(Stress Part II, has been delayed (Lao Du is sleeping)
Exercise is a crucial component of a Parkinson’s treatment program. It’s not an option – it’s a MUST. Keeping fit by working out promotes neuroplasticity and is as important as the pharmacological regimen. Remember, too, that Parkinson’s disease is a progressive disease. It gets worse in the long term leading to a range of disabilities, including (potentially) immobility – falling is an especially treacherous and hazardous risk – and cognitive deterioration. This is where the exercise therapy comes in. It can (and does) prevent the progression of the illness. It can prevent falling. It can improve quality of life.
If we do one thing only for PwP who show up at our club on a weekly basis, it is to have them physically exert themselves by way of a multifaceted program. We aim to improve the physical health of our Pongers primarily through Ping Pong, but we augment the table tennis with a 10 minute exercise/warm up derived from several disciplines (yoga, tai qi) and with a similar time spent on juggling. Turns out that mental health and social support are collateral benefits.
There are many exercises especially tailored for Parkinson’s Disease, ranging from aerobic, to balance, to coordination, to agility (moving quickly and easily) and flexibility (suppleness), to muscle strengthening. Swimming, walking, jogging, cycling, boxing, dancing and ping pong – these have all been put to use – and they’re all probably good and effective, but as yet there is no general agreement among neurologists as to which is the most efficacious. However, there is some consensus that the ones most neuroprotective are those that challenge the brain – those that require some learning component. (For example, when we did lunges, we would call out an hour by the clock face, instructing the Pongers to move in a certain direction. Or, when we marched to music, a leader would have the line of Pongers and volunteers copy his dance steps.) There is also research which specifically supports aerobic-type exercise plus weight and balance training for PD.
There are so many things we could do that could have beneficial cardio-respiratory effects. I’m not saying we should get a treadmill ( we don’t have space for it), but we might consider something like Zumba or latin-salsa or even foxtrot dancing routines. Something like that could be fun and requires learning. Learning to dance involves a “dual” activity, which is a good type of exercise for PD. Learning a new skill is good for the Parkinson brain (and for anyone else, for that matter). It’s dopaminergic (increases dopamine by creating new connections – new circuitry). Other forms of cardiovascular exercise that we could utilize are boxing (we’ll be incorporating a boxing segment with the addition of some donated boxing paraphernalia) and increasing the speed on the ping pong robot (which feeds the balls at various frequencies) plus other various vigorous exercises (e.g., jumping jacks).
Increasing muscle strength poses a challenge for us. Certain type of yoga and tai qi exercises (weight bearing) might be positive additions. Balance training can be targeted with some tai-qi and yoga-type exercises.
Well, we can’t do everything. The patients will have to supplement whatever the physical work outs we provide during our weekly hour and a half sessions. The following is a list of exercises that we’ve used in the past:
1-stretching: (Yoga inspired) neck movement; arms reaching upward from sides; Nenad’s “Pistol of Love” – front and back
2- stretching: arms, wrist, fingers (hand thrusts, wrist rolls, finger grips, thumb taps)
3- stretching: crouching (squatting): ‘Ping Pong Pick-up;’
4- stretching- ‘Torso Twist’; top spin motion beginning with crouch (reach for the stars/ceiling –
5- Lunges by the clock (i.e., lunging by calling out the direction)
6-Balancing: (pick one or do 3) Standing Tree; Airplane; Romberg (feet together or heel-to-toe)
7- Coordination: Ping Pong Ball taps (both hands); reverse taps; skim the ball; Bounce ball on racket and control the bounce until it stops.
8- Aerobic: (pick one) Marching in place; elbows to knees; Marching around tables
9- Aerobic: Jumping Jacks
10- Aerobic: Boxing: jabs, crosses and uppercuts.
Our 10 minute exercise segment should be sensible and well-founded. It doesn’t have to be tedious, dull and boring. However, if it does transform to being a real snoozer, let’s blame our exercise mavens, Ellen and Margie.