Nonpharmacologic Treatments

Exercise

Physical activity improves general health and emotional well-being. The disabling movement symptoms of PD, however, often cause a person to reduce physical activity. This can decrease strength and stamina, and make muscles more rigid. An exercise program is an important component in the overall treatment of PD. Exercise and physical therapy can put muscles through their full range of motion and promote strengthening of critical muscle groups. This can help maintain mobility and balance.

What kind of exercise program is appropriate for the PD patient?

Research has shown that regular exercise benefits people with Parkinson's disease (PD). Exercise reduces stiffness and improves mobility, posture, balance and gait. PD patients may benefit from an exercise regimen that includes aerobic activity (done at a training rate of 60 to 70% maximal heart rate), strengthening exercises, and stretching. Ideally, the exercise regimen will be followed at least three times per week and will improve aerobic capacity, and muscle strength and flexibility. One of the features of Parkinson's which is most difficult to treat with balance, may respond better to exercise to improve balance and leg strength than to medication treatment.

Patients may want to consult a physical therapist or PD exercise group for specific exercise suggestions. One good book for Parkinson's exercises is Parkinson's Disease and the Art of Moving, written by John Argue. In addition to the website, John Argue can be called at 510-985-2645. The APDA has an exercise booklet available online: APDA exercise booklet.

Medication and exercise

The best time to exercise is when mobility is best. For individuals who take medications for Parkinson's disease, the best level of function often occurs about 1 hour after a dose of medications. There are no studies that have shown exercise to interfere with any PD medication nor are there any studies to indicate that exercise boosts or prolongs the effects of medications.

Using visual and auditory cues

Visual and auditory cues can reduce "freezing", a frequent problem for individuals with Parkinson's disease. Auditory cues, such as walking in time to music or a metronome, have benefits that persist after discontinuing the cue. (Some patients are able to produce their own auditory cues by saying "Right/Left" or "heel first" to themselves as they walk.) Pretending to step up onto an imaginary step or "marching' rather than stepping can also be helpful. Visual cues may aslo be helpful. Even when completely unable to initiate a step on their own, many patients can step over an object or a line, thus initiating gait. When using lines as visual cues, the lines should be spaced at least one foot apart and should be parallel to one another. Some patients have found that following a laser pointer dot on the floor may enable them to start walking more easily.

Are there hints to help me get out of bed?

For some people with Parkinson's disease, getting out of bed may become difficult. Try rolling over in bed, put your feet over the edge of the bed and then sit up. This technique is better for your back and may make it easier to get out of bed Another technique is to wear satin pajamas or use satin sheets (although not both).

Techniques to Improve Speech

• Increase loudness
• Face the listener directly
• Emphasize key words
• Use short sentences
• Range-of-motion exercises for muscles of speech
• Breathing exercises
• Attend speech therapy

Dietary Recommendations see diet page Parkinson's Diet Information

• Eat a balanced diet, including all food groups
• Consume sufficient calories to maintain weight
• Consume adequate fiber and fluids to avoid constipation
• Take vitamin D and calcium to prevent osteoporosis
• Reduce protein to minimum daily allowance (not for everyone: only with significant motor fluctuations)

Management of Sialorrhea (drooling) and Swallowing Difficulty

• Do not rush
• Be aware of saliva accumulation and swallow often
• Eat soft foods
• Eat small bites of food
• Swallow only well-chewed food
• Empty mouth before next bite
• Family should learn Heimlich maneuver

Sexual Desire and Function

• Individual variation in effect of PD
• Some patients have short-lived hypersexuality with dopaminergic drugs
• Erectile dysfunction
• Side effect of several types of medications

Other causes of sexual dysfunction

• depression
• some antidepressants (Prozac, Paxil, etc.)
• endocrine (hormone) dysfunction

Miscellaneous Concerns

• Seborrheic dermatitis ( a kind of skin lesions)

- treated with shampoos or lotions with ketoconazole, selenium, pyrithione zinc

Driving

- patient should be assessed regularly for reaction speed, judgment, mental status

- patient should retake driver's test