Breathing and Parkinson's Disease

Written by Kristi Riker OTD, OTR/L

Why does Parkinson’s affect breathing?

Breathing problems may arise from changes in muscle control, posture, medications, and the way the brain regulates breathing. You may have noticed shortness of breathing, shaky breathing, or trouble feeling like you can get a full breath into your lungs. While there is much debate on the causes of respiratory dysfunction with PD, studies have found these to be the main issues that arise: 

Main breathing problems with PD:

• Restrictive breathing problems: 

  • trouble expanding the lungs fully

  • feels like you cannot get a full breath

  • caused by rigidity in chest wall muscles, diaphragm, and trunk, stooped posture

• Upper airway obstruction

  • PD can cause narrowing of the airway

  • may notice ‘stridor’ - high pitches breathing sound

• Dsypnea on exertion

  • Shortness of breath with activity

  • due to decreased endurance, weaker respiratory muscles, autonomic nervous system changes

  • can be worsened by coexisting heart or lung problems

• Impaired automatic breathing

  • in advanced PD, the brain’s ability to regulate breathing can be impacted, leading to irregular or shallow breathing 

  • Occurs especially during sleep

• Sleep related breathing disorders 

  • higher rates of sleep apnea with PD

  • may have slow shallow breathing during REM sleep

• Dyskinesia-related breathing problems

  • Involuntary movements of the chest and diaphragm muscles can make breathing jerky and uncoordinated 

• Aspiration

  • swallowing problems can increase chances of food/liquids entering the airway, increasing risk of aspiration pneumonia 

Whew! There is clearly an increased risk of breathing problems with Parkinson’s disease. So, what can you do to improve your breathing and decrease your risk of respiratory issues? First, always consult your medical provider to determine what type of treatment is appropriate for you. Depending on your specific case, your doctor may suggest treatment through medication alterations, speech therapy breathing exercises, posture therapy, oxygen therapy, etc. 

If your doctor finds your respiratory barriers are related to postural issues, they may refer you to an OT or PT. Your therapist will work with you on stretching your respiratory muscles! Respiratory training has been found to have a positive effect on breathing with PD and should be considered when breathing issues arise. 

Why does stretching and strengthening the respiratory muscles work?

• Better posture improves lung expansion. When your posture is stooped forward, your chest cavity compresses and your diaphragm becomes restricted, limiting the amount of air you can inhale.

• Stretching and strengthening can open up the airway. When slouched forward, the airway can become constricted, making it harder to breathe freely. 

• When the respiratory muscles are strong and flexible, they are less likely to fatigue, allowing for consistent deep breathing while awake and asleep

There are multiple main and accessory muscles involved in respiration. Now, how can you stretch and strengthen them? Here is an example of exercises geared towards improving the function of some of the respiratory muscles. Make sure to consult your doctor or PT/OT before attempting these exercises.

The Diaphragm: 

While standing, place one hand on your breast bone and one hand on your abdomen near your navel. 

Slowly take a deep breath in and focus on trying to get the hand on your stomach to rise while the hand on your breast bone remains still. 

Repeat 10x

Complete 3 sets daily

Pectoralis: 

While standing at a corner of a wall, place your arms on the walls in the shape of a "W.” Take one step forward towards the corner. Bend your front knee until a stretch is felt along the front of your chest. Your arms should be pointed downward towards the ground.

Repeat 3x

Hold 20 seconds

Complete 3 sets

Intercostals:

Standing straight with feet shoulder width apart, hold a weight in one hand at the side of the body with the elbow and shoulder relaxed. Let the weight gently pull the trunk toward the side.

When a comfortable stretch is felt on the side of the body opposite the weight, return to upright in a controlled manner. Repeat on the other side.

Repeat 10x / Hold 5 seconds / Complete 3 sets

Sternocleidomastoid:

In sitting, place one hand over the front of your collarbone, then extend your head backwards and to each side.

Repeat 3x

Hold 20 seconds

Complete 3 sets

Scalenes:

Tilt your head to the side and then rotate your head downward. Hold for a stretch. Return to original position and then repeat.

Repeat 3x

Hold 20 seconds

Complete 3 sets, 1x/day

Serratus Anterior:

Standing with elbows and forearms on wall, dip chest into wall and push back out through the elbows, keeping elbows on wall throughout motion.

You want to feel the shoulder blades wrap around your rib cage

Repeat 10x

Complete 3 sets

Resources:

Torsney KM, Forsyth D. Respiratory dysfunction in Parkinson's disease. J R Coll Physicians Edinb. 2017 Mar;47(1):35-39. doi: 10.4997/JRCPE.2017.108. PMID: 28569280.

van de Wetering-van Dongen VA, Kalf JG, van der Wees PJ, Bloem BR, Nijkrake MJ. The Effects of Respiratory Training in Parkinson's Disease: A Systematic Review. J Parkinsons Dis. 2020;10(4):1315-1333. doi: 10.3233/JPD-202223. PMID: 32986684; PMCID: PMC7683068.