Parkinson’s & Exercise, 3hr/$21

A15: Parkinson’s Disease and Exercise, 3 CE hours, $21


Professor Rudolf Klimes, PhD, welcomes you to this online course. Keep going.

START the course here. TAKE the exam at the end. PAY after the exam.

Course Description: The following course contains discussion on Parkinson’s disease (PD), which are motor system disorders resultant from the loss of dopamine-producing brain cells. If you have Parkinson’s or are close to someone that does, know that there are many different levels and various indication, some not as serious as others. Please read on to learn more about the intricacies of this ever more prevalent disease.

Course Objectives: At the end of the Parkinson’s and Exercise course, you will be equipped to 1) Describe what it is 2) Define common diagnosis and symptoms 3) Discuss the prognosis and current research being done 4) Learn about the benefits of exercise and study sample exercise programs 5) Explore disease management an coping mechanisms 6) Explore current resources with include patient resources, financial issues, current clinical trials and genetics.

Course Format: Online linked resources and lectures that you can use anytime 24/7. One multi-choice test.

Course Developers and Instructors: R. Klimes, PhD, MPH (John Hopkins U), well known author and scholar in health-related research and health behaviors. 

Course Time: About three hours for online study, test taking with course evaluation feedback and certificate printing.

START the course here. TAKE exam at the end. PAY after the exam.

A 15   Parkinson’s Disease and Exercise  

What is Parkinson’s Disease?

Parkinson’s disease (PD) belongs to a group of conditions called motor system disorders, which are the result of the loss of dopamine-producing brain cells. The four primary symptoms of PD are tremor, or trembling in hands, arms, legs, jaw, and face; rigidity, or stiffness of the limbs and trunk; bradykinesia, or slowness of movement; and postural instability, or impaired balance and coordination. As these symptoms become more pronounced, patients may have difficulty walking, talking, or completing other simple tasks. PD usually affects people over the age of 50.  Early symptoms of PD are subtle and occur gradually.  In some people the disease progresses more quickly than in others.  As the disease progresses, the shaking, or tremor, which affects the majority of people with PD may begin to interfere with daily activities.  Other symptoms may include depression and other emotional changes; difficulty in swallowing, chewing, and speaking; urinary problems or constipation; skin problems; and sleep disruptions.  There are currently no blood or laboratory tests that have been proven to help in diagnosing sporadic PD.  Therefore the diagnosis is based on medical history and a neurological examination.  The disease can be difficult to diagnose accurately.   Doctors may sometimes request brain scans or laboratory tests in order to rule out other diseases.


Is there any treatment?

At present, there is no cure for PD, but a variety of medications provide dramatic relief from the symptoms.  Usually, affected individuals are given levodopa combined with carbidopa.  Carbidopa delays the conversion of levodopa into dopamine until it reaches the brain.  Nerve cells can use levodopa to make dopamine and replenish the brain’s dwindling supply.  Although levodopa helps at least three-quarters of parkinsonian cases, not all symptoms respond equally to the drug. Bradykinesia and rigidity respond best, while tremor may be only marginally reduced. Problems with balance and other symptoms may not be alleviated at all.  Anticholinergics may help control tremor and rigidity.  Other drugs, such as bromocriptine, pramipexole, and ropinirole, mimic the role of dopamine in the brain, causing the neurons to react as they would to dopamine.  An antiviral drug, amantadine, also appears to reduce symptoms.  In May 2006, the FDA approved rasagiline to be used along with levodopa for patients with advanced PD or as a single-drug treatment for early PD.

In some cases, surgery may be appropriate if the disease doesn’t respond to drugs. A therapy called deep brain stimulation (DBS) has now been approved by the U.S. Food and Drug Administration. In DBS, electrodes are implanted into the brain and connected to a small electrical device called a pulse generator that can be externally programmed. DBS can reduce the need for levodopa and related drugs, which in turn decreases the involuntary movements called dyskinesias that are a common side effect of levodopa. It also helps to alleviate fluctuations of symptoms and to reduce tremors, slowness of movements, and gait problems. DBS requires careful programming of the stimulator device in order to work correctly.


What is the prognosis?

PD is both chronic, meaning it persists over a long period of time, and progressive, meaning its symptoms grow worse over time.  Although some people become severely disabled, others experience only minor motor disruptions. Tremor is the major symptom for some individuals, while for others tremor is only a minor complaint and other symptoms are more troublesome.  It is currently not possible to predict which symptoms will affect an individual, and the intensity of the symptoms also varies from person to person.

What research is being done?

The National Institute of Neurological Disorders and Stroke (NINDS) conducts PD research in laboratories at the National Institutes of Health (NIH) and also supports additional research through grants to major medical institutions across the country.  Current research programs funded by the NINDS are using animal models to study how the disease progresses and to develop new drug therapies. Scientists looking for the cause of PD continue to search for possible environmental factors, such as toxins, that may trigger the disorder, and study genetic factors to determine how defective genes play a role.  Other scientists are working to develop new protective drugs that can delay, prevent, or reverse the disease.  


Exercise and Parkinson’s disease

Evidence suggests that regular exercise can improve some symptoms of Parkinson’s disease and improve your quality of life. You should consult closely with your doctor, physiotherapist or healthcare professional when devising your own exercise program.

Benefits of regular exercise with Parkinson’s disease

Benefits of regular exercise for a person with Parkinson’s disease can include:

  • Better control over gross motor movements, such as walking
  • Greater muscle strength and flexibility
  • Increased cardiovascular fitness
  • Improved coordination and balance
  • Improved posture
  • Reduced muscle cramping
  • Greater confidence in performing daily activities
  • Reduced stress levels
  • Improved joint mobility.

General recommendations on exercising and Parkinson’s disease

General recommendations on getting started include:

  • Aim for at least 15 minutes of exercise every day.
  • Include a thorough stretching program that targets each joint and muscle group.
  • Spend a few minutes warming up and cooling down. This could include marching in place or stretching.
  • Start with the easiest exercises first. Slowly introduce the more difficult exercises as your fitness increases.
  • Try to perform each movement to the best of your ability.
  • Stop and rest if you feel tired at any point, as over-exertion can make your symptoms worse.
  • Stop doing any exercise that causes you pain.
  • If you suffer from fatigue, try exercising earlier in the day.
  • Try to make exercising fun. You could exercise with others or play your favourite music.

Safety while exercising and Parkinson’s disease

If you are at risk of falling or freezing (sudden inability to move), general safety suggestions include:

  • Do your exercises sitting down.
  • Hold onto a chair when doing standing exercises.
  • Don’t do floor exercises if you can’t get up by yourself.
  • Only exercise when other people are at home who can help if necessary.
  • Exercise with others.
  • Ask for assistance from a family member or friend.

Sample exercise program for a person with Parkinson’s disease

Be guided by your doctor, physiotherapist or healthcare professional when devising an exercise program. Aim to build up to 8–10 repetitions of each exercise. Ideally, the exercise program should target overall fitness and muscle flexibility, as well as specific body parts.

Exercises for overall fitness

Walking is excellent for overall fitness. Suggestions include:

  • Choose flat, obstacle-free terrain.
  • Gently stretch your leg muscles before you start walking.
  • Taking larger strides may help you balance better.
  • Focus on lifting each foot and placing it down heel first.
  • Count each step – this can help to make a smoother, more rhythmic walking style.
  • If walking isn’t practical or possible for you, explore other options such as water aerobics or stationary cycling.
  • Aim to perform aerobic exercise about three times per week.

Exercises for muscle flexibility

Stretching suggestions include:

  • Hold an easy stretch and don’t bounce.
  • Maintain the stretch for 30 seconds.
  • Repeat each stretch twice.
  • If you feel any pain or discomfort, ease off.
  • Incorporate gentle stretching into your warm-up and cool-down routines.

Exercises for your face

Pull faces at yourself in the mirror. Suggestions include:

  • Surprise – lift your eyebrows and open your mouth.
  • Displeasure – frown and purse your lips together.
  • Disgust – crinkle your nose as if you’re smelling something truly awful.
  • Pleasure – make a big smile.

Exercises for your head and shoulders

Suggestions include:

  • Turn your head slowly from left to right, aiming to glance over each shoulder.
  • Lift your face to the ceiling, then drop your chin to your chest.
  • Drop your left ear to your left shoulder. Straighten up. Drop your right ear to your right shoulder.
  • Raise and lower your shoulders. Roll your shoulders forwards, then backwards.

Exercises for your arms and torso

Suggestions include:

  • Clasp your hands and raise your arms overhead. Lower slowly.
  • Put your hands behind your head and open out your elbows.
  • To improve your posture, spend time lying flat on your back, preferably without a pillow. If this is too difficult, use the flattest pillow you can tolerate.

Exercises for your hands and wrists

Suggestions include:

  • Touch the tip of each finger to your thumb.
  • Rotate your hands so the palms face up, then down.
  • Bend your hands at the wrists, up and down.
  • Clench and unclench your fists.

Exercises for your legs

Suggestions include:

  • Lie flat on your back, bend one knee, and hug it to your chest. Straighten the leg. Repeat with the other leg.
  • Sit down, extend one leg and make a circle with your foot. Repeat on the other side.
  • While sitting down, rock your feet from heel to toe, encouraging full ankle movement.
  • While sitting down, straighten one leg at a time.
  • While sitting down, slowly raise and lower your leg as if stamping your foot in slow motion. Repeat with the other leg.
  • Perform stationary marching, lifting each leg as high as you can.
  • Lie flat on your back with your knees bent. Lift your buttocks off the bed.

Exercises using light weights

Light weights can increase the intensity of your exercise program. You can buy weights that strap with Velcro tape to your wrists and ankles, or use household items such as soup tins or water-filled bottles. Choose a weight that you can push or lift (without pain or fatigue) for an easy 10 repetitions. Only increase the weight once you can comfortably perform three sets of 10 repetitions.




Primary Outcome Measures:of study on Parkenson’s and Exercise.

  • Adherence to exercise [ Time Frame: 6 months ] [ Designated as safety issue: No ]
    To test whether individuals with de novo Parkinson’s disease (naïve to drug treatment) can achieve the randomly assigned levels of mean exercise intensity (60-65% average HRmax or 80-85% average HRmax) and adhere to the exercise protocol.

Secondary Outcome Measures:

  • Potential for therapeutic efficacy [ Time Frame: 6 months ] [ Designated as safety issue: No ]

    To determine if intense endurance exercise warrants further investigation as a therapeutic intervention for motor symptoms in the treatment of de novo Parkinson’s disease by conducting a futility trial.

    The exercise groups will demonstrate potential for therapeutic efficacy using a futility threshold of theta = 3.5 points on the Unified Parkinson’s Disease Rating Scale(UPDRS)motor scale at 6 months when compared with the no exercise control group who are wait-listed to then receive treatment. The incidence of adverse events and 6-month attrition associated with the exercise groups will also be evaluated.


Resources: Read what you need…

Illustration of the brain

National Institutes of Health


  • MedlinePlus links to health information from the National Institutes of Health and other federal government agencies. MedlinePlus also links to health information from non-government Web sites. See our disclaimer about external links and our quality guidelines.


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