonFranklin Wilkins Building,Waterloo Campus London, England

Kings County Hospital / SUNYDownstate Medical Center

Brooklyn, New York

Madden/ NPF Center of Excellencefor Parkinson's Disease and RelatedMovement Disorders,The Ohio State UniversityColumbus, Ohio

Massachusetts General HospitalNPF Center of Excellence, HarvardMedical School

Boston, Massachusetts

Medical College of Georgia, MovementDisorders Program

Augusta, Georgia

Muhammad Ali ParkinsonResearch Center

Barrow Neurological InstitutePhoenix, Arizona

Northwestern University Parkinson'sDisease & Movement Disorders CenterChicago, Illinois

Oregon Health & Science UniversityParkinson Center of Oregon

Portland, Oregon

Pacific Parkinson's Research Centre,

University of British ColumbiaVancouver, British Columbia Canada

The Parkinson's Disease & OtherMovement Disorders CenterUniversity of Southern California

Los Angeles, California

Parkinson's Disease and MovementDisorders Center of the University ofPennsylvania

Philadelphia, Pennsylvania

Parkinson's Disease Center & Movement

Disorders Clinic at Baylor College ofMedicineHouston, Texas

Rabin Medical Center, Sackler School ofMedicine, Tela Aviv University

Beilinson CampusPetah-Tikva, Israel

Scott & White ClinicTexas A & M University Health ScienceCenter Temple, Texas

Segawa Neurological Clinic for ChildrenChiyoda-Ku, Tokyo Japan

Southern Illinois University School ofMedicineSpringfield, Illinois

Struthers Parkinson's CenterGolden Valley, Minnesota

Technion - Israel Institute of TechnologyHaifa, Israel

Toronto Western Hospital Movement

Disorders CenterToronto Western Hospital MovementDisorders Centre University of TorontoToronto, Ontario

Universit Pierre et Marie Curie,Hopital de la Salptrire

Paris, France

University of CaliforniaSan Francisco Parkinson's DiseaseClinic & Research CenterSan Francisco, California

University of Florida Parkinson's Disease

& Movement Disorders CenterGainesville, Florida

University of Kansas Medical CenterParkinson's Disease Center

Kansas City, Kansas

University of North Carolina at ChapelHill School of MedicineChapel Hill, North Carolina

University of Pittsburgh School ofMedicine

Pittsburgh, Pennsylvania

University of Rochester Medical CenterRochester, New York

Klinik und Poliklinik fr Psychiatrie undPsychotherapie University of WrzburgWrzburg, Germany

Vanderbilt University Medical CenterNashville, Tennessee


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National HeadquartersBob Hope Parkinson Research Center

1501 N.W. 9th Avenue, Bob Hope Road Miami, Florida 33136-1494

Telephone: (305) 243-6666 Toll Free Natl: 1-800-327-4545 Fax: (305) 243-5595

E-mail: [email protected] World Wide Web: http://www.parkinson.org

VISIT US ON THE WEB AT:

WWW.PARKINSON.ORG

pakinson's disease fitness counts

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