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Feature Story

Exercise as Medicine for Parkinson’s Patients

June 12, 2014



Woman holding onto back of chair stretching in a physical therapy roomLinda Teichman, during one of the April trainings.

When Ramon Queseda, MD, told his patient Linda Teichman that exercise could help her Parkinson’s symptoms, she was skeptical. But she followed his advice anyway.

Today, the Los Altos, Calif. woman is a model patient: She exercises five days a week, at least two more times than before her diagnosis a year ago. She says she’s stronger now.

“I know it can’t hurt,” she said. “If it can slow down my disease, and that’s the only thing that can, I’ll do it.”

Parkinson’s is a degenerative brain disorder interfering with movement, flexibility, balance, agility and other motor skills. It affects about 1 million people in the United States. The progression is considered gradual, and there’s no cure — only medication to relieve symptoms.

Dr. Queseda is a physical medicine and rehabilitation physician who cares for patients with neurological diseases at Kaiser Permanente Redwood City, the Northern California regional center for neuroscience and neurosurgery. He said emerging research suggests that exercise, especially in the early stages of Parkinson’s, may slow down the disease’s progression, improve quality of life, and delay the end stage of being bedridden. Exercise is beneficial because it appears to prevent the brain’s neurons from breaking down, which is what happens with Parkinson’s.

However, most Parkinson’s patients don’t exercise, in part because they would need assistance and guidance to do so. Many patients are referred to physical therapists, but there’s a need for ongoing, community-based exercise programs for this population.

Physical medicine and rehabilitation physician Ramon Queseda, MD, and physical therapist John Berdoulay.

Physical medicine and rehabilitation physician Ramon Queseda, MD, and physical therapist John Berdoulay.

In an effort to create more exercise opportunities for people with Parkinson’s, Dr. Queseda and physical therapist John Berdoulay, who also works at Kaiser Permanente Redwood City, assembled a committee of mostly physical therapists representing several Kaiser Permanente San Francisco Bay Area facilities. Their goal: Bring greater awareness about the importance of exercise for Parkinson’s patients, inform practitioners about the type of exercises needed, and help build more community-based exercise programs.

Four years later, their work culminated in three April events put on by Kaiser Permanente, along with nonprofit Parkinson’s Wellness Recovery, the Redwood City Veterans Memorial Senior CenterParkinson’s Patients Support Groups, Inc. and the American Parkinson Disease Association chapter at Stanford University.

The events included a community forum on exercise for Parkinson’s patients and their families, a two-day training called Parkinson Wellness Recovery Training for physical and occupational therapists, as well as a separate two-day training for community exercise instructors.

“We want to translate research into clinical practice,” Dr. Queseda said.

Exercises for Parkinson’s patients address balance, coordination and agility, and emphasize large, almost exaggerated, movements involving the whole body because the disease causes movements to shrink. An example would be to bounce a ball while taking extra wide steps in multiple directions.

Berdoulay said after he tailored the exercises to the specific needs of Parkinson’s patients, he saw a significant improvement among patients’ balance and walking.

Several physical therapists who attended the training said they left with ideas on how to best approach patients, including how to lead group classes. Almost half of the 62 therapists attending were from 13 Kaiser Permanente Northern California medical centers.

“I’ve learned that patients with Parkinson’s disease can do more,” said Janet Schmidt, a physical therapist from Kaiser Permanente Martinez Medical Center. “They just need encouragement.”

Teichman attended the trainings as a patient demonstrating exercises. A year after religiously keeping a regular exercise routine, doubts remain. Even so, she is convinced her symptoms would be worse if she were sedentary.

“Exercise is recommended for anyone,” she said. “Remember, if you don’t use it, you’ll lose it.”