January 8, 2015

Parkinson's, Exercise, and Falling

Last night, I saw an article from the December 31, 2014 edition of the e-journal Neurology. The headline got my attention: “Exercise for falls prevention in Parkinson disease.”

My Parkinson’s disease (PD) diagnosis came over five years ago. I’ve been lucky; I’ve enjoyed a long honeymoon from difficult symptoms, though that seems to be winding down.

I've only had a few falls attributable to Parkinson's, most of which happened when I’ve stopped and changed directions too quickly. I also struggled last year with bouts of hypotension, sudden drops in blood pressure that create wooziness and greatly increase the risk of falling and subsequent injury. (I'll report next week on the  latest developments on this.)

I've been talking with my housemates and family about alert systems to notify others in the event I sustain a serious fall when no one else is around. This is a major concern for most of  us in our later years.

So  I was interested in what the article in Neurology about a new Australian study had to say.
We know that about 60 percent of Parkinsonians fall each year, and almost 66 percent of them will fall again. Said study author Colleen G. Canning, PhD, and associate professor of physiotherapy at the University of Sydney in Australia, “The resulting injuries, pain, limitations of activity, and fear of falling again can really affect people’s health and well-being.”

The abstract defined the study’s purpose this way: 
To determine whether falls can be prevented with minimally supervised exercise targeting potentially remediable fall risk factors, i.e., poor balance, reduced leg muscle strength, and freezing of gait, in people with Parkinson disease.
How the Study Worked
Researchers randomly assigned 231 PD patients in Australia into one of two groups:
  • Group I (116 people) received the usual care,
  • Group II (115 people) got the usual care AND an exercise program.
That informal exercise regimen for group II consisted of 40-60 minutes of balance and leg strengthening exercises performed three times weekly for six months. Most of these exercise sessions happened at home, without supervision by a physical therapist. The exercises were designed to address falls and freezing of gait and to improve balance and mobility.

After half a year, the results might not be what you’d expect:
  • An exercise program targeting balance, leg strength, and freezing of gait did not reduce falls but improved physical and psychological health.
  • While there was no significant difference between the two groups in rate of falls or proportion of fallers, falls were reduced in people with milder disease but increased in those with more severe PD.
  • After the study concluded – and after adjusting for baseline performance -- Group II scored significantly better than Group I on the Short Physical Performance Battery, sit-to-stand, fear of falling, and quality of life.
The Case for Early Exercise Intervention
Study leader Dr. Canning said, “These results suggest that minimally supervised exercise programs aimed at reducing falls in people with Parkinson’s should be started early in the disease process.”

The authors made another comment in their report: “These findings add weight to evidence supporting the efficacy of exercise for people with PD but, unlike previous trials of supervised exercise, were achieved with an exercise program in which more than 87% of the prescribed exercise sessions were undertaken independently.”

The report suggested that patients with more severe PD could benefit more from a “multifactorial,” more closely supervised intervention.

And for Me?
Group exercise has never appealed to me. I'm much more likely to exercise at home. But I have benefited greatly from having a physical therapist work with me on selecting the most appropriate exercises and training me on how to do them.  Fortunately my therapist was a specialist in exercises best suited for those with Parkinson's.

Much of our work centered around the BIG exercise program, designed for people with Parkinson's by Lee Silverman Voice Therapy (LSTV) , the same organization that developed the LOUD speach therapy for people with Parkinson's.  To see videos my PT took of my attempts at the BIG exercises, click here.

I've slacked off on doing these exercises. Three of the BIG exercises are particularly good for balance and I usually do a single set of each of these excercises during my middle-of-the-night "quiet hour." But I'm suppposed to do each 10 times.

I know I've really benefited from the limbering-up exercises I do during the 3 or 4 a.m. quiet hour. But that doesn't justify not exercising for the other 23 hours in the day.

As I sit at the computer, I can see the stack of exercise DVD's sitting next to it. Several are videos designed for people with Parkinson's. Others are for seniors. One is on Tai Chi, which is supposed to be especially good for Parkinsonians.

I'm very good at "Get Ready" and "Get Set." It's just "GO" that's a problem.

But I've installed the Delay the Disease video on exercises for Parkinson's on the computer and I'll sign off now so I can fire it up and get started.

Ooops. The phone just rang. I better answer it. 

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