Join our NEW Fitness for Parkinson's Class

Exciting News! Our Brand-New Group Exercise Class is just around the corner!

You probably have heard that exercise is essential with Parkinson's Disease, but sometimes it's hard to know what to do.

Our class, taught by our very own Dr. Jessica, PT will use evidence-based techniques such as high intensity, large amplitude training to work on maintaining and improving your balance, strength, and functional mobility.

Are you interested? Fill out the form at this link, and we will be in touch.

Here are the details:

• Where : Fit Lab Studios Durham, 2500 Meridian Parkway, Suite 180, Durham, NC 27713

• When : Thursdays at 2PM

• How much: Classes are $120 for the 4 week session, or $20/class at a drop in rate.

• How to sign up: Fill out the interest form at this link, and Dr. Jessica will be in touch to get you registered.

• More information: Check out this webpage with more information

What to do when Parkinson’s Disease makes it difficult to “Go”

We’ll be talking about a less than polite topic in this article; however, it is one that affects over 80% of people with Parkinson’s Disease (PD). We will discuss Constipation. What it is, why it’s a problem, and how to manage it. Let's get started!

What is Constipation?

Constipation is a condition of slow-moving bowels. If you are having fewer than 3 bowel movements a week, or are straining to go, you are likely constipated. Ideally, you should be having at least one formed bowel movement a day.

Why is Constipation so common in PD?

Parkinson’s Disease is a disorder of the automatic processes of the body. This causes improper functioning of the autonomic nervous system which regulates smooth muscle activity. The muscles lining your entire GI tract are smooth muscles, can improper function of these can cause disruptions in peristalsis.

Peristalsis is the rhythmic contraction of smooth muscle that allows for food to move through the digestive tract. When this process is not working correctly, the movement of food/waste products in the intestinal tract becomes slower.

Also, many of the medications needed to treat Parkinson’s Disease can cause constipation as a side effect.

Finally, lifestyle factors that can cause constipation include:

1. Dehydration

2. Low fiber consumption

3. Decreased exercise

4. A change in routine or Stress

5. Consuming large quantities of dairy

6. Fighting the urge to have a BM until a more opportune time

Why is Constipation a problem?

You probably know, the timing of your medication cycle is very important to managing your PD symptoms. Did you know that the beneficial compounds in the pills you take are absorbed through your intestine into the bloodstream before they become active?

As your bowels move more slowly or become backed up due to constipation, the pills’ effectiveness decreases, and you may not receive the full benefit of the dose at the right time.

Other concerns with constipation include bloating, feeling uneasy and a desire to avoid exercise. With prolonged constipation, hemorrhoids or even bowel obstruction can occur. In bad cases, bowel obstruction can result in hospitalization.

Okay, so how do I prevent Constipation?

For a Happy Gut, here's a few helpful tips:

1. Consume enough fiber. The American Heart Association recommends 25 grams of Fiber daily. Fiber helps to hold water and bulk up the stool making it much easier to pass. The best way to eat enough fiber is by eating a variety of fruits, vegetables, legumes (like beans), and whole grain bread or cereal. You can also add prune juice, dried fruits, or bran to your diet to achieve your fiber needs. You’ll probably have some gas as you increase your fiber consumption, but this will improve with time.

2. Drink 6-8 cups of water and other fluids a day. Try drinking a tall glass of water with your medication doses, this will help flush the medication to the intestines where it can be absorbed, and if you do this with each dose, you’ll easily be able to achieve this goal.

3. Perform Vigorous exercise daily. Not only will this help your gut, but it will help you stay healthy and can slow the progression of PD symptoms.

4. Use the bathroom when you feel the urge.

What if I’m already constipated?

Along with the prevention techniques listed above, here are some other things you can do to help move things along.

1. Abdominal Massage: Take 10 minutes and give your belly a massage. With small circular movements starting down by your right hipbone, move upward toward your ribs, across to the left side, and down to your left hip bone. Research has shown this may stimulate peristalsis and lower the pain and discomfort that often occur with constipation.

2. Get a Squatty Potty! This 7-inch stepstool tucks under your toilet before and after you go (allowing you to safely get your feet to the floor to stand up). But when you’re ready to go, you put your feet on the stepstool to put your body into a more natural position which lets gravity do the work, allowing you to strain less.

3. Listen to your body. When you feel the urge to have a bowel movement, honor this and go to the toilet. It may not always be at the same time, and you may not always be home, but resisting the urge can cause more stool to backup and become harder to pass later.

Want to learn more? Check out our References and Resources:

• [Podcast Recording] Constipation and the Gut in Parkinson’s - Davis Phinney Foundation

• Current Overview on Clinical Management of Chronic Constipation (nih.gov)

• Abdominal massage for the alleviation of symptoms of constipation in people with Parkinson's: a randomised controlled pilot study - PubMed (nih.gov)

• Squatty Potty - The #1 Way to #2! | SquattyPotty

Using Neural Detours can help you Move Better with Parkinson’s Disease

What is Parkinson’s and What does it effect?

Parkinson’s Disease (PD) is a disease resulting from the death of the group of neurons in the brain that produce dopamine. Dopamine is a chemical that helps transmit information between nerves. Dopamine is associated with pleasurable sensations, learning, memory, motivation, sleep, mood, and most importantly for our topic today the speed, quality, fluency, and ease of movement.

The “typical” motor symptoms of PD including slow, small movements, and difficulty with automatic tasks are related to the factors we’re discussing today, while the non-motor symptoms of PD are often related to the other roles of dopamine as well as the medications needed to manage motor symptoms.

Brain Anatomy

The neurons that create Dopamine are in a part of the brain known as substantia nigra, which is a part of the Basal Ganglia.

The Basal Ganglia play a major role in motor control, motor learning as well as emotions, and executive function. This means, they are very important for learning new movement skills and performing “automatic” movement skills.

Research and experience have shown that both the learning of the motor skill, as well as the execution of automatic skills become difficult with PD. Research comparing brain MRIs of people with and without PD as they learn and perform an automatic task show that although those with PD may take longer to learn a new movement pattern, they can achieve similar results using different nerve pathways in the brain. This ability for the brain to make new pathways is called neuroplasticity.

This Neuroplasticity means we can use these new pathways (detours) to achieve better movement!

If you get stuck or freeze while walking or turning around, have a hard time getting out of tight spaces, chairs, or the bed, or just feel like you are moving more slowly or smaller. It’s time to use the alternate neural pathways (the detours) to make moving more effective.

The main detours we will use are purposeful movement and auditory cuing. Learn more about these "detours" below, and then check out this article on ways you can use them!

Purposeful Movement or focusing on the big picture task at hand like crossing the street while the crosswalk sign is still white, uses attention to “bypass” the damaged automatic pathway and allow for improved movement quality.

Auditory Cuing, or more specifically, Rhythmic Auditory Cuing, utilizes a rhythmic beat/cadence/etc to cue the body to move at a specific rate over a longer period of time. Many people with Parkinson’s often start walking with large, controlled steps, but after a while, the steps become smaller, quicker, and more “shuffly”. The rhythmic cues help maintain even steps.

How can I use this information?

Some of my most frequently offered recommendations for people with Parkinson's use these techniques.

Both types of "detours" are found in the major exercise programs for people with Parkinson’s such as ‘LSVT”, “PWR”, and “Rock Steady”. These programs are evidenced based, and they produce excellent results. However, if you’re having difficulty with everyday movements, it is smart to reach out to a PT who focuses on those with neurological conditions to get started.

Move Free Physical Therapy at Home is experienced with treating neurological conditions such as Parkinson's Disease and we would love to help you move better. You can schedule a FREE phone consultation, or an PT evaluation to get started here. We are located in the Triangle of NC, however we provide consulting and telehealth services more widely.

References and Resources:

• DAVIS PHINNEY FOUNDATION: I highly recommend their webinars and their “Every Victory Counts” Guide full of useful information shared in an accessible format (Live Well with Parkinson's TODAY - Davis Phinney Foundation)

• Attention to Automatic Movements in Parkinson's Disease: Modified Automatic Mode in the Striatum (nih.gov)

• Functional Neuroanatomy of the Basal Ganglia (nih.gov)