• Welcome back to the third blog of this four part series about exercise.  In part one you learned about the importance of exercise for the body and the brain as well as the concept of neuroprotection (the slowing, stopping, or reversing of a neurodegenerative process with exercise).  Part two discussed the concept of neuroplasticity, or how the brain can be altered by doing and not doing, in detail.  In this third installment, our national exercise guidelines and different types of exercise will be discussed. Please remember when reading this series to keep your own personal medical history in mind and consult with your physical therapist or physician before beginning or changing your exercise program.

    How much exercise should I be doing?

    The 2008 Physical Activity Guidelines for Americans aimed to answer that question.  The guidelines break up recommendations by age group.

    For adults up to age 65, the guidelines recommend at least 2 hours and 30 minutes (150 minutes) of moderate-intensity exercise a week or 1 hour 15 minutes (75 minutes) of vigorously intense aerobic exercise.  They also note that you can do a combination of vigorous and of moderate intensity exercises.  The guidelines recommend that aerobic exercise should be done a minimum of 10 minutes at the time and should be spread throughout the week.  The guidelines also state that for additional health benefits, you may want to consider increasing your aerobic physical activity to 5 hours per week of moderate intensity or 2 hours 30 minutes per week of vigorous intensity.  In addition to the aerobic exercise, adults should do muscle strengthening exercises at a moderate or high intensity that target our major muscle groups on 2+ days per week.

    The guidelines have specific recommendations for older adults (above age 65) as well.  They continue to recommend the 2 hours and 30 minutes per week of moderate intensity aerobic activity and, in addition, recommend that balance exercises are performed regularly.

    What is aerobic exercise?

    Aerobic exercise, often called “cardio,” is a type of exercise in which the muscles use oxygen through a process of aerobic metabolism to efficiently meet your body’s energy demands.  Examples of aerobic exercise include walking, water aerobics, biking, tennis, dancing, running, swimming laps, jumping rope, hiking…the list goes on and on.  Aerobic exercise will usually increase your heart rate – unless you are on heart rate modifying medications (which is why it is important to work with your physical therapist or physician before starting or modifying your exercise program).  Aerobic exercise will also increase your rate of breathing.

    How do I know if I am achieving moderate or vigorous intensity?

    This is an interesting and very important question.  The 2008 guidelines describe reaching a level of moderate intensity exercise when a person doing the activity can talk but is unable to sing during the activity.  They describe vigorous intensity activity as not being able to say more than a few words without pausing for a breath.  In my opinion, these descriptors of exercise intensity can be helpful but they can also lead to confusion – especially for someone who has not experienced the feeling of moderate or vigorous intensity in a while.

    In an interesting study by Canning and colleagues, published in May 2014, the authors looked at how accurate a person is when identifying various intensities of exercise using the physical activity guidelines descriptions.  Each participant was instructed in the guideline’s definitions of physical activity and then was asked to walk or jog at different aerobic intensities (light, moderate, and vigorous) in a random order.  The researchers then compared the participant’s self-selected intensities to more objective heart rate measurements associated with each level of intensity.  The researchers found that the participants correctly estimated a light effort exercise.  However, participants tended to underestimate the intensity needed for moderate and vigorous effort while walking or jogging.

    This study shows that the physical activity guidelines descriptions may not be the best way for us to be measuring the intensity of our aerobic exercise.  Please don’t get me wrong – I’m not telling you this to discount the “talk but not sing” rule.  Instead, I want you to be aware that (1) you may think you are achieving the appropriate intensity benchmarks but instead are falling short of the mark and (2) there may be more accurate methods such as heart rate max measurements to measure your exercise intensity.  A full discussion of calculating heart rate max is out of the scope of this paper as the calculations are personalized and must take into account your specific age as well as your medical history.  However, if you are interested in learning more I recommend you contact your physical therapist, physician, or exercise trainer.

    So what’s the bottom line on intensity?  If you are unfamiliar with exercise or have not experienced moderate/vigorous intensity exercise, you may want to work with a physical therapist or athletic trainer so that they can teach you what it feels like to exercise at those levels.

    What about stretching?

    Stretching should be another important part of your exercise routine.  Stretching helps to loosen tight muscles and can also help with posture.  Please keep in mind though that stretching alone is not considered moderately or vigorously intense and should be combined with aerobic activity and strength training for a complete exercise program.

    What are some types of exercise that have been found to be beneficial to people with Parkinson’s disease?

    Any exercise is better than no exercise, no matter a person’s health condition.  But there are some exercises that research indicates may be especially valuable for people with Parkinson’s disease.  Walking is shown to be extremely beneficial (especially if you are taking those BIG steps!) and Nordic Walking, walking with long poles, has also been suggested as a useful form of exercise for people with Parkinson’s diseasae.  There is also evidence that biking is a helpful form of exercise – although researcher Jay Alberts argues that it is in fact the intensity or rate of pedaling rather than just being on a bike that is important (recall part two where we discussed the concept of intensity of exercise leading to brain changes).  In regards to balance activities, tai chi has also been shown to be beneficial in reducing fall risk and improving balance.

    There are also exercise programs that have been designed specifically for people with Parkinson’s disease.  Both LSVT BIG and PWR! programs are evidence-based, target neuroplasticity, address intensity, and target specific movement patterns that are challenging for people with Parkinson’s disease.  The John Argue Method is another technique that people with Parkinson’s often find useful.  David Zid’s Delay the Disease series is an exercise program that uses the concepts of neuroplasticity to create a well rounded exercise program.

    There are numerous ways to exercise aerobically for body and brain health and this article is not intended to discount your preferred form of exercise.  Basically, if you are “using it” in a moderately or vigorously intense way, you are going to “improve it.”  I recommend you consult with your physical therapist for personalized suggestions on a moderately to vigorously intense aerobic and task-based exercise program designed to target your body’s needs.

    You have now learned about the benefits of exercise, the concepts of neuroprotection and neuroplasticity, the importance of task practice, our national exercise guidelines, and different types of exercise that are beneficial for people with Parkinson’s disease.  Please stay tuned for Part 4 to learn how a physical therapist can help people with PD move better through exercise and tips on how to find a neurologic physical therapist.

    All the best,

    Theresa

    References:
    “23 and 1/2 hours: What is the single best thing we can do for our health?”  Video. DocMikeEvans.  Accessed at:  https://www.youtube.com/watch?v=aUaInS6HIGo  Accessed on:  4/15/2014
    “2008 Physical Activity Guidelines for Americans.” U.S. Department of Health & Human Services.  Accessed at: http://www.health.gov/paguidelines/pdf/paguide.pdf Accessed on: 9/3/2014
    Alberts J et al.  It is not about the bike, it is about the pedaling: forced exercise and parkinson’s disease.  Exercise & Sport Sciences.  2011;39(4):177-186.
    Another reason to get out there and get moving! Harvard Health Letter.  March 2012.  Accessed at: http://www.health.harvard.edu/newsletters/Harvard_Health_Letter/2012/March/another-reason-to-get-out-there-and-get-moving Accessed on: 9/3/2014
    Canning KL et al.  Individuals underestimate moderate and vigorous intensity physical activity.  PLOS One.  2014.  Accessed at: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0097927 Accessed on: 9/3/2014
    DiNubile N.  The Pharmacolologics of Exercise: Yes, Exercise Is Medicine! Huffington Post. Accessed at: http://www.huffingtonpost.com/nicholas-dinubile-md/exercise-medicine_b_5552755.html?utm_hp_ref=tw Accessed on: 9/3/2014
    Ellis T et al.  Barriers to exercise in people with Parkinson disease.  Phys Ther. 2013; 93: 628-36.
    Hackney M, Earhart G.  Tai Chi improves balance and mobility in people with Parkinson’s disease.  2008;28(3):456-460.
    Hirsch MA, Farley BG.  Exercise and neuroplasticity in persons living with Parkinson’s Disease. Eru J Phys Rehabil Med.  2009;45(2):215-29.
    Garber CE et al.  Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in aparently healthy adults: guidance for prescribing exercise.  Medicine and Science in Sports and Exercise.  2011;43(7):1334-1359.
    Kleim JA, Jones TA.  Principles of experience-dependent neural plasticity: Implications for rehabilitation after brain damage.  Journal of Speech, Language, and Hearing Research.  S225-S239.  2008
    “Neuroprotective Benefits of Exercise.” National Parkinson Foundation.  Accessed at: http://www.parkinson.org/Parkinson-s-Disease/Treatment/Exercise/Neuroprotective-Benefits-of-Exercise  Accessed on: 4/20/2014.
    Pahor M et al.  Effect of structured physical activity on prevention of major mobility disability in older adults.  JAMA.  2014;311(23)2387-2396.
    “Physical Activity.”  Centers for Disease Control and Prevention.  Accessed at:  http://www.cdc.gov/physicalactivity/  Accessed on: 9/3/2014
    Uc E et al.  Phase I/II randomized trial of aerobic exercise in Parkinsons disease in a community setting.  Neurology. 2014;83(5): 413-425.