Escolar Documentos
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Fitness
Counts
3rd Edition
DISCLAIMER
The information contained in this publication is provided for informational and educational purposes only
and should not be construed to be a diagnosis, treatment, regimen, or any other health-care advice or
instruction. The reader should seek his or her own medical or other professional advice, which this publi-
cation is not intended to replace or supplement. NPF disclaims any responsibility and liability of any kind
in connection with the reader’s use of the information contained herein.
ii
Contents
Appendix A Resources........................................................................... 30
Acknowledgements .................................................................................... 35
iii
About this booklet
This manual is intended to be a resource for increasing your fitness level, and for
improving your ability to do everyday activities. Read Chapter 1 for an overview of
stretching, strengthening and conditioning—the foundation for fitness. For the
“how to” of exercises, see Chapter 2. Chapter 3 explains how fitness counts for good
balance, posture, and preventing falls. Other therapies that are complementary to an
exercise program are explained in Chapter 4. The appendices provides resources for
caregivers.
iv
Introduction
WHY EXERCISE?
Some people turn away from exercise because they think that it will be too difficult,
or that they can’t fit it into their busy schedules. Others simply do not understand
how exercise can help them. Exercise is important for everyone. It is the foundation
for fitness, and it also helps us fight the effects of aging.
If you have Parkinson disease (PD), exercise is even more important. Recent
research shows that regular exercise can help people with PD stay more flexible,
improve posture, and make overall movement easier.
While medication has long been the most promising treatment available, a regular
exercise program should always be part of managing PD. Exercise is one of the few
treatments available that is free, has no bad side effects, and can actually be enjoyable!
Though exercise is not a cure, it can help you to stay ahead of the changes that take
place in your body and can help you feel more in control of your condition.
Your doctor or other health care professional should be able to refer you to a thera-
pist in your area. When possible, it is best to see a therapist that has special training
and/or experience with PD. Visits to a physical or occupational therapist are usually
covered by medical insurance with referral by a physician.
v
Chapter 1:
Foundation for Fitness
To build a foundation for fitness you will need three main components:
stretching, strengthening, and aerobic conditioning. Each component on its own
is important, but together they can help you remain as active as possible and bet-
ter equipped to deal with the changes that PD can bring. After learning more
about each of these components, you may follow along with examples of each in
Section 2.
Stretching
Regular s-t-r-e-t-c-h-i-n-g is the first step in your exercise program, and it can
be one of the most enjoyable. Stretching helps you combat the muscle rigidity
which comes with PD. It also helps your muscles and joints stay flexible.
People who are more flexible tend to have an easier time with everyday move-
ment.
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A good thing about stretching is that you can do it at any time. Get your
day off to a good start by stretching before getting out of bed. Try to stretch
throughout the day. For example, you can stretch while you watch television or
ride in a car.
Choose a time for exercise when you are well-rested and your
PD medications are working.
Each stretch should be done 3 times. If you can’t do the entire series of stretches
at one time, select a few stretches to do at different times throughout the day.
For at least 3-5 breath counts. 1 breath count = 1 full breath in and out.
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Breathing exercise
Strengthening
Strengthening is another important part of a PD exercise program.
Strengthening certain muscles can help you stand up straighter and can make
tasks like getting up from a chair easier. Strengthening exercises also helps to
make bones stronger, so if you fall, you are less likely to get a fracture.
Strength training is more than just lifting weights. If you have access to hand
held weights or a gym with weight machines, by all means, use them. However,
you can build strength by using your own body weight as resistance. Like
stretching, you can do strengthening exercises in the privacy of your home.
The trick is to find out what kind of strengthening exercises work best for you.
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There are many tools available that you can use to build strong muscles and
bones. Choose the one that best suits your situation and surroundings.
Here are some examples:
Use a technique known as the 10 Rep Max. This means that you use the
maximum amount of weight you can lift for 10 repetitions. For example, if you
can lift 3 pounds 10 times with no difficulty, the weight is too light for you. You
could try 5 pounds. If you can only do 10 repetitions with 5 pound weights
before getting too tired to continue, 5 pounds is a good weight for you to use.
You shouldn’t perform strengthening exercises on the same muscles two days
in a row. So, you could strengthen your arms one day, and your legs the next,
but you shouldn’t strengthen your arms on both days.
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■ Walking
■ Swimming
■ Water aerobics
■ Biking
■ Dancing
A program of regular aerobic exercise performed 3 or more times per week can:
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Your goal should be at least 20 minutes of aerobic exercise 3 times per week.
Start slowly and gradually increase the time until you reach 20 minutes or more.
■ Begin by performing a 3-5 minute warm-up. This does not necessarily have
to be the same as the activity you are going to perform.
Example: Walk around the block or march in place for 3-5 minutes before
swimming or biking.
■ Finish your routine with a 3-5 minute cool-down. This can be done by
continuing your activity for an additional 3-5 minutes at a lesser intensity, or
switching to a different activity.
Example: If you were biking, either take a gentle walk or sit and perform leg
kicks.
You should get approval from your doctor before beginning an aerobic, or condi-
tioning program. This is especially important if you are over 50 years of age, or
have a history of cardiovascular disease.
There are two methods to rate how hard you are working.
The first is the Target Heart Rate method. This method helps you keep track
of your heart rate while exercising. For the best benefit, you should keep your
heart rate between 60-and-80% of your maximum heart rate. For beginners, it is
good to start out at 60%.
To calculate your Target Heart Rate, subtract your age from 220. This is the
maximum number of times your heart can beat in a minute. This number is then
multiplied by the percentage of your maximum heart rate that you want to
exercise. If you are just starting you aerobic program, your target heart rate
should be between 60 to 75% of your maximum heart rate. Generally, after 6
months at this rate, you may increase to 85%.
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You can periodically check your heart rate by counting your pulse for 6 seconds
and multiplying by 10. If the total is lower than your target heart rate, you can
increase how hard you are working. If the total is higher, you should work less
hard.
The following chart can give you a quick gauge of your target heart rate at 60%
and 85% of your maximum heart rate.
60% 85%
30 114 161
40 108 153
50 102 144
60 96 136
70 90 127
80 84 119
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The second method is the Borg Rating Scale. This scale assigns a number to
describe how hard you feel you are working. For your aerboic program, you
should gradually work up to level 13.
Least Effort
6
7 Very, Very Light
8
9 Very Light
10
11 Fairly Light
12
13 Somewhat Hard
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15 Hard
16
17 Very Hard
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19 Very, Very Hard
20 Maximum Effort
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Chapter 2:
Putting it all together
Stretches
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SEATED ROTATION
STRETCH
1. Sit tall in a chair with one arm behind
back of chair.
OVERHEAD STRETCH
1. Sit tall in a chair and interlock fingers together.
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HAMSTRING
STRETCH
1. Sit tall in chair and place one leg
straight out on another chair.
LYING SHOULDER
STRETCH
1. Lie flat on your back.
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STANDING SHOULDER
STRETCH
1. Stand tall with feet hip width apart.
ROTATION STRETCH
1. Lie on your back, with knees bent and feet flat. Arms should be
outstretched at your side.
2. Rotate both knees to one side, keeping arms and upper torso flat.
Turn head in opposite direction.
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CALF STRETCH
1. Support upper body on wall. Stand at
arms length from wall.
ANKLE CIRCLES
1. Kick foot in front of you.
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Strengthening
REMEMBER:
WALL SLIDES
1. Stand with feet about 6-8 inches from
the wall.
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BRIDGING
1. Lie on back with
knees bent and feet
flat.
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QUAD STRENGTHENING
1. Sit tall in chair.
QUADRAPED TRUNK
1. Begin on hands and knees,
keep back level.
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PRONE ON ELBOWS
1. Lie on stomach.
NOTE: Remember, this is not a push up. Your back muscles should be doing
the work, not your arms.
Aerobic exercise
See the section on aerobic exercise on page 5.
Perform aerobic exercise at least 3 times per week.
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Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
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Chapter 3:
Balance, Falls, and Posture
Balance
Balance problems are one of the main symptoms of PD. Another name for
balance problems is postural instability. Balance problems increase the risk of
falling, especially when combined with other symptoms and complications of
PD, including:
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BALANCE EXERCISES
1. Stand with feet hip width apart and one
foot ahead of the other.
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■ Try not to move too quickly, think about what you are doing.
■ When walking, tell yourself to land with the heel striking down first.
■ Do not carry many things while you are walking. It has been shown that
people with PD have difficulty performing more than one task at a time.
“Side-step Arc” Technique - Useful in
■ Avoid walking backwards, small spaces & as a way to avoid stepping
instead try: backwards. Take slow side-steps in an
arc...
■ Stepping sideways.
■ Take large marching steps to
turn and then walk forward.
■ When returning to sit, turn all of
the way around and make sure that both
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legs are touching the chair. Reach back with both arms to slowly lower
yourself. NEVER reach forward for the chair first and then turn to sit. This
can lead to landing sideways on the end of the chair, landing too hard in the
chair, or missing the chair and falling to the floor.
INCORRECT CORRECT
A physical or occupational therapist can teach you the best techniques for getting
up from the floor.
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Posture
PD can cause many changes in the body. One easily recognizable change is
posture. The characteristic changes in posture can include:
Exercise and proper body positioning can help to limit or correct these changes.
Even without PD, it is very easy for anyone to fall into the habit of bad pos-
ture. Some typical positions we place ourselves into contribute to bad posture.
These include:
Fortunately, there are some easy ways we can break bad habits.
The following tips are helpful for maintaining good posture in all positions:
Sitting
■ Avoid sitting in chairs without back support or arm rests.
■ Avoid recliners. They promote rounding of the neck, shoulders and
head, and also tightness in the hips.
■ Avoid low, soft couches and chairs.
■ The height of the chair should allow for your hips and knees to be level
with one another.
■ Keep your chin parallel to the floor.
■ Avoid crossing your legs.
■ Keep your head, shoulders and hips in line with one another. Sit so that
your back is fully in contact with the chair back and seat.
■ Use a lumbar roll along your low back, especially for long car rides,
plane rides and in the theater – it will help you to sit tall.
■ Your computer screen and TV should be at eye level to minimize
neck and eye strain.
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■ While reading, use a book stand or rest your elbows on a pillow or a table.
This allows you to look directly ahead at the pages. When reading in bed, sit
with your entire back resting on the head board, not just your head and
neck.
DO NOT sit for long periods at a time. After about 20-30 minutes, get up and
move around.
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■ Keep your thumbs facing forward with your palms facing in at your sides.
■ Keep your hands free – carry light loads in fanny packs or small back packs.
■ Have walkers and canes adjusted to proper heights. A physical or
occupational therapist can help you with this.
Lying Down
■ Avoid using too many pillows, or too thin of a pillow under the head.
■ The best postures for sleeping include lying on your back with a soft
pillow under the knees or lying on your side with a soft pillow
between the knees.
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Chapter 4:
Complementary Therapies
Massage Therapy
Massage therapy has been shown to increase circulation, stimulate lymphatic
drainage, reduce muscle tension, and promote relaxation. It can be particularly
helpful to the person with PD who experiences problems with rigidity.
Massage is not a substitute for regular movement and exercise, but may be a
useful part in your overall exercise program. Select a massage therapist who is
certified by the American Massage Therapy Association, and interview the
potential therapist regarding the techniques they prefer to use. It is also impor-
tant to provide feedback to the therapist throughout the massage regarding the
level of pressure being used and any discomfort you experience.
Self-massage and care partner-assisted massage is possible. Using items
such as wooden rollers or hand-held electric massagers will allow you or your
care partner to apply gentle pressure to tight areas of the body. These items can
be purchased at most drug or department stores. It is important to note that
massage services are often not covered by health insurance.
Tai Chi
Tai chi, an ancient form of Chinese exercise, is a slow, flowing form of move-
ment which has been shown to aid in flexibility, balance, and relaxation. Many
people with Parkinson's disease have reported benefits from learning and prac-
ticing tai chi principles.
There are several forms of tai chi that can be done by anyone regardless of
age or physical condition. Classes are often offered at fitness centers, senior cen-
ters, and community recreation centers. It is important to first speak with the tai
chi instructor to learn if the type of tai chi they teach is best for you. Videotapes
teaching basic principles and moves of tai chi can also be purchased or rented at
a variety of retail stores.
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Yoga
Yoga is a form of exercise which can be very helpful for persons with PD.
Yoga has been shown to increase flexibility, increase breathing and posture
awareness, and help with relaxation and stress reduction. Yoga is a self-paced
activity, which means that not everyone has to perform a pose in the same way
or hold it for the same amount of time. Most poses can be modified depending
on your needs. Yoga can even be performed in a chair.
Since there are many types of yoga, it is important to contact the instructor
prior to beginning a class. Generally, a beginner class or a class for those with
special needs is a good place to start for those with PD.
Pet Therapy
"Lap" pets, such as dogs and cats, can provide great satisfaction in the lives of
their human companions. Numerous studies have shown that having animals in
the home improves both mental and emotional health of their owners, not to
mention ample opportunities for movement and exercise. Research has demon-
strated that pets can:
Creative Expression
Creative expression, unique to each person, may also stimulate movement
and physical activity. Painting on an easel with large, forceful strokes stretches
the arms and shoulders. "Conducting" the music of a favorite symphony or
opera has shown to have a strengthening and aerobic benefit.
Ceramics, woodworking (using extreme caution with power tools), and other
creative endeavors stimulate fine motor skills and improves manual dexterity and
strength. Singing alone or in a choral group promotes deep breathing needed for
louder speech and increased endurance.
Persons with PD are encouraged to research and identify the creative outlets
that best fit their talents and abilities.
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Chapter 5:
Carepartner Assisted Exercise
Persons with advanced Parkinson symptoms may not be able to follow com-
mon exercise programs due to changes in physical or thinking abilities. It may
be better to work exercises and stretching into the daily routine. Here are some
suggestions for doing this:
■ Sitting and reaching in different directions can stretch the arms and trunk.
■ Simple games such as balloon volleyball, playing catch with a large, soft ball
or blowing soap bubbles are fun alternatives to structured exercise.
■ Perform a few extra arm and leg motions during dressing tasks.
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29
Appendix A:
Resources
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Gentle Fitness
A videotape of gentle stretches and exercise, guided by recreational therapist
Catherine MacRae.
Telephone: (800) 566-7780
Website: www.gentlefitness.com
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Appendix B:
A Word to Rehabilitation Therapists
Recommended Readings
Here is an abbreviated reference list to help in your treatment of
people with PD:
32
About the Author
33
Acknowledgements
■ NPF staff for their guidance, assistance and support: Ruth Hagestuen, Field
Services Director, and Julian Pearson, Administrator.
■ Members of the NPF Publications Task Force and the Task Force for
Caregiver Initiatives for their thoughtful reviews and assistance in
development of NPF publications:
Jill Burkholder, RN, Markham-Stouffville Health Centre, Markham,
Ontario, Canada; Joan Carpenter, RN, NP, Bear, DE; Carol Eickhorn,
ARNP NPF Florida Care Center, North Ridge Medical Center, Fort
Lauderdale, FL; Joan Gardner, RN, BSN, Struthers Parkinson’s Center,
Minneapolis, MN; Gladys Gonzalez-Ramos, PhD, Ehrenkranz School of
Social Work, New York, NY; Ruth Hagestuen, RN, MA, NPF Director of
Field Services, Miami, FL; Susan Hamburger, MA, MS, Chevy Chase, MD;
Gale Kittle, RN, MPH, Barrow Neurological Institute, Phoenix, AZ; Sharon
Metz, RN, MPH, NPF Florida Care Centers, Miami, FL; Deborah Orloff-
Davidson, RN, MPH, Michigan Parkinson Foundation, Detroit, MI; Patricia
Simpson, RN, MHA, Scott & White Clinic, Temple, TX; Marge Thurin,
MEd, MSW, Minneapolis, MN; Mignone Trenary, MA, Orange County
Chapter, NPF and Hoag Hospital, Newport Beach, CA; Jane Wright, MSW,
The Parkinson Council Chapter NPF, Philadelphia, PA.
35
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