The Five Rs of Exercise Design
Most folks truly don’t like to exercise. It takes time and effort and often it is not fun. But for the Parkinson’s sufferer it is absolutely essential to keep moving as much as possible and exercise can help in that quest.
The ideas I apply to exercise are to try to answer as many of the symptoms of Parkinson’s as I can in any given movement. To try to make the exercise relevant to the individual and their specific set of symptoms. And as much as possible I try to make the exercises fun.
Some of the common symptoms I try to answer with exercise include difficulty initiating movement, difficulty changing direction, stiffness of the joints and poor balance. I have developed the 5Rs of exercise design as a way to try to address as many symptoms as possible.
ROTATION
Walking requires us to rotate all up and down our body in ways large and small. This is most evident in the disassociation of limb movements – one limb moving forward while the other is moving back and in the coordination of opposite arms and legs. Studies on treadmills have shown that rotation increases with speed as a means of maintaining balance. A person unable to rotate their trunk will feel more out of balance and will only willingly walk at slow speeds. Some exercises that incorporate rotation include dancing, swinging a bat or tennis racquet, tai-chi and water aerobics. Lying on your back and dropping your knees side to side is a gentle exercise to try at the start of your day.
RHYTHM
The nervous system includes an “internal clock mechanism”, it is how we are aware of the passage of time and how we are able to compute time, speed and distance with regard to moving around objects or dealing with others in a moving crowd. This mechanism is affected by Parkinson’s Disease. Exercises that include cadence help the nervous system cope with the damage to its internal clock or exercising to music can assist the cadence of exercise. Exercises might include dancing, tennis, catching and throwing a ball or just walking in time to music.
RANGE OF MOTION
Stretching muscles helps reduce rigidity and pain. Moving joints through their range of motion help prevent losses of the end of their range and prevents stiffness. It is best to time stretching exercises to the time when medications provide the most relief so as to avoid injury to overly tight muscles. Exercises could include stretching, throwing a ball, Tai-chi- yoga and water aerobics.
REACTION
Research has found that it is easier to move if it is done in reaction to an external stimulus. For example someone having difficulty raising their hand might do so more quickly if done to catch a ball thrown to them. This adds the benefit of rehearsing the interpretation of sensory input. Also I have often set up obstacle courses made of simple blocks and steps either to step on or step over. Obstacle courses need not be in a straight line and can challenge the person to vary step length as well as change directions.
REHEARSED MOVEMENTS
Movements that are familiar are easier to repeat and adjust to changes. If you used to dance try it now. If you used to play tennis go bounce some balls off a back board. If you used to golf go to the driving range or the putting green. Your body and nervous system are changing but your nervous system will more readily adapt to these changes with a familiar movement than with an exercise that is completely new.
Not every exercise will address all five Rs but the more the better. And sometimes one R can be used to make addressing another R easier. Reacting to an incoming tennis ball to perform the rehearsed movement of swinging the racquet and thereby increasing rotation and shoulder range of motion includes four Rs and is fun!