Exercise and Parkinson Wellness: What We’re Learning
Written by Kristina Dorkoski. Posted on June 14th, 2016.
Parkinson’s disease (PD) progressively impairs movement through the depletion of the neurotransmitter dopamine. By diagnosis, patients with PD have lost at least 50% of their dopamine-producing neurons and are already less active than their peers. Dopamine loss produces both motor and non-motor symptoms. Classic motor symptoms include bradykinesia (slow movement), hypokinesia (small movement), rigidity, resting tremor, postural instability, and impaired kinesthesia (ability to self-monitor and regulate movement). These deficits can lead to deterioration of walking, balance, fine motor skills, and speech production and articulation. Non-motor symptoms of PD, including depression, anxiety, apathy, sleep disorders, constipation, pain, and difficulty with dual tasking/ dividing attention, often compound the motor problems.
Treatment options for PD have come a long way since the discovery of dopamine deficiency in the brains of Parkinson’s patients in the 1960s. Starting in 2011, staff at Allied Services Integrated Health System became certified in the LSVT Big® and Loud® protocol, an intense program that includes physical, occupational, and/or speech therapy four times a week for four weeks. Dr. Becky Farley, a physical therapist and neuroscientist who established the efficacy of LSTV BIG® in a randomized clinical trial, has now spearheaded a more flexible therapy approach to PD—the PWR!4Life™ model. Her non-profit, Parkinson Wellness Recovery (PWR! ®) advocates for a new paradigm in PD care—that rather than waiting until people with PD have significant difficulty with mobility, they should be referred to therapy at diagnosis, start exercising early, and continue exercising for life.
For the past two years, I’ve had the opportunity to volunteer at a week-long exercise retreat hosted by PWR! ® in Scottsdale, Arizona. The PWR! ® Retreat is attended by people with PD and their care partners. Participants experience research-based, PD-specific exercise programming tailored to optimize neuroplasticity and function, and they are educated by Parkinson’s experts on current research developments, optimization of medications, and lifestyle modifications to maximize quality of life and delay progression of their PD.
PWR! ® emphasizes Parkinson’s as a mind-body disease that requires a holistic approach to wellness. Patient education on sleep hygiene, nutrition, stress reduction, etc. are viewed as paramount to treatment success. PWR!4Life™ therapy (http://www.pwr4life.org/pwr4life/) involves high-intensity aerobic training in conjunction with PD-specific skill acquisition. This combination, which addresses both motor and non-motor symptoms of Parkinson’s, has been shown most effective in improving mobility and quality of life in patients with PD. The aerobic training may come from a variety of means, depending on what interests the patient. It may involve circuit training, agility drills, treadmill training, cycling, etc. At the retreat, patients participated in hour-long Nordic walks with poles, Circuit classes (interval training), and Nexus classes (boxing and drumming activities) to fulfill the aerobic requirement. PD-specific skill acquisition was achieved through PWR!Moves™, a set of exercises created by Dr. Farley. These amplitude-focused movements target the specific deficits identified by research to hamper normal mobility in Parkinson’s. More information on these exercises can be found at http://www.pwr4life.org/pwr4life/.
At the PWR! Retreats, I led PWR! Moves™ classes for participants and their care partners, sat in on lectures by PD experts, and assisted participants with walking and agility drills during Nordic walking groups each morning. I was also selected to teach a daily “Breath Boost” class, in which I discussed research on the effects of breathing patterns and demonstrated proper breathing techniques for relaxation and exercise. Additionally, I participated in sessions on Mindfulness and Meditation, Qi Gong, yoga, dancing, nutrition, and Tai Chi for Parkinson’s.
I continue to utilize PWR! Moves™, Nordic walking, agility drills, yoga, and mindfulness with my patients with PD and look forward to incorporating boxing, drumming, dancing, and other new PWR!® therapies as they are developed.
About Kristina Dorkoski
Kristina Dorkoski, PT, DPT, PYT, CPI is an outpatient physical therapist, professional yoga therapist, certified Pilates instructor, and Reiki practitioner, specializing in neurological and geriatric rehabilitation. She was certified in LSVT Big® in 2011 and trained in PWR!Moves™ in 2013. Dr. Dorkoski is an adjunct faculty member in the Physical Therapy department at Misercordia University, where she instructs neuroscience labs and a special practices course she created on the use of Pilates and medical therapeutic yoga in rehabilitation. Additionally, Dr. Dorkoski serves as an adjunct faculty member at Professional Yoga Therapy Studies. She has lectured about Medical Therapeutic Yoga for the Pennsylvania Physical Therapy Association. Her research group’s poster (Dorkoski K, Vitale S, Trepper G, Castaldi M. The Influence of Yoga on Chronic Low Back Pain: A Review of Literature) was presented at the American Physical Therapy Association’s Combined Sections meeting in February 2016 in Anaheim, CA.