The Impact of Exercise Rehabilitation and Physical Activity on the Management of Parkinson's Disease

A.M. Johnson, PhD; Q.J. Almeida, PhD

Disclosures

Geriatrics and Aging. 2007;10(5):318-321. 

In This Article

Musculoskeletal Rehabilitation Strategies

The most frequently targeted symptoms of PD (in both musculoskeletal and neurological rehabilitation paradigms) are gait dysfunction and postural instability--perhaps because these rehabilitation strategies have proven less effective, thus far, for tremor and bradykinesia. To this end, physical therapy programs typically emphasize strength training (predominantly trunk strength but also for all four limbs), balance training, and a range of techniques aimed at improving flexibility. Furthermore, the most effective therapeutic programs involve repetitive exercises that can be practised by patients at home. de Goede et al.[11] conducted a meta-analysis of physical therapy interventions among patients with PD and found that conventional musculoskeletal therapy had a significant effect on (in order of descending effect size) walking speed, stride length, activities of daily living, and neurological signs.

Improving trunk strength, in particular, has numerous implications for individuals with PD, impacting posture, balance, and cardiopulmonary status.[12] Physical therapy programs focusing on trunk strength in individuals with PD have been demonstrated to produce significant improvements in weakness and stiffness that are similar to improvements demonstrated by healthy older adults. Similarly, exercises that focus on improving mobility of the trunk have been demonstrated to produce a significantly improved ability to recover from postural disturbances.[13,14]

Another key rehabilitation technique that has met with success is bodyweight-supported treadmill training (Figure 1). In this technique, patients are harnessed within an overhead sling that supports a portion of their weight while they walk on a treadmill. The technique is intended to allow patients an opportunity to walk at an increased rate (and for a longer distance) than would otherwise be possible. This simple physical training method has been shown to produce greater gait improvements than conventional physical therapy approaches,[15] with effects lasting for at least 4 months after the conclusion of therapy.[16] Interestingly, studies that compare actual gait practice and training (where the patient walks) have shown a significant benefit over the training of individual components of gait (i.e., gait preparation exercises).[17] Future research in this area needs to investigate whether improvements elicited by treadmill training are attributable to increased safety and security (which may improve compliance with prolonged physical activity), increased feelings of self-efficacy, or improved motor programming.

Managing Parkinson's Disease with Physical Therapy and Exercise Rehabilitation

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