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The Bridges For Parkinson's Exercise Prescription


Written By: Colleen Bridges, M. Ed., NSCA-CPT, Parkinson’s Fitness Specialist

Dear Fighters and Care-partners,


Let me start out by announcing, "I am giving each of  you a “Prescription” you can “swallow” without having to take a single pill or sip of water!"  


You’re probably asking yourself, “What does Colleen mean by prescription? I'm already taking all the  Parkinson’s medication I want to take.”  


Well, you know that exercise benefits those living with Parkinson’s. You know the science of WHY exercise helps slow the progression of PD proven by our three year research project with Vanderbilt University Movement Disorder Physician, Dr. Daniel Claassen, along with individual fighter’s testimonies, and 20 years of experience working with those living with PD. In a nutshell, think of exercise as medicine and just like your doctor writes a prescription for your dopamine replacement medication, I’m going to write you a “prescription for exercise.” 

Whether you prefer to exercise on your own or create a plan that coincides with participating in my program, you need to have a plan… specifically a PD exercise plan that incorporates your overall physical abilities and limits.  Note the common theme here - having a PLAN.


BRIDGES FOR PARKINSON’S EXERCISE PRESCRIPTION


*2-3 days of “ Comprehensive Exercise”:  This includes…


  • forced- intense exercise - In the gym, this is when I “push” you to do an exercise for an extended amount of time harder/faster than you would probably do on your own. Remember, each of us moves at different intensity levels.  So, we always use good sense in our approach to how hard/fast we perform an exercise. Safety is our first priority! 

EXAMPLES of Forced-Intense Exercise

  • Walk faster for 30 seconds- minute then return to original pace

  • Bike sprints for 10-20 seconds fast then slow for 10-20 seconds

  • Boxing at a consistent tempo for 1 minute

  • Boxing -20 sec fast KOs/10 sec KOs (Knock-Outs)


Comprehensive Exercise Prescription also includes:

  • Strength 

  • Cardiovascular endurance

  • Balance, agility

  • Dual-tasking

  • Stretching

  • Fine motor skills

  • Vocal drills


We wrap all of the above into one straightforward, doable routine!  When you attend a Bridges For Parkinson’s/ Rock Steady Boxing Music City/ Franklin class, this is the type of comprehensive exercise routine we do in every class. 


Then on your own you will do:


*2 days of moderate cardio; walking, cycling, swimming, dance (our online class is called, Music and Movement)

*1-2 days of low impact/stress-reducing exercise such as Tai Chi and/or Yoga (Laura and Theresa lead these classes online)



WHY COMPREHENSIVE EXERCISE ROUTINES??


1. Why? Because it mirrors your everyday life specifically the 7 daily functional movements - push, pull, carry, rotate, lunge, squat, hinge 

  • When you carry groceries in from the car, you have bags in your arms while turning corners, watching out for your pet, perhaps talking to someone or stepping up and down stairs.

  • What about when you vacuum? Pushing, pulling, bending over to move things, working around the cord, walking etc…and depending on your house, you can work up a good sweat!

  • When you roll out of bed, you don’t just roll a part of your body out of the bed and leave the rest there! NO! You roll over, prop yourself up, then push yourself to standing then walk to the restroom which includes turning, leaning over or twisting to flush or a sit to stand then back to the bed where you have to turn your back to the bed, sit down, roll into position, recover yourself.

Your body moves as a single unit to perform daily activities,  so you need exercise routines that mirror your daily activities. 

The Comprehensive Exercise Plan includes drills to integrate the seven functional moves and help your brain fight back.


2. Two Days of Moderate Cardio: You MUST keep moving to maintain cardiovascular health! Plus, movement is critical for bone density!  When you walk or jump and create an impact in your body, new bone begins to develop!  


Check out my blog on www.bridgesforparkinsons.com to read articles on the importance of bone health as it pertains to Parkinson’s Disease. I highly recommend weight bearing exercises to promote strong bones such as walking, jogging, boxing, tennis, golf. Anything that requires you to “load” your body.  Biking, swimming, rowing, and using the elliptical is great for those who cannot walk for long distances but remember that in order to stimulate new bone growth you must perform exercises that involve impact and/or heavier loads.


3. One to two days a week of stretching and/or Tai Chi.

There are numerous reasons to take a stretch class, Yoga, or Tai Chi for anyone.  BUT,  for the person living with Parkinson’s Disease, rigidity, and anxiety are a good place to start when considering participating in these classes. 

An article published in 2019 titled “Tai Chi Versus Routine Exercise in Patients with Early or Mid-stage Parkinson’s Disease: A Retrospective Cohort Analysis (Li et al. 1-7)  shares that five hundred people living with Parkinson’s Disease were divided into two groups. The Tai Chi group saw a decrease in falls and some were able to decrease the amount of dopamine replacement treatment. 


Yoga is also a wonderful class for those living with Parkinson’s Disease. For individuals struggling with insomnia, depression, anxiety, or rigidity, Yoga provides relief of these symptoms through breathing techniques and focus-driven stretches.


Bridges For Parkinson’s offers Tai Chi classes twice a week via ZOOM with Coach Laura and Yoga once a week with Coach Theresa! Make sure to check out these classes!  


BUILDING A COMPREHENSIVE EXERCISE ROUTINE


Just as a house has a blueprint, so does the PD Comprehensive Exercise routine. It starts with the foundation…THE MICRO WARMUP

  1. The micro warmup is an opportunity for you to get your blood flowing, tune into your body, evaluate your movement and turn your focus to the task at hand. You start at the top of your body (your head) and go all the way down to the feet. 

  2. This also gives the assistant coaches and interns and volunteers the opportunity to check out how folks are doing who might need a little extra help in class versus who might need to be challenged during class. 

  3.  It’s usually 5-7 minutes long.

Once you have completed the micro-warm-up and your blood is pumping, you will then move into the DYNAMIC WARM-UP

  1. In the dynamic warmup, you perform large/dynamic movements that encourage active ROM and flexibility, and what I refer to as the “wake-up call” for strong posture, gait, rotation, agility, speed, strength, fall prevention and more.

The dynamic warmup also includes activities that increase your cardiovascular output. The dynamic warmup is going to be less demanding than the next phase, the work phase of the program) it prepares you for more vigorous movement and elevates internal temperature so you begin to sweat.. or if you’re in the south, glisten.

The dynamic warmup starts with simple movements and graduates to larger range of motion exercises that are more complex and require more from the brain but also mirror what you will do in the work phase.  I want you to do something in the dynamic warmup that is similar to what you plan on doing in the work phase. (example squat/row dynamic warmup = squat/row with the tube in the work phase) 


EXAMPLES of some dynamic warmup drills 

  1. Rainbow

  2. “T”/half jack

  3. Diagonal step/row

  4. Jazz hands

  5. Criss cross applesauce series (in class I say “shoulder, shoulder, knee, knee”)


Now you are ready to dive into the WORK PHASE!  Everything leads up to this moment!  And I can tell you this.. it will be more demanding from beginning to end with modifications as needed.


The work phase will include:

  1. Cardio- (this is where you perform “forced-intense” cardio) which includes boxing… And this is a very special part of our program. Why? Because everything a pro boxer works on is the same thing you are working on.  Improved gait, flexibility, power, speed of motion, memory, mental focus, agility, hand-eye coordination.  But when it comes to the boxing portion of the work phase, here is what I want you to know… we teach boxing for PD. I’m not trying to turn you into Joe Frazier or Ali. Yes, the coaches and I will teach you how to properly stand and hold your hands and move your body BUT…if you have musculoskeletal issues, we are going to modify your foot stance, or for shoulder issues, we are going to change your arm position.

Perhaps you have a fused back from stenosis or scoliosis or another type of back issue or bad hip, or maybe arthritis in your hands, we are going to show you how to box without aggravating the situation.


  1. Strength exercises mirror everyday life (remember the 7 functional movements) but also address the upper/lower body, aka: compound movements that challenge your balance, agility and planes of motion, cognition and proprioception. Once again, this is how you move throughout the day.


EXAMPLE WORK PHASE ROUTINE:

  • Sit to stand- JC pyramid (Stand- 2 punches- sit- stand 4 punches- sit- etc)

    • Functional movements: squat, push, pull, hinge

    • Cardio/coordination/dual tasking/strength

  • “T” with abduction kick or step

    • Functional movements: pull

    • Balance (from toes to hip)/agility/ dual tasking/strength

  • Diagonal step/speed bag arms

    • Functional movements: lunge, hinge

    • Balance/coordination/dual tasking/cardio/agility/strength

  • 2/10 arms - tandem stance (stand with one foot in front of other or split stance)

    • Functional movements: carry

    • Balance/strength/coordination/dual tasking

  • 20 fast/10 slow then turn R - repeat 2x

    • Foundational movements: rotation, lunge

    • Cardio/balance/agility/coordination/push/pull

    

As you can see, we take much of what we do in dynamic warmup and “turn up the volume" in the work phase .

Now once you complete the work phase, you begin the transition to the stretch portion of the routine.  


STRETCHING TIPS

  1. Perform seated or with back on the floor to eliminate excessive lumbar flexion (think 1980’s style of stretching). This also protects those with spinal issues and osteoporosis.

  2. Include static flexibility & breathing techniques-  We hold our stretches at the end of exercise. This tells the body we are “cooling down”.

  3. Posture- Keep spine long 

  4. NO BOUNCING!! 


You may have noticed that my routine had an order to it. Yes! From the micro warmup to the final stretch and everything in between, I write each routine from a neurological perspective. I do not pick and choose my exercises from YouTube or Facebook…instead, I study how you move, the activities of daily living you need to perform, the areas of the brain affected by PD, the additional issues you are struggling with, the goals I want you to accomplish. THEN, I compile the information and sit down once a week and write out all my routines for the coming week.


I want you to do the same…


To help you “fight back “ strong, I have created a guide for you to use if you are unable to attend a class online or in-person(see below). Remember, you can find classes in our video library on the www.bridgesforparkinsons.com members only portal AND/OR on the Rock Steady Boxing Music City, Members Only FACEBOOK PAGE.


Together, we fight back stronger!

Always in YOUR corner…


Colleen


BUILDING A COMPREHENSIVE EXERCISE ROUTINE GUIDE

Micro-warmup

  • Gets your blood flowing

  • Allows you to tune into your body

  • Evaluates your movement and turn your focus to the task at hand

  • Start at your head and go down to feet. 

  • Usually 5-7 minutes long.

Dynamic warmup

  • Increase cardiovascular input

  • Prepares you for more vigorous movement and elevates internal temperature

  • Starts with simple movements and graduates to larger ROM exercises

Work Phase

  • Cardio/Boxing:

  • Works on Gait, flexibility, power, speed of motion, memory, mental focus, agility, hand-eye coordination

  • Strength

  • Addresses compound movements (upper and lower body together)

  • Challenges balance, agility, planes of motion, cognition and proprioception

Stretch

  • Static stretching (no bouncing) and keep spine neutral to protect spine

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