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Pilates for People with Parkinson’s Disease

By Lindy Royer and Kriste Waldmann 
As seen in the Balanced Body Summer 2007 Pilates COREterly
According to the National Parkinson Foundation (, Parkinson’s disease (PD) is the most common neurodegenerative disease after Alzheimer’s. PD affects both men and women in almost equal numbers. It shows no social, ethnic, economic or geographic boundaries. In the United States, it is estimated that 60,000 new cases are diagnosed each year, joining the 1.5 million Americans who currently have PD. While the condition usually develops after the age of 65, fifteen percent of those diagnosed are under 50.

PD is a chronic, progressive disease that results when nerve cells that produce dopamine die or are impaired. Dopamine is a chemical messenger that transmits signals from the substantia nigra to another part of the brain called the corpus striatum, controlling coordinated movement. When these cells die, the other movement control centers in the brain become unregulated. These disturbances cause the symptoms of PD. Initially, the physical symptoms are mild, usually on one side of the body, and may not require medical treatment. The primary signs of PD are:

Resting tremor of a limb (shaking with the limb at rest)
Slowness of movement (bradykinesia)
Rigidity (stiffness, increased resistance to passive movement) of limbs or trunk
Poor balance and coordination (postural instability)
Other signs of Parkinson’s disease may include:

Small, cramped handwriting
Stiff facial expression
Shuffling walk
Muffled speech
Treating PD…
Current treatment approaches for Parkinson disease include medication, surgical procedures, and nutritional, physical, occupational and speech therapies. Many patients also seek complimentary therapies such as acupuncture, massage or hypnotherapy.

Many medications are currently available for treating the signs and symptoms of PD, but none has yet has been proven to slow or stop the progression of PD. There is hope that a medication will soon be developed, which proves itself as a true neuroprotective agent capable of stopping, slowing or reversing the effects of PD. Since each person with Parkinson’s has such individualized symptoms, the goal of medication is to reduce specific symptoms. This is usually accomplished with a combination of drugs, depending on the patient’s tolerance. Most PD medications work by influencing dopamine, and these drugs can produce a number of side effects such as nausea, low blood pressure, dyskinesias (writhing movements) and hallucinations. The primary symptoms of PD can all be reduced with medication, but the disease is progressive and many patients will require more medication as time passes.

Surgical procedures have been used for the past fifty years. The latest surgical approach is deep brain stimulation (DBS), a technique developed in the 1990s and approved by the FDA in 1997. This approach is especially effective for PD patients with disabling tremors, wearing-off spells (which occur when individual doses of a patient’s antiparkinson medication lose their long-term effect) and dyskinesias. DBS involves inserting electrodes into a target area of the brain, determined by the patient’s symptoms, and implanting a device under the collarbone. The device provides continuous current to affect motor function. DBS does not help improve balance or gait freezing, and is only minimally effective on speech and posture. Other surgical procedures include thalamotomy and pallidotomy, both of which involve the destruction of small amounts of tissue in the thalamus and globus pallidus, respectively.

Therapies such as nutritional support, speech therapy and occupational therapy can all help improve a patient’s quality of life and decrease the daily challenges experienced by Parkinson’s patients. Physical therapy in particular has been shown to improve mobility and coordination. According to a study published in the Journal of the American Geriatrics Society (1998; 46:1207-1216), ten weeks of a coordination and flexibility-based exercise program, three times per week, was shown to have significant measurable improvement in mobility and coordination compared to control subjects. Numerous research studies indicate improvement in gait, motor function and activities of daily living. It is worth mentioning that an ongoing, consistent rehabilitation program seems to be of significance in treating the symptoms of Parkinson’s disease. According to a study published by the American Academy of Neurology, once a rehabilitation program is stopped, the improvement is not sustained. (Neurology 1994; 44:376)

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