Physical Therapy for Parkinson’s Disease
Physical therapy and exercise are crucial aspects of Parkinson’s disease (PD) treatment and APDA has many ways to help you get up and moving.
Many people are curious about why exercise is so important for someone with PD and what type of exercise is best for someone with PD, which we’ve talked about in earlier programs and blog posts. This previous Q+A session also addresses the best way to approach exercise and PD.
Common questions about PT and exercise
People have many other questions about physical therapy and exercise that we would like to answer today. For example, there are times when doing exercise or physical therapy doesn’t seem to be helping and is in fact causing fatigue or pain. What should someone do then? Some questions we’ll discuss:
- What should someone do when exercise or PT doesn’t seem to help or may be causing fatigue or pain?
- What should a person with PD expect from exercise and rehab after a medical illness?
- What about particular trends in exercise – are these helpful to people with PD?
Learning about PT and Parkinson’s from the experts at Boston University
We turned to our trusted partners who are experts at the APDA National Rehabilitation Resource Center for Parkinson’s Disease located at Boston University to help us address these often-asked physical therapy and exercise related questions. Thank you to physical therapist Tim Nordhal, PT, DPT, who along with the help of Nick Wendel, PT, DPT and Teresa Baker PT, DPT, provided us with this important information.
Rehabilitation After a Medical Challenge
PD must be taken into consideration when facing a hospitalization, surgery, or illness. If the hospitalization or surgery is planned, it is very important to first have a conversation with your neurologist as well as others on your health care team to get a clear idea of what to expect. It is also very important to talk to the doctors taking care of you in the hospital about the importance of receiving your PD medicines on schedule. This can impact your recovery and your outcome.
Before any surgery, discuss anesthesia options with your surgeon and neurologist. This can help to reduce potential complications following the surgery. It will also ensure that you are able to proceed with your rehabilitation efforts, which may include physical and occupational therapies, as well as any other treatments designed to return you to your previous level of physical functioning, as soon as possible.
Starting rehabilitation as soon as possible after an illness can facilitate recovery. While in the hospital, getting out of bed (when it is safe to do so) and gradually increasing the amount of walking is important to get you home as soon as possible. We strongly encourage you to be optimistic and to advocate for yourself while hospitalized. It’s important to ask questions, ask for your PD medications on time, and ask for physical therapy to get started asap!
Weighing the Risks and Benefits of Joint Replacement Surgery
The risks and benefits of joint replacement (i.e., hip, knee, shoulder) must be weighed for each individual when deciding on whether to pursue surgery. The potential benefits of surgery include reduced pain and increased mobility – both of which can substantially improve the Parkinson’s symptoms of a person with PD in the long run and improve quality of life.
The short-term risks include (but are not limited to):
- Decreased mobility that occurs immediately after surgery and before recovery
- Anesthesia reaction
- Possible infection
If you decide to proceed with joint replacement surgery, you should start rehabilitation as soon after the surgery as you are medically stable. The rehabilitation course will be different depending on what joint is replaced and the specific surgical approach used, but the first few weeks are generally focused on getting you safely moving. Some people will go to an inpatient rehabilitation hospital after surgery if more intensive care is needed. Others may go straight home where physical and occupational therapies will be provided. The focus will be on restoring mobility – getting up and down stairs, getting in and out of bed, and standing up from a chair. Making sure you can get yourself dressed and safely navigate the bathroom and shower will be priorities.
After becoming more independent at home, many people will proceed to outpatient physical and occupational therapies where the focus should be on getting you back to, or hopefully exceeding your prior level of function (since the goal of a joint replacement is typically to reduce pain and get you more active). The focus will be on improving the quantity and quality of your walking and your overall level of mobility in the community. This entire process can take a while, for most people around 3-5 months or so. Typically, rehabilitation for people with PD may be a longer process than for people without PD – so be patient with yourself, and don’t give up on the process — you’ve got to stick with it to get the full benefits.
PT-related Pain, Fatigue, and Breathlessness
Feelings of Discomfort or Pain after Physical Therapy
In general, you should not experience prolonged discomfort or pain from physical therapy or exercise. Some people experience muscular soreness when starting an exercise routine, but this should not last more than a day or two and we can minimize this by being thoughtful about how you progress through your exercise program. A big part of our jobs as physical therapists is to provide you with an individualized exercise program that can help you to meet your goals without leading to additional problems like orthopedic injuries or pain. In other words, exercise should enhance your life and not take away from the activities in your daily routine that are most important to you! If you feel pain after a session of PT, tell your physical therapist and he/she will modify your regimen.
Assessing Shortness of Breath After PT
Sometimes people report feeling out of breath after a PT session. This is tricky to assess because people use the phrase “out of breath” differently. There is research demonstrating that vigorous exercise can help reduce the motor symptoms of Parkinson disease – so it can be good to feel like you are pushing yourself, which means you may be breathing faster and working up a sweat during a PT session. If you are new to exercise and just getting started, you may feel “out of breath” when just getting started but this should improve as you become more fit. It is important to note that if you experience the sensation of shortness of breath with exercising, it is important to discuss this with your doctor and physical therapist to ensure your exercise routine is a good fit given your general health and any other medical conditions you may have.
Exercise and Fatigue: Finding the Balance
Fatigue is a complex symptom. Many people with fatigue find that a regular exercise routine can help reduce fatigue, while others feel that exercise can make the fatigue worse. In general, it is helpful to find a good balance between engaging in exercise while avoiding the type of fatigue that can linger over the rest of the day. Fatigue over the rest of the day may be a sign that you may be exercising too hard or for too long in one session. We recommend ramping up exercise gradually and taking rests as needed. If prolonged exercising leads to fatigue, it can help to exercise for shorter bouts more frequently. Sometimes, a short rest after exercising can help. Meeting with a physical therapist can help so you can talk through a few other options for your exercise routine that can help you stick to it and reap the most benefit from your program over the long term. And as always, keep your neurologist informed about any symptoms you are experiencing.
Trends in Exercise
What are the Benefits of Trends Such as High Intensity Interval Training for People with PD?
One of the most common questions we get asked about in our practice is whether or not particular trends in exercise also benefit people with PD. One such example is high intensity interval training (also called HIIT training), an exercise regimen in which a person engages in bursts of very impactful exercise for short periods, followed by periods of less intense exercise. Another is forced exercise, via a tandem bike, in which a partner pedals faster than a person with PD would pedal on their own.
As clinicians, we are always looking for ways to answer our patient’s questions that are pulled right out of the latest, high-quality studies. However, because research develops slowly, we don’t have as much data on these newer trends. But we do know a lot about certain types of exercise for PD, which are summarized below. We also encourage readers to download the APDA Be Active & Beyond booklet which has a lot of great information about exercise for people with PD and very helpful instructions on how to incorporate it safely into your routine
Research Reveals Benefits of Aerobic, Resistance, and Balance Exercise
The evidence from the research suggests that there are several elements of exercise that are important for people with PD.
Aerobic, Resistance, and Balance Exercises
- Aerobic exercise should be done at least at a moderate intensity (e.g., you can talk, but not sing) for about 30 minutes 3-4 days per week. Aerobic exercise can be done in a variety of different ways including walking on a treadmill, brisk walking in your neighborhood, or cycling on a stationary bike. There isn’t enough evidence to suggest that using a tandem bike is more beneficial than using a regular exercise bike if you can maintain at least moderate intensity.
- Resistance training can involve using weights, elastic bands, or even just body weight (e.g., squatting) to help strengthen muscles and improve the speed of movement.
- Balance training can involve balance exercises (e.g., standing on one leg) or activities like tai chi or dance, and should be carried out 2-3 times per week for about 30 minutes.
High intensity interval training can include aspects of these important elements — aerobic, resistance, and balance training — although there isn’t sufficient evidence to determine whether there are added benefits (or drawbacks) of high intensity interval training specifically for people with PD.
Finding an Exercise You Enjoy Doing
What is most important is that you incorporate the key elements of exercise into your routine in a way that works best for you – so that you can continue the program safely over the long-term. It is very helpful to find a type of exercise you enjoy doing so you will be more inclined to stick with it; and you might need to try more than one type before figuring out what you enjoy most. (Helpful tip: A great way to try out different types of exercise is though our virtual exercise and movement classes that you can try from home – check out our Virtual Event Calendar to see what’s coming up next.)
It is also important to be aware of “fads” or highly marketed programs, as there really isn’t one best routine for every person with PD. If you are not sure what is best for you, consult with a physical therapist who can provide guidance as to the type of exercise that will best meet your individual needs.
When is the best time to exercise?
Effects of medication
It is a good idea to exercise when your PD medications are most effective because the PD medications help with mobility – making it easier to move and do your fitness class or physical therapy exercises. You are also more likely to get a rigorous workout when the medications are working well. Experiences may vary from one person to another depending on how much improvement occurs after taking medication. The most important thing is to find a routine that works for you – something that is safe, enjoyable, and sustainable!
Time of day
In addition to your medication timing, it’s also important to factor in your unique preferences and life situation when determining the best time for you to exercise. When do you typically have the most energy? When during the day do you have the fewest distractions in your schedule that can get in your way? For some people, early in the morning works best, but others find their schedule clears and the inspiration strikes later in the afternoon. Set yourself up for success by scheduling your exercise and/or physical therapy at times that best suit your life. Keep in mind the importance of being well-medicated to make sure you can move your best while exercising.
Tips and takeaways
- Exercise and physical therapy can be very beneficial for people with PD, although people have many common questions about how to best incorporate fitness and movement into their lives.
- Rehabilitation efforts should begin as soon as possible after a hospitalization or surgery and return to baseline may take longer for someone with PD than someone without PD.
- PT and exercise should not cause pain, substantial fatigue, or shortness of breath. If these things do happen, talk with your PT as well as neurologist so that adjustments can be made and/or a better exercise regimen can be planned for you.
- Schedule your exercise for when your PD medications are working best and at a time of day that best suits your symptoms and lifestyle.
- Learn more about physical therapy and safely exercising at home by viewing our Let’s Keep Moving With APDA webinar series.
- If you have questions about physical therapy for PD, you can contact the APDA National Rehabilitation Resource Center for Parkinson’s Disease at 888-606-1688.