According to Stanford Medicine, for people with PD, exercise is just as important as taking your medications on time, every time. The evidence showing the ability of exercise to affect the course of Parkinson’s disease is so impressive that physical therapist and neuroscientist Becky Farley, PhD, felt called to make it her life’s work. Dr. Farley is the founder and chief scientific officer of Parkinson Wellness Recovery, an organization that offers exercise programs specifically designed to slow the progression of the disease and improve quality of life. “The research in animal models was just so compelling compared to any other neurodegenerative disease: There were animal studies that showed positive brain changes, even to the point of halting the disease. I was shocked by the potential, and it changed my career path; it made me want to work with people with Parkinson’s,” says Farley. The evidence for using exercise to treat Parkinson’s disease in humans is also compelling. For example, a study that compared aerobic exercise at two different intensities to stretching and resistance exercises found that “exercise can improve gait speed, muscle strength, and fitness for patients with Parkinson’s disease,” with different types of exercise conferring different benefits. In another example, a commentary that examined previous studies of exercise in people with Parkinson’s found that exercise “provides promise for improving both motor and non-motor symptoms in PD.” In particular, the author noted that different types of exercise “demonstrate potential for improvement of cognitive dysfunction and sleep disorders.” And a recent randomized, control trial of exercise and its effects on sleep concluded that “High-intensity exercise rehabilitation improves objective sleep outcomes in PD.” Farley’s reading and the research she subsequently conducted on her own eventually became the whole-body exercise program for people with Parkinson’s disease known as Parkinson’s Wellness Recovery (PWR).
Unlocking the Potential of People With Parkinson’s Disease
PWR was established as a nonprofit, explains Farley. That allows the organization to translate the latest research into programming that’s not necessarily “standard of care,” she says. “Our gym in Tucson is kind of like a laboratory — we wanted to be able to work with people using what the most current evidence indicates is the most effective.” Aerobic exercise is a critical component of the program, says Farley. Aerobic exercise is any type of physical activity that increases the heart rate and the body’s use of oxygen. “There’s no magic type of aerobic exercise; it can even just be movement, but to be the most efficacious, people with Parkinson’s do need to be challenged aerobically, to work harder than they want to,” she says. That’s because higher levels of activity have been linked with positive brain changes during animal studies, says Farley.
Functional Skill Training Can Help People With PD Navigate Life
PWR also emphasizes what it calls “functional skill training,” which not only helps people with PD perform specific tasks and movements but also can improve quality of life. “If you can’t go out and walk with your dog, engage in your favorite sports, and do the hobbies you enjoy, then those are the things you need to practice. We call it functional skill training, and we make it more like life,” says Farley. The program doesn’t just focus on one specific movement or set of protocols, says Farley. “You can achieve this in 100 different ways — it’s really about challenging people both physically and cognitively. And the more closely the exercise relates to moving in everyday life, hopefully, the more applicable and helpful it will be out in the world,” she says. These exercises, which often focus on mobility and balance, have been shown to improve cognition, she says. “Cognition is the ability to move in complex environments, and that’s what is hard with Parkinson’s. It’s one thing to get up at home and walk to the living room, but it’s another to walk across a crowded gym or a shopping center: That’s a cognitive challenge,” says Farley. Functional training not only helps people with PD improve their ability to solve problems and negotiate complex environments — in some cases, they also experience improvements in mood and sleep, notes Farley.
PWR Can Inspire Hope and Help People With PD Feel Better Emotionally
When people with Parkinson’s disease experience individualized goal setting, rehabilitation, and exercise programing, it often changes their disease trajectory, says Farley. “Of course, there are concrete physical improvements: They start to walk better and balance better and do things again that they had stopped doing, but to me the most important thing is that they actually feel better emotionally; it changes how they live with Parkinson’s,” she says. The program can help people realize that they still have control over some aspects of their lives, and that can inspire hope, says Farley. “Quality of life, hope, resilience — those things can come back when the individual realizes that the diagnosis doesn’t mean that they can’t enjoy life.”
More Than 6,000 PWR Trainers and Virtual Classes Make the Program Accessible Around the United States
In addition to individual and group exercise options, PWR also offers rehabilitation services and interventions that address other aspects of wellness, such as nutrition and stress management. “Part of our vision statement is that we want everyone with Parkinson’s to have access to this type of cutting-edge and integrated care; that’s what we’re trying to do as an organization,” says Farley. Toward that goal, the organization offers PWR training to physical therapists, as well as other fitness and exercise professionals, about how to target specific exercises to address individual PD symptoms, which can be customized for each person’s needs and skill level. “We make the exercise and rehabilitation Parkinson’s-specific, based upon the client’s motor, cognitive, and emotional symptoms. It is comprehensive; we want to address all of those pieces, because all of those things contribute to their functional decline and motor deterioration,” says Farley. So far, more than 6,000 therapists and exercise specialists around the United States have completed PWR training. The organization’s website offers a searchable directory by ZIP code to help people locate the closest PWR-trained professional. There’s also a separate PWR website that offers people with Parkinson’s an opportunity to try out classes virtually and learn about the program, she says.
PWR Can Provide Coaching and Support at Every Stage of Parkinson’s
PWR can be beneficial at any stage of Parkinson’s, says Farley. “Ideally, you want to start immediately after diagnosis and get on a positive path, but we see people at any point in the disease,” she says. There is research to indicate that even if people don’t start right away, they still can have benefits and a better quality of life, she adds. As a first step, everyone who is diagnosed with Parkinson’s disease should consult with a physical therapist who understands the disease, says Farley. “I don’t care how fit they are or how advanced their Parkinson’s is, they need to find a therapist who understands Parkinson’s and who can actually set goals for them and help them get a personalized rehabilitation and exercise prescription,” she says. People need to know the benefits of doing more every day, but that can be tough, because therapists often don’t get to see their patients daily, says Farley. “The research shows that not only do people need to work at high intensity but they also need a lot of practice. People with Parkinson’s disease benefit more from an intensive program where they see someone daily for a couple of hours a day to work on different goals,” she says. That’s not really the status quo in terms of our healthcare system, she says. “The problem isn’t necessarily insurance; Medicare will typically cover daily therapy appointments, if needed. But in many cases, healthcare facilities don’t have the protocols in place for that to happen. It takes changing some paradigms to make the right dosage of exercise and rehabilitation happen for people with Parkinson’s,” says Farley.
PWR Provides People With Parkinson’s With a ‘Coach for Life’
Farley acknowledges that for many people with Parkinson’s, simply living day-to-day with the disease may seem sufficiently challenging, and the idea of adding high-intensity exercise to the mix may seem overwhelming. But although it may seem paradoxical, it can be truly transformative, as long as you have the right programming and a supportive coach: “We can help them find resources, create a personalized plan, and hold them accountable,” Farley says. “In regular traditional therapy, a lot of people do drop out — they get lost in the system, and no one is there for them. Because we see people for life, we’ve had to develop multilevel exercise classes; we don’t just have one class and put everybody in it,” she says. “We have people who have been coming to our program for 12 years. The programming is continually updated and personalized to address the goals of the individual, and that’s where the magic can happen,” she says. “We tell our clients, ‘We’re going to be your coach for life and help you through all these changes.’”
