Exercise, Diet and Therapy for Parkinson’s Disease

Exercise  has shown to be helpful for maintenance of good health for normal individuals in the population. It has especially been demonstrated to improve a variety of different features of Parkinson’s disease including gait, strength, balance, and speed of movement. In the general population including patients with Parkinson’s disease, cardiovascular exercise improves cognitive function, mood, sleep, fatigue, and reduces constipation. There have recently been several clinical trials studying the effect of exercise on symptoms of Parkinson’s disease. Cardiovascular training focusing on treadmill exercise produces significant and sustained benefit in bradykinesia and gait. A recent study of forced exercise has been shown to improve features of Parkinson’s disease perhaps even more than exercise done at a comfortable rate chosen by the patient. In this study, patients with Parkinson’s disease rode a tandem bike behind a professional cyclist, forcing a constant rapid speed. Functional MRI studies showed increased cortical activation in patients undergoing forced exercise, suggesting that exercise may alter motor control. Tai Chi is a popular exercise in many Parkinson’s disease support groups and, in fact, this has been shown to significantly improve balance and reduce falls. In animal models of Parkinson’s disease, exercise causes release of growth factors in the brain also known as neurotrophic factors. These may reduce the loss of dopamine-producing cells and, in fact, prevent the loss of dopamine-producing cells in response to toxins in animal models of Parkinson’s disease. It is hoped that similarly, exercise may slow the progression of the underlying progressive cell death process in Parkinson’s disease. Indeed, a recent trial comparing intensive to moderate exercise suggested that intensive exercise, but not moderate exercise might slow the progression of PD. Patients with Parkinson’s disease should maintain a  well-balanced diet  focusing on consumption of fruits and vegetables. Because constipation is virtually ubiquitous, a substantial intake of fiber and water is helpful in reducing constipation. Protein-rich foods can interfere with the absorption of levodopa if taken around the same time. As a result, we generally recommend that patients should take levodopa at least one hour away from meals. In patients who have advanced Parkinson’s disease with severe motor fluctuations, occasionally a protein redistribution diet is recommended in which most of the daily protein is consumed with the evening meal only. On the other hand, some patients have nausea or vomiting due to levodopa. Taking levodopa with food, then, reduces the peak levodopa concentration in the blood which can reduce nausea and vomiting induced by levodopa. Physical therapists  work with patients with Parkinson’s disease in order to improve range of motion, exercise tolerance or endurance, and overall motor function. It is especially helpful to improve axial or midline motor function such as difficulties with gait, arising from a chair, poor posture, and reduction in balance. In addition to working with a physical therapist, patients must follow an ongoing home exercise program incorporating the suggestions made by the physical therapist in order to obtain maximal benefit. Occupational therapists  work with patients to maintain quality of life by suggesting adaptive devices or other methods to overcome physical limitations. Most of the adaptive devices focus on tools which may help compensate for reduced dexterity such as specialized utensils for eating. Home safety evaluations can also be helpful in reducing environmental dangers such as reduction of falls by removing obstacles in walkways in the home, adding railings, and adding assistive bars in baths. Speech therapy  using the Lee Silverman Voice Technique, or LSVT, has been shown to improve hypophonia or low speech volume in patients with Parkinson’s disease. In the past few years, this LSVT program has been combined with a physical therapy program called the BIG Program in order to combine loud speech with large-scale or explosive gestures or movements. The combination can be quite helpful with increased carry-through to day-to-day living. Expiratory muscle strength training, or EMST, involves patients breathing against resistance in order to strengthen swallowing muscles in order to reduce trouble with eating and drinking.