Defeating the Barriers to Implementing Exercise Regimens in Parkinson’s Disease Patients
You can find out more about NPF's National Medical Director, Dr. Michael S. Okun, by also visiting the NPF Center of Excellence, University of Florida Center for Movement Disorders & Neurorestoration.
The recent surge in publications on Parkinson’s disease related exercise has left many patients and doctors ill equipped to implement these types of programs for individual sufferers. Most of the exercise trials in Parkinson’s disease have revealed meaningful benefits both in Parkinson’s specific symptoms, and in quality of life. Though we have yet to sort out the best types of exercise regimes, the mot appropriate frequency of exercise, and the optimal intensity of therapy for any individual patient, there is unfortunately an even larger issue facing the field. Many people suffering from Parkinson’s disease simply stated do not exercise. Understanding the barriers preventing implementation of a regular Parkinson’s disease exercise program will be important for both prescribing clinicians and for patients.
In the January 3rd issue of the journal Physical Therapy, Ellis and colleagues explored the barriers to exercise in community dwelling people with Parkinson’s disease. The authors studied 260 Parkinson’s disease patients and compared exercisers to non-exercisers. The patients were asked to complete the barriers subscale of the Physical Fitness and Exercise Activity Levels of Older Adults Scale. The study revealed that in people who did not exercise, there was a low expectation for positive benefit. The non-exercise group also was concerned about the amount of time needed per day to initiate such a program, as well as the fall risk associated with exercise.
Making our clinicians and our patients aware of the barriers to implementing exercise programs for Parkinson’s disease will aid us in overcoming the issues unearthed by Ellis et. al. There will, in the near future, likely be more Parkinson’s specific research studies that will shed even more light on this issue. In the man time, education will play a pivotal role in facilitating the implementation of exercise plans, and health care practitioners as well as family members should be prepared to present Parkinson’s disease patients with recent scientific data supporting the use of exercise. A higher level conversation about exercise, citing its proven benefits, has an enhanced potential to reverse some of the low expectations expressed by many Parkinson’s sufferers. Additionally, it should be stressed to patients that consistent daily exercise may be performed in small aliquots of time (30-60 minutes a day), and in many cases within the home setting. Finally, there are many exercises that can be performed safely without increasing the fall risk. Involvement of a physical therapist and a care partner can be useful in setting up a safe, and consistent home-based or gym-based program.
As more studies clarify the types of exercise we should be prescribing for individual patients, more clinicians will need to develop strategies to defeat the barriers to implementing exercise programs in Parkinson’s disease. Exercise is likely to improve the quality of life for most Parkinson’s disease sufferers, but we must meet the meet the public health challenge to get it adopted, and get it embraced by the Parkinson’s disease community.
Ellis T, Boudreau JK, Deangelis TR, Brown LE, Cavanaugh JT, Earhart GM, Ford MP, Foreman KB, Dibble LE. Barriers to Exercise in People With Parkinson Disease. Phys Ther. 2013 Jan 3. [Epub ahead of print] PubMed PMID: 23288910.
Ahlskog JE. Does vigorous exercise have a neuroprotective effect in Parkinson disease? Neurology. 2011 Jul 19;77(3):288-94. doi: 10.1212/WNL.0b013e318225ab66. Review. PubMed PMID: 21768599; PubMed Central PMCID: PMC3136051.
Posted: 2/4/2013 12:34:30 PM by
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