According to the World Health Organization, “Disability and death due to Parkinson’s disease are increasing faster than for any other neurological disorder. The prevalence of PD has doubled in the past 25 years. Global estimates in 2019 showed over 8.5 million individuals with PD.”i
Many people, including Pilates and movement professionals, are unaware of this disconcerting trend. And there is no clear explanation for it, other than the fact that people are living longer, and PD mainly (90% of the time) affects people over the age of 60.
No doubt, a diagnosis of Parkinson’s disease—a degenerative neurological disease that causes motor and cognitive impairments—is distressing news to receive, but there is much that can be done to improve the health and wellbeing of those living with PD, and the sooner after diagnosis, the better (although it’s never too late!).
Beyond well-established drug interventions such as the most potent and common, carbidopa- levodopa (brand name Sinemet), non-pharmaceutical exercise modalities, such as Pilates, tick many of the boxes when it comes to helping improve quality of life for people living with PD. This is largely because of the emphasis on core control, postural alignment, strength, stability and mobility, complex movements, sequential exercise cueing, and mind-body integration. And when paired with a somatic approach (sensing and feeling), cognitive exercises, vocalizations, “big” movements, balance training, and aerobic exercise, it can be immensely helpful.
In this article we will unpack what Parkinson’s disease is and the ways in which it can affect people progressively over years and even decades. We will also lay out some useful guidelines for selecting movements, exercises and activities that meet clients where they’re at as their PD progresses—all with a view to helping them reduce or delay the symptoms of Parkinson’s and enjoy the things they love to do for as long as possible.
Before we dive in, let’s look at what Parkinson’s disease is and the kinds of symptoms that may present themselves over time.
What is Parkinson’s disease?
Parkinson’s Canada offers a relatively simple description, even though the journey of someone living with PD is anything but simple and predictable. Nevertheless, simplifying the definition can help with getting to the root of this complex neurological disease in order to more clearly identify the types of exercises that should be considered when developing a therapeutic program for people with PD:
“Parkinson’s is a neurodegenerative disease. Movement is normally controlled by dopamine, a chemical that carries signals between the nerves in the brain. When cells that normally produce dopamine die, the symptoms of Parkinson’s appear.”
Dopamine is a type of neurotransmitter and hormone. It plays a role in many important body functions, including movement, memory, and pleasurable reward and motivation.ii
Dopamine is produced in two areas of the brain—the substantia nigra, a tiny strip of tissue on either side of the base of the brain, and the ventral tegmental area, which is close by.iii
Regular exercise has been shown to improve the efficiency with which dopamine is utilized in people with PD, in addition to improving motor function in people and facilitating neuroplasticity.iv
Graphic courtesy of Parkinson.org.
“Parkinson’s is commonly characterized by its motor (movement-related) symptoms. But many people experience other changes that are often not identified as symptoms of the disease. These are known as non-motor symptoms and are often left untreated,” according to Parkinson’s Canada, a leading non-profit organization committed to PD education, advocacy and research.
Motor symptoms generally develop slowly over years. The progression of symptoms is often a bit different from one person to another due to the diversity of the disease.v People with PD may experience:
- tremor, mainly at rest
- slowness and paucity of movement (bradykinesia and hypokinesia)
- limb stiffness (rigidity)
- gait and balance problems (postural instability, including forward head posture/kyphosis)
- involuntary movements (dyskinesias)
- painful involuntary muscle contractions (dystonias )
- problems swallowing (dysphagia)
- softened and slurred speech (dysarthria)
People with PD are often more impacted by their non-motor symptoms than motor symptoms. Examples of non-motor symptoms include: depression, anxiety, apathy, hallucinations, constipation, orthostatic hypotension, sleep disorders, loss of sense of smell, and a variety of cognitive impairments.
The research into exercise and Pilates for people with Parkinson’s disease
Scientific evidence demonstrates that exercise training programs have a positive effect on motor symptoms such as gait, balance, fall risk and physical function, as well as non-motor symptoms, including cognitive function, sleep disorders and quality of life, in people with PD.vi
Exercise is an important part of healthy living for everyone. For those with Parkinson’s disease, exercise is more than healthy—it is a vital component to maintaining balance, mobility and activities of daily living.vii
In addition to its well-documented physiological benefits, exercise is also known to help rewire the brain in a way to compensate for losses in function. And while it is still early days for all components of exercise to be scientifically validated in terms of their neuroplasticity benefits, there has been promising research into cardiovascular exercise as it relates to neuroplasticity in people with PD.
Exercise increases dopamine release and synaptic plasticity [the ability of the brain to change, adapt and compensate at a cellular level], changing the way the brain is wired in people with Parkinson’s disease and potentially slowing the degenerative effects of the disorder, according to a study published in the Journal of Movement Disorders.viii
Although there have not been many controlled PD and Pilates-related studies, Pilates is one of several mind-body exercise modalities recommended by the Parkinson’s Foundation. As well, a review and meta-analysis was undertaken by a group of researchers in 2019, resulting in the following conclusion: “Pilates can be safely prescribed for people with mild-to-moderate PD. Preliminary evidence indicates that its practice could have a positive impact on fitness, balance and physical function. Its benefits on lower-body function appear to be superior to those of other conventional exercises.” ix
Of course, there is ample anecdotal evidence demonstrating that Pilates-based programs and other less conventional exercise and movement modalities (e.g. yoga and dancing) are well-suited to delaying and/or alleviating PD symptoms. Indeed people living with PD who participate in such programs report improvements in everything from mood and movement to posture and balance.
What does big and loud mean for people with PD?
In the case of more advanced PD, in addition to the limb motor system, the speech motor system is often affected, resulting in a less audible voice and/or slurred speech. As you can imagine, this symptom can be extremely frustrating and isolating for those who experience it.
Recent advances in neuroscience have suggested that exercise-based behavioural treatments may improve function and possibly slow progression of motor symptoms in individuals with PD. Two research-backed programs developed and run by LSVT Global leverage this research to address the speech motor system (LSVT LOUD) and the limb motor systems (LSVT BIG). The unique aspects of the LSVT programs include the combination of (a) an exclusive target on increasing amplitude (loudness in the speech motor system; bigger movements in the limb motor system), (b) a focus on sensory recalibration to help patients recognize that movements with increased amplitude are within normal limits, even if they feel “too loud” or “too big,” and (c) training self-cueing and attention to action to facilitate long-term maintenance of treatment outcomes.x
While it is within a certified Pilates or fitness instructor’s capacity to incorporate loud vocalization exercises and big movements into their work with PD clients (in the same way that the acclaimed Dancing With Parkinson’s program does), LSVT certified practitioners are usually also physiotherapists, occupational therapists or speech and language pathologists who work cooperatively with movement educators. You can learn more about LSVT here.
In part 2 of this article, we will look at how to take all that’s been learned about Parkinson’s disease and what we know about Pilates, movement and exercise science, to create an innovative, evidence-based Pilates and movement program for people with PD.
Exercise recommendations for people with Parkinson’s disease
- Choose an exercise program that you will actually do
- Follow a varied routine: Daily “stretching” (i.e. flexibility/mobility exercises) and posture exercises; aerobic and strengthening exercises several times per week
- Keep intensity at a level that feels “somewhat challenging”
- Consider classes that are motivating and encourage socializing
- Include rhythmic music to enhance performance and movement coordinationxi
Want to learn more about working with people with PD?
• Body Harmonics On Demand
> Restorative Pilates & Movement classes
> Active Aging 50+ videos
• Body Harmonics Continuing Education
• Davis Phinney Foundation
• International Council on Active Aging
• LSVT Global
• Michael J. Fox Foundation for Parkinson’s Research
• Parkinson Alliance
• Parkinson’s Resource Organization
• Parkinson’s Foundation
• Parkinson’s Canada
[ii] & [iii] https://www.snexplores.org/article/explainer-what-dopamine