Universal Fitness Innovation & Transformation
She is 56 years old and lives with her husband and 2 teenage daughters. Pam began to notice tremors in her right arm and hand about a year ago (she is right-handed). Since then she has also had some difficulties with the way she walks (her new gait pattern means she takes small steps when walking) and with her balance, especially in crowds or if the environment is unpredictable. Although her speech is fine, Pam has noticed that it’s become more difficult to sign her name, especially when there is only a small space provided.
He is 68 years old and is having increasing difficulty with functional activities, such as moving more slowly and with more effort to stand up after being seated in a chair. Steven has tremors on both sides of the body now and he loses his balance more regularly. When he tries to move his body suddenly, Steven often finds that his neck and shoulders freeze up and it is difficult to move through narrow spaces such as doorways. Steven has noticed that he has to repeat himself several times when ordering food in a restaurant and his partner Chris has started cutting up his food if it requires a knife and fork.
Both Pam and Steven have been diagnosed with Parkinson’s Disease, however, they are experiencing PD differently.
Parkinson’s Disease (PD) is the most common neurodegenerative disease following Alzheimer’s disease (Farley, 2004). It’s a progressive condition involving the nervous system (specifically, the extrapyramidal part) that results in impaired motor function (ACSM, 2016 p.273). This means that messages from the brain get interupted on their way to the nervous system. See ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities for more detailed description of the pathophysiology related to PD.
Who is typically affected?
(Parkinson’s Disease Foundation, 2017, http://www.pdf.org/en/parkinson_statistics)
Exercise is important for everyone! For people with Parkinson’s disease, the benefits of regular exercise include:
In addition to gathering medical information and details about their fitness/ physical activity experience, you can focus on goal setting and learn about what they want. In addition to talking about exercise, ask the participant about how they will get to the fitness center, and what kind of support (if any) they need to be ready to exercise (for example, accessing the locker room).
You want to support the participant to be as independent as possible. Depending on the individual, this may change over time as they become more familiar with the setting and feel more confident and capable. Some participants may choose to include task-specific training as part of their goal setting (e.g., movements to help with getting out of bed or stopping and changing directions).
When someone with PD comes in for their consultation you may notice the following:
What are you going to do?
For someone with PD, they may experience motor difficulties due to a loss of dopamine, which regulates neural activity in the brain that is responsible for starting and stopping movements. This means that you might notice the following related to how someone with Parkinson’s disease moves:
Every person is like every other person, like some other person, and like no other person.
It’s really important that people who are new to exercise learn how to monitor and describe how they are feeling or how their body responds to exercise. One helpful way to do this is to introduce a Rate of Perceived Exertion (RPE) scale. The smiley face RPE Scale or the OMNI scale (see below for examples of both) may be more suitable for participants with various disabilities than the age-predicted maximal heart rate (220 – age) (Stanish & Aucoin, 2007).
In the beginning, it is also recommended that participants measure their heart rate (using wearable technology such as a heart rate monitor may make this easier!). This information will help you and the participant work together to learn about how they perceive their exertion during exercise and it may help you with program planning. For example, you may encourage the participant to work towards a specific level of RPE, which can be complemented with information from the HR monitor to measure exercise intensity. Monitoring HR may also be useful in the event that participants are exercising at a level beyond the recommended intensity, which may happen if the person is very engaged in the activity or if they are trying to make a positive impression on you.
Smiley Face Relative Perceived Exertion Scale
Individuals with Parkinson’s disease will most likely be taking regular medications. They may have regular cycles that they go through in which they feel on or off, depending on where they are at in their medication cycle. This cycle might include when they take medications, and how long or frequently they feel on or off. Feeling off, may lead to increased fatigue, tremors or dyskinesias (involuntary, excessive, and abnormal movements), which might not be an ideal time to introduce new exercises or increase intensity, duration or frequency. You can raise this question during the consultation or as part of your regular check in to see how the person is feeling each day. It is also important to ensure the individual has the go ahead from their health care provider prior to beginning a new exercise program.
If you would like more information about some of the common medications used by individuals with PD, along with some of the possible side-effects, ASCM has produced a great manual that will provide more details (ACSM, 2016)
The tips and strategies found within the inclusive TIMES section will help you to create an environment that will support your participant’s participation in physical activity as independently as possible. It is important that you involve the participant whenever possible, along the way to ensure the program that you design will meet their needs physically, as well as emotionally and socially. Introducing a few simple strategies such as offering visual images of the participant’s program will help them to be more independent in completing their fitness programme. Ultimately, they will gain confidence and belief in their abilities (increasing self-efficacy) and experience self-determination (sense of control over their own destiny). This is key to establishing healthy habits that will be adopted for the long term.
Copyright © 2020 by UNESCO Chair , Institute of Technology Tralee
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UFIT c/o, UNESCO Chair, Institute of Technology Tralee, Tralee, Co Kerry. Ireland
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