Exercise
is important for a healthy lifestyle but it is also a key part of therapy,
rehabilitation and disease management. For Parkinson’s disease, exercise
routines are often recommended to help maintain stability and the coordinated
movements necessary for everyday living. An NIH-funded study, reported in the
February 9, 2012 issue of the New England Journal of Medicine,* evaluated three
different forms of exercise – resistance training, stretching, and tai chi –
and found that tai chi led to the greatest overall improvements in balance and
stability for patients with mild to moderate Parkinson’s disease.
Parkinson’s
disease is a movement disorder that is caused by the loss of brain cells which
control coordinated and purposeful motions. This cell loss results in tremor,
rigidity, slowed movement (known as bradykinesia) and impaired balance
(postural instability). While some symptoms, such as tremor, at least benefit
from drug therapy initially, the medications currently available to treat
Parkinson’s are not as effective in restoring balance. This is a special
concern for Parkinson’s patients because postural instability frequently leads
to falls.
Several
studies have demonstrated that resistance training, for instance with ankle
weights or using weight-and-pulley machines, has positive effects on balance
and gait. As a result, doctors often suggest exercise or prescribe physical
therapy to address problems with instability.
Fuzhong
Li, Ph.D., research scientist at the Oregon Research Institute in Eugene, was
part of a team of researchers who, in 2007, published a pilot study showing
that tai chi was a safe exercise for individuals with mild to moderate
Parkinson’s disease. “We had been using tai chi for balance training in healthy
older adults, “ Dr. Li commented, “and older adults and patients with
Parkinson’s disease share some difficulties with falls.”
Tai chi
is a balance-based exercise that originated in China as a martial art. While
there are many different styles, all are characterized by slow, relaxed and
flowing movements. In both the pilot study and the recent New England Journal
of Medicine study, patients performed a tai chi routine designed to challenge
patients’ stability and address the balance and stability-related symptoms of
Parkinson’s. The routine included slow, intentional, controlled movements that
maximized the swing time of arm and leg motions, and repeatedly incorporated
gradual shifts of body weight from one side to another, varying the width of
their base of support by standing with feet together or further apart.
With
support from the NIH’s National Institute of Neurological Disorders and Stroke
(NINDS), Dr. Li and colleagues conducted a larger clinical trial to compare tai
chi to resistance training and stretching. The study assigned a total of 195
patients with mild to moderate Parkinson’s disease to one of three exercise groups:
tai chi, resistance training, or stretching. Patients attended class twice a
week for 24 weeks. The investigators assessed balance and movement control by
testing how far patients could lean and shift their center of gravity without
losing balance, and how directly the patients could reach out to a target, with
a minimum of extraneous movement.
After
six months, the patients in the tai chi group showed the greatest amount of
improvement in balance and stability. Furthermore, patients in the tai chi and
resistance training groups had a significantly fewer falls over the six month
period compared to participants in the stretching group.
“There is a learning curve involved,” Dr. Li
noted, adding that improvement is seen after four to five months of continued
practice twice a week, and this trend is similar to what he had noted in his
studies of older people.
Dr. Li
described tai chi as similar to resistance training, the more commonly
recommended physical therapy, in that it requires repetitive movement. Tai chi,
however, not only involves shifting a person’s weight and center of gravity,
but it is also practiced at a dramatically slow speed and greatly emphasizes
intentional control of movement.
“In tai
chi we emphasize very slow and intentional movement,” Dr. Li commented. “That
imposed a lot of challenge, especially to those in the tai chi group who were
used to fast movement.”
Dr. Li
also noted that tai chi is very safe and can be performed without equipment and
in limited space.
Beth-Anne
Sieber, Ph.D., a program officer at NINDS, said that falls are a dangerous side
effect of Parkinson’s disease and commented on the significance of Dr. Li’s
work. “The key observation in Dr. Li’s study is that a specifically designed
sequence of tai chi movements improves postural stability and prevents falls
for an extended period of time in persons with Parkinson’s disease. In
addition, tai chi sequences can be tailored to improve balance in a spectrum of
patients with mild to moderate symptoms.” Dr. Sieber also noted that this study
is indicative of a growing interest in examining how physical activity may
improve symptoms of Parkinson’s disease. Further research will provide
additional information on ways in which physical activity can improve disease
symptoms and quality of life for people with Parkinson’s disease.
- By
Nicole J. Garbarini, Ph.D.
For more
information about Parkinson’s disease, visit: www.ninds.nih.gov/PD.
