Intense exercise was strongly discouraged for PD patients because, the prevailing belief of the medical community was that exercise might further deplete the already low amount of neurotransmitters available. The idea that intense exercise might increase production or effectiveness of neurotransmitters was considered improbable (at best) and potentially harmful (by most). It was a “given” that PD patients could not increase their strength or muscle mass significantly (due to the steadily declining production of neurotransmitters).

What seemed logical to researchers and people treating PD, seemed counter-intuitive to my sports medicine trained way of thinking. Exercise improves the performance, production and function of all the systems of the body. Lack of exercise decreases the performance of the body systems. Might intense exercise stimulate the body to produce or improve use of neurotransmitters?

My dad volunteered to test my theory. He was very motivated because his goal was to live the highest quality of life for as long as possible. His wish was to never see the inside of a skilled nursing facility. I designed a program for him that involved daily exercises at home and three to four days of weight lifting at a gym. After six consecutive months of increased strength, endurance and functional scores, his neurologist was very intrigued and helped me recruit other PD patients for a larger study.

This time we tracked cognitive and physical performance (via standardized PD tests) and medications. The results of this study demonstrated that patients who exercised daily either increased or maintained all their scores, while patients who did not exercise (or stopped exercising) saw a significant and often rapid decrease in their scores. Unfortunately, when I presented the results of this study to PD experts at a regional Parkinson’s Institute and several medical campuses, the unanimous response was that something other than weight lifting was responsible for the increased scores (such as data error). It was the opinion of the PD experts that weight training could not and did not improve physical or cognitive performance—especially over a period of six months or more.

Fast forward 15 years. The benefits of weight training are becoming more accepted in medicine in general and, more specifically, in the treatment of many neurological disorders. Recent studies have demonstrated that weight training stimulates the brain (in a good way) at a much higher level than any other intervention. In regards to PD, one recent study showed that weight training not only improved the symptoms of PD, but was also the only intervention studied (so far) that was able to maintain this improvement over two years (the length of the study).

Do we know if weight training increases the production of neurotransmitters? No. We also do not know if weight training can slow the progression of or prevent PD. While much more research is needed, a more wide-spread acknowledgement of the benefits of weight training is also needed within the medical and research communities. In the meantime, I will continue to encourage PD patients to add weight training to their treatment program. A higher quality of life is possible through weight training.

Since most tissues in the body have weakened/deteriorated (due to prolonged inactivity), it is important to resume exercise without causing damage to the these tissues. This means resuming exercise at a much lower intensity than your normal level. Combining low intensity with high repetitions (low load high rep or LLHR) allows the body to strengthen the bones, muscles, cartilage, etc. in a manner that greatly reduces risk of injury. Studies have shown that LLHR actually encourages the body to repair itself more quickly and better prepares the various tissues for vigorous activity. See http://www.coastrehab.com/blog/2004/02/03/why-we-use-high-repetition-exercises-the-tissue-toughening-technique/ for more information on LLHR exercise.

As the tissues become structurally stronger, higher resistance exercises can be added. High load low repetition (HLLR) exercises promote increase in bone density, muscle mass, neuromuscular connections and brain stimulation, among other benefits. Adding HLLR to a LLHR program provides for better long term results than a HLLR program alone. HLLR exercises are necessary to prepare the body for the higher demands/tissue stress loads associated with sports.

Knowing when and how to apply (high/low) loads and repetitions is the art behind rehabilitation, and the difference between full recovery and chronic injury.

Loss of bone density is especially troubling since it is difficult for the body (over 30 years old) to regain bone density. Twelve weeks of bed rest can decrease bone density up to 50%. The body increases the loss (resorption) of bone mass at a faster rate when there is a lack of weight bearing and muscle activity. It takes years to recover from significant bone loss.

The effects on the cardio-vascular system are just as significant. Lung capacity (measured as VO2 max) decreases about 1% each day, blood volume decreases and resting heart rate increases.

Exercise will help restore bone loss, muscle strength and improve cardio-vascular function—but at different rates. Muscle strength usually increases at a faster rate than cardio-vascular capacity, and bone density improves very slowly. Resuming exercise after a prolonged period of rest frequently leads to injuries, because the various tissues are not properly prepared. That’s the tricky part of starting an exercise program—how much exercise is too much or not enough? Next month I will discuss the proper way to prepare the body for return to exercise/sports.

Using our hands for daily tasks such as gripping and lifting is an effective way to strengthen many of the muscles in our hands…but not all of them. The muscles on the back of our hands (finger/wrist extensors) are essential for lifting and positioning our fingers and hands. When these muscles become weak, over-use injuries such as carpal tunnel, wrist tendinitis, and tennis elbow occur. Maintaining good strength with all of your hand muscles is a highly effective way to prevent these injuries.

A simple exercise to strengthen the finger and thumb extensor muscles is to wrap a rubber band around the tips of the fingers and spread the fingers and thumb as far apart as possible. Repeat as many times as possible in one minute.

This exercise can be performed with wrist straight and/or bent. To increase the difficulty, use thicker rubber bands or multiple bands. Do not perform this exercise if it causes pain. Consult with your medical doctor or physical therapist if you have persistent finer or wrist pain.

Muscles tend to get stiff when we don’t use them. Muscles will also tighten/shorten up when held in a position for a long period of time (think of your neck muscles when sitting at a computer all day). Stress can also cause muscles to tighten up. Muscles tend to remain in a shortened position unless we do something to relax them.

Most of the time, when a person complains of neck and upper back stiffness/spasms, the trapezious  is involved. This large muscle is involved with almost all neck, upper back and shoulder movements and is your most important postural muscle.

Gentle stretching combined with easy repetitive movements is one of the most effective methods for relaxing a muscle. Shoulder shrugs is an exercise that targets this muscle and can be performed as often as needed to relax the muscles of the upper back. This exercise can be done sitting or standing. First, lift both shoulders as high as possible. Then squeeze the shoulder blades together and lower the shoulders back down to a resting position. Repeat for a minimum of a minute.

This exercise can be made more difficult by holding small weights in your hands. Do not perform this exercise if it causes pain. Consult with your medical doctor or physical therapist if you have persistent shoulder or arm pain.