Exercise routine for Parkinson’s. How to start? A Physical therapist & Neurologist explain.

If you have been diagnosed with Parkinson's disease and your doctor is recommending exercises, but you are unsure how to begin or cannot afford a physical therapist or personal trainer, then this video is for you. It is also suitable for those who are starting from scratch, even if they do not have Parkinson’s.
STAGE 1 (Warming up phase): The first step you should always take before exercising.
1. As with any athlete, warming up is crucial. You can just walk at a comfortable pace for 3-5 minutes. I call it talking pace. The idea of warming up is to get your muscles ready (activating the muscles) and minimize injuries. We are susceptible to injury, and this might be a limiting factor for many of you.
You may gradually increase the inclination to make the warm-up more challenging. Keep in mind that stepping out of your comfort zone is crucial!
2. If you have parkinsonism and are unable to perform tandem gait, it is unsafe for you to use a treadmill alone.
Other warm-up options include using stationary bikes or marching in place.
STAGE 2 (Drills, breathing, balance, and stretching phase)
Please find below a set of exercises that you can perform to improve your flexibility, balance, and breathing. You should aim to do these exercises for 6 days per week.
1. Slow Neck rotation: Sit down and gently rotate your neck, bringing your chin towards your shoulder for 10 to 15 seconds.
2. Breathing and relaxation exercise: Stand with your legs apart to create stability. Close your eyes and inhale while elevating your arms all the way up with palms and fingers very open, palms facing each other. After holding for 2-3 seconds, exhale and lower your arms with palms facing the floor. Imagine that you are introducing energy to your body when you are moving your arm down. Keep your eyes closed for 3 more seconds and repeat it 2 more times. If it's too easy, then do it in a standing position.
3. Sitting position: Do 8-10 repetitions of stepping aside (abduction of the hip) synchronized with reaching movement ipsilateral.
4. Sitting position: Rotate your trunk with hand grips in front of you, like a washing machine.
5. Sitting position: Raise your shoulder to flex ~30 degrees, elbow 90 degrees, palms facing each other, fingers open, then inhale while moving the shoulder backward. Hold it for 3 seconds, then exhale and move the arms to the initial position. Focus on feeling the stretching of the pectoralis muscles. Repeat 3 times.
6. Sitting position: Touch your outstretched hands with your knees, alternating between knees.
7. Sitting position: Circularly move your shoulders for about 10 seconds in each direction.
8. Stand up: Exaggerate arm swings with one leg in front of the other; flex and extend your shoulders. Keep your hand open but relaxed. Do this for about 10 seconds each time while alternating legs.
9. Narrow base of support for 30 seconds (close to something fixed to hold on if needed)
10. One leg stance for 30 seconds. More flexion of the knee, more difficulty.
11. Leg swing holding the sink, alternating with arm swing.
12. Hold the sink, lateral weight shift exercises.
13. Hold the sink or close to the sink to perform a tandem walk.
14. Alternating backward stepping. Move your center of gravity backward, and after 1 second, move the leg backward.
15. Alternate stepping. You can put a pillow to tap it with your foot.
------------
STAGE (STEP) 3: To strengthen your muscles, perform resistance exercises twice a week on Mondays and Thursdays for six weeks. After that, you can progress to three days per week, adding Saturday to your routine.
Here are the exercises you should do:
1. Alternating hip flexion and abduction while sitting. Do two sets of ten repetitions per leg. You can increase the difficulty by using a resistance band.
2. Sit to stand, starting from a half position and progressing to a full position. 2 sets of 8-10 repetitions.
3. Wall knee drive. If this exercise is too easy, you can use ankle weights. 2 sets of 8-10 repetitions.
4. Seated calf raises. Place two books that you do not like on your lap, and raise your calves while sitting. 2 sets of 20 repetitions.
5. Standing calf raise. 2 sets of 8-10 repetitions.
6. Seated ankle dorsi flexion and heel walking for more difficulty.
7. Wall push-ups. Do 2-3 sets of 8-10 repetitions.
8. Resistance band triceps extension. Do 2 sets of 8-10 repetitions.
9. Bridge exercises. Do 2-3 sets of 8-10 repetitions.
To improve your quality of life, it's important to stay consistent with your exercise routine and have a clear structure and schedule. Relying solely on medications or deep brain stimulation (DBS) won't be enough.
Dr. Z
Luis E. Zayas, MD PT
Clinical Assistant Professor-University of Tennessee
Board Certified in Internal Medicine, Neurology & Epilepsy
Fellowship trained in Movement Disorders and Neuro-Critical Care
Former NJ & PR physical therapist
www.cdc.gov/nchs/data/databri...

[@omarpallares9794]

Dr Saludos desde Colombia, en otro video usted habló como alternativa para disminuir el temblor la aplicación de toxina botulínica. Acá en Bogotá la aplican algunos neurólogos en movimientos anormales. Yo solicité cita médica para este próximo viernes y la Dra me dijo que si, que comprará Toxina Botulínica vial por 100 UL (un vial para aplicación intramuscular en MSD - Dosis única). Dr. por favor orientarme, la Dosis es conveniente y además cuando dice que es Dosis única). Toda mi admiración y gratitud

[@luisezayasmdpt4397]

La dosis depende del paciente. Hay muchos factores para determinar la dosis en adultos. Tendria que evaluar el caso personalmente para decir. Pare prevenir complicaciones, Siempre empieza con una dosis baja y despues aumenta si es necesario.

[@whosebonesaresharp]

Dr Zayas do you still practice anywhere in Johnson City? Knoxville is a bit too far for us as we are in Black Mountain NC

[@luisezayasmdpt4397]

I see patients in Knoxville, TN only.

[@omarpallares9794]

Disculpe Dr por referirme a un tema distinto a lo comunicado en este vídeo. Hace muchos años ha venido creciendo en mi espalda una mancha oscura y el dermatólogo me dijo que es Amiloidosis, y que se ha demostrado que tiene relación con la enfermedad de Parkinson. Agradezco su opinión sobre el particular. Un gran abrazo desde Colombia

[@luisezayasmdpt4397]

Hay muchos tipos de amiloidosis. En Parkinson se cree que es una alfa sinucleopatia, que es una forma de amiloid ( agregado anormal de proteínas), pero no se sabe si esta proteína es el problema o solo está ahí para ayudar. La mancha negra podría ser un melanoma, que es más común en pacientes con Parkinson, no se sabe bien porque. Ese tema es controversial, no se entiende bien

[@omarpallares9794]

@@luisezayasmdpt4397 Muchas gracias Dr por compartir sus conocimientos. Aprecio sobremanera que me haya respondido

[@JoseLopez-jc4ut]

Ese viejo está acabau 😹😹 (Milton)

[@Simon-qt9nz]

"Promo SM" 😝