Nick Berners-Price explains that exercise is the only disease-modifying therapy for Parkinson’s, and how PTs can help people with Parkinson’s
Evidence shows that exercise can slow the progression of Parkinson’s. There is currently no medication that can do this. Parkinson’s as a condition offers the perfect example of why exercise should be funded as a treatment methodology on the NHS
About Parkinson’s
People with Parkinson’s don’t have enough of the chemical dopamine in their brain because some of the nerve cells that make it have stopped working. Around 166,000 people live with Parkinson’s in the UK. Parkinson’s is on the rise; in the UK today, someone is diagnosed every 20 minutes. By 2050, the number of people with Parkinson’s worldwide will double to 25 million.
When referring to Parkinson’s, we prefer not to use the word ‘disease’ because some people with Parkinson’s have told us it sounds negative, or like an infectious illness. Unlike diseases like the flu or measles, you can’t catch Parkinson’s from someone.
We don’t yet know exactly why people get Parkinson’s. Researchers think it’s a combination of age, genetic and environmental factors that cause the dopamine-producing nerve cells to die.
There are over 40 symptoms of Parkinson’s, from a tremor or stiffness to problems with sleep and mental health. Everyone’s experience is different.
Common symptoms of Parkinson’s include: tremor, rigidity (stiffness), slowness of movement, mild memory and thinking problems, sleep problems, pain, and mental health problems, including anxiety and depression.
But not everyone gets these symptoms. People will have different experiences of how their condition changes or progresses. How Parkinson’s affects someone can change from day to day, and even from hour to hour. You may hear Parkinson’s symptoms referred to as motor symptoms and non-motor symptoms.
Motor symptoms affect movement and balance. They include tremor, stiffness and slowness of movement. Non-motor symptoms affect you in other ways that may not be easily seen by other people. They include pain, sleep problems and mental health issues.
How can we as PTs help people with Parkinson’s?
The message that most people diagnosed with Parkinson’s receive is that it is something happening to them and completely out of their control, but medication can help the symptoms.
Gradually, the message is getting through that exercise can significantly improve the journey of somebody with Parkinson’s. Despite the fantastic work of organisations like Parkinson’s UK, support to exercise is still hard to find for so many people who are diagnosed.
The National Register of Parkinson’s Specialist Personal Trainers has been set up to create an army of personal trainers with the specialist knowledge required to work with people with Parkinson’s … and then make it easy for people with Parkinson’s to connect with them.
One of the key factors of a well-designed Parkinson’s-specific programme is a focus on quality of movement as much as on quantity.
Parkinson’s tries to reduce the amplitude, speed and separation of movements. By practising BIG movements, we can maintain amplitude. By practising FAST movements, we can maintain speed of movement. And by practising PRECISE movements, we can prevent movements overlapping each other and becoming confused.
Cardiovascular exercise can improve the brain’s ability to use dopamine. This is significantly important on two fronts:
- If dopamine is scarce due to reduced production in the brain, function can be improved by making less go further.
- The primary medication for people with Parkinson’s is dopamine supplementation through tablets. Over time, the body develops significant side-effects to this medication. By using exercise to enhance the body’s sensitivity to dopamine, less medication goes further and side effects are slower to develop.
Some key elements of a Parkinson’s-specific exercise programme include:
- Cardiovascular exercise – at least 150 minutes of moderate- or 75 minutes of vigorous-intensity cardio exercise.
- Resistance exercise – a whole-body strengthening routine at least twice a week, including movements that improve posture.
- Balance training – Parkinson’s tends to degrade the ability to balance and increase risk of falling. Specific techniques can be used to train and maintain balance mechanisms.
- Mobilisation and flexibility – Parkinson’s tends to reduce both mobility and flexibility. Identifying tight areas and stretching them, together with daily mobilisation movements, form key parts of Parkinson’s-specific programmes.
- Walking – Parkinson’s can significantly degrade gait cycle. Practising good-quality gait cycle regularly can play an important part in maintaining function and quality of life.
As with any personal training client, the key is a comprehensive assessment of individual capability and needs, followed by a bespoke programme. Then constant adaptation to circumstances.
Other key considerations for clients with Parkinson’s are:
Dual tasking – performing two specific tasks at the same time. Evidence shows this has a positive effect on maintaining and improving cognitive function. Using a wide variety of task combinations may be ideal – so, cycling plus naming capital cities, or strength movements plus specific breathing, or counting repetitions in threes.
Skill acquisition – developing a new physical skill, like learning to play a new sport, appears to stimulate the brain and help it develop new neural pathways in a manner that can improve symptoms and maintain cognitive function.
If you would like to learn more about how to effectively train people with Parkinson’s and become a Parkinson’s Specialist Personal Trainer, please visit nrpspt.org or call 0800 328 5849. If you have Parkinson’s, or know somebody who does, you can look at the 4D Life Programme for support and guidance here: 4Dlife.org
National Register of Parkinson’s Specialist Personal Trainers (NRPSPT) and FitPro have teamed up to offer NRPSPT members an exclusive 10% off FitPro’s CPD course; Parkinson’s Pro taught by expert Tim Webster. Find out more on why you should become a Parkinson’s specialist personal trainer here.
Nick Berners-Price
Nick Berners-Price is Managing Director of 4D Life Ltd and The National Register of Parkinson’s Specialist Personal Trainers: NRPSPT.org. He has over 30 years’ experience in the fitness industry as a personal trainer and business owner. He created 4D Fitness in 1998 and since then he and his team have been delivering leading edge health and fitness solutions across the full spectrum of the population.
Nick has also had Multiple Sclerosis since 2006. This has created a very personal desire to find the best solutions available to help people with medical conditions. He uses the Marginal Gains technique – the system that Sir Dave Brailsford used to propel British cycling to world leaders at the 2012 Olympics and Tour de France. It is now commonly used in business, sport and performance, but rarely applied to managing medical conditions.
4D Life Ltd have launched the National Register of Parkinson’s Specialist Personal Trainers, in partnership with Parkinson’s UK and supported by CIMSPA, FitPro and Cure Parkinson’s. The goal is to train and accredit Parkinson’s specialist trainers across the UK, and then make it easy for people with Parkinson’s to connect with them.
