Exercise and advice for people with Parkinson’s disease

Parkinsons Disease – Exercises and Advice

Parkinson’s disease (PD) is a progressive condition which can result in the loss of smooth and controlled movement of your muscles and joints, as well as causing problems in posture, balance and walking. Exercise can help to maintain your strength and flexibility and also your general fitness and wellbeing.

In PD, exercise has been recommended as an adjunct to pharmacological interventions for the management of symptoms unresponsive to pharmacological and surgical therapeutic approaches. Today, it is also recognized as one of the most promising therapeutic interventions for delaying disease progression.

The exercises in this leaflet are designed to help you with a regular programme to fit into your daily routine. Information is also given regarding cardiovascular exercise that is also important in maintaining your abilities.

SAFETY

If you experience a sudden shortness of breath, chest pains, angina or dizziness STOP exercising and contact your doctor or consider dialling 111 or 999 as appropriate.

Exercises should be done slowly and with control. 

If you have not exercised for a while you may experience aching the next day.  This will become easier as your muscles get used to exercising. It is important to gradually introduce and increase exercises over a period of weeks and may be useful to keep a diary to monitor this.

Stop if an exercise causes you severe pain.  Next time do fewer repetitions and if still painful, stop the exercise and talk to your physiotherapist.

For the exercises in standing, make sure you have something to hold onto for balance that is stable and will not tip or move.

Stretches

Stretches should be performed at least 2-3 times a week – greater benefits will be seen with daily exercises.  Hold all stretches for 10- 30 seconds. (30- 60 seconds for older adults)

Repeat each exercise 2-4 times.

1) Lying on your back, curl up into a tight ball.
2) Lying on your back with your knees bent and feet flat on the floor, roll knees over to right side and hold.  Repeat this to the left side.
3) Starting from the same position as above, take knees apart and hold
4) Stretch arms above head and legs out straight
5) Take your hands behind head with elbows facing the ceiling.  Take a deep breath in and allow your arms to open, elbows out to either side. Bring elbows back in as you breath out.
6) In standing, take one foot behind the other, keeping your toes pointing forwards. Slowly bend the front knee until you feel a stretch in your rear leg around the calf. In sitting, with your leg outstretched, put a towel around your foot and pull up towards your body.
7) Slowly turn your head to the right, hold when you feel a stretch for 30 seconds. Bring head back to the middle and repeat to the left.  Look up towards the ceiling then take your chin to your chest, again hold to stretch.

Strengthening exercises
Your therapist will give you individual advice and indicate how many repetitions of each exercise to do.

1) Hip and knee bends Slowly and controlled, bend your leg up, keeping your knee towards the ceiling. Return it gently straight and repeat with the other leg.
2) Pelvic tilt and bridging Bend your knees up, place your feet flat and hip width apart. Tighten your tummy muscles, push your lower back into the bed and lift your bottom up off the bed.  Hold for 3 seconds.
3) Single knee drop outs Bend up your knees as above. Slowly and controlled drop one knee out to the side and then return it to start position. Repeat on each leg.
4)  Controlled knee rolls Lying on your back with your knees bent and feet flat on the floor, slowly and controlled roll knees over to right side.  Repeat this to the left side.

Exercises in Sitting
Sit in a firm chair with a supportive back.  Hips and knees should be at right angles with feet flat on the floor. 

1) Lower back curls. Slump down in the chair, letting your lower back become rounded. Slowly straighten up, growing tall from the bottom of your back. Don’t thrust shoulders back.
2) Rotations Sitting tall, fold your arms and turn to the right as far as you can. Hold this position for 5-10 seconds then turn to the left side.
3) Alternate arm lifts Sitting tall in a chair, lift each arm alternately high above your head.
4) Knee strengthening Pull toes up towards you and straighten up the leg.  Hold for 5 seconds then slowly lower.
5) Sit to stand Sitting on a firm chair, bring your bottom forwards, feet back and flat on floor. Lean forwards, shoulders over toes and push up with hands on arms of chair to stand.  Keep your back straight. Slowly lower back into the chair. Progression:          1)  Pushing up with hands on knees          2)  Pushing up without using your hands.

Exercises in Standing

1) Side hip strengthening Keeping toes pulled up, pointing forward and leg straight, take leg out to the side, hold for 3 seconds, then lower.  Use hand support as needed.
2) Hip extension Keeping the leg straight and toes pointed forward, take the leg out behind and hold for 3 seconds.
3) Marching on the spot At a comfortable pace, march on the spot, lifting your knees. Increase the speed as you feel able.
4) Step Ups Do these on the bottom step only (you can hold on to the handrail if needed). Change leading leg after 10 steps.
5)  Superman In standing, with some support as needed, extend your left leg behind you and lift your right arm above your head. Repeat extending your right leg behind you and lifting your left arm above your head.
6) Walking forwards, backwards and sidestepping. Holding onto a table or work surface, Practise stepping forwards, backwards and sideways.
7) Standing rotations Turn your body so you are looking over your right shoulder as far as possible.  Return to the middle and repeat to look over your left shoulder.
8) 180° Turn Practise completing a half turn to face the opposite direction.  Practise turning towards both sides, picking the feet up and not shuffling them.  Hold on, if you need to, for balance.

Resistance exercise

In Parkinson’s Disease it has been shown that resistance training can improve muscle strength, functional mobility and quality of life therefore introducing a small weight into your exercise routine should be considered if advised to do so by your physiotherapist. 

Aerobic Exercise

Cardiovascular exercise will help to maintain and improve your general fitness and this may reduce the speed of deterioration of your Parkinson’s Disease. 

Appropriate aerobic exercise may include:

Quick step ups
Fast walking
Swimming
Cycling (Static Bike)

Please discuss this with your physiotherapist if you have any questions or need any advice.

Feedback for Inpatient Therapies

Please scan the QR code or follow the link below: 

If you have been seen by a Physiotherapist or Occupational Therapist during your admission, please leave us some feedback by scanning the QR code or following the link and filling in the short survey.

https://apps.worcsacute.nhs.uk/PublicSurvey/AHPFeedback

Ward admitted to:__________________________________

Therapy team who treated you: _______________________

If your symptoms or condition worsens, or if you are concerned about anything, please call your GP, 111, or 999.

Patient Experience
We know that being admitted to hospital can be a difficult and unsettling time for you and your loved ones. If you have any questions or concerns, please do speak with a member of staff on the ward or in the relevant department who will do their best to answer your questions and reassure you. 

Feedback
Feedback is really important and useful to us – it can tell us where we are working well and where improvements can be made. There are lots of ways you can share your experience with us including completing our Friends and Family Test – cards are available and can be posted on all wards, departments and clinics at our hospitals. We value your comments and feedback and thank you for taking the time to share this with us.

Patient Advice and Liaison Service (PALS)
If you have any concerns or questions about your care, we advise you to talk with the nurse in charge or the department manager in the first instance as they are best placed to answer any questions or resolve concerns quickly. If the relevant member of staff is unable to help resolve your concern, you can contact the PALS Team. We offer informal help, advice or support about any aspect of hospital services & experiences.

Our PALS team will liaise with the various departments in our hospitals on your behalf, if you feel unable to do so, to resolve your problems and where appropriate refer to outside help.

If you are still unhappy you can contact the Complaints Department, who can investigate your concerns. You can make a complaint orally, electronically or in writing and we can advise and guide you through the complaints procedure.

How to contact PALS:
Telephone Patient Services: 0300 123 1732 or via email at: [email protected]

Opening times:
The PALS telephone lines are open Monday to Friday from 8.30am to 4.00pm. Please be aware that you may need to leave a voicemail message, but we aim to return your call within one working day.

If you are unable to understand this leaflet, please communicate with a member of staff.  

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