By Bryan Dondero, SPT University of Vermont
Imagine for a minute that you have just met with your doctor and they told you they are going to write you a prescription for a new wonder drug that will not only address your Parkinsonian symptoms like balance and walking, 1 but will also improve your mood, lower your blood pressure, help you lose weight, lower your cholesterol, and improve your cardiovascular fitness. 2 Best of all, this new wonder drug is free! In fact, you’ve had access to this drug your entire life and didn’t know it. What drug could this possibly be? Well, according to the British Journal of Pharmacology, this drug is exercise! 2 Now before you go running to the nearest Crossfit gym, let’s take a look at a simple, free, exercise that you can do anywhere: walking.
Physical therapists examine how someone walks because it can reveal valuable information: how fast a person walks, the quality of their movements, and how well they maintain balance while navigating obstacles. Walking and mobility are fundamental to how well someone can function in everyday life, so much so, that it is being considered the 6th vital sign by medical professionals. 3
Walking is an excellent exercise for people with Parkinson’s Disease. First and foremost, it gets you outside and in the community! Walking can also be a great group activity to do with friends and family, or maybe it is just an opportunity to get outside and get some fresh air. In order to get more benefits from walking, make it purposeful: walk with BIG arm swings, heel strikes, and an upright posture. Practice balancing on different terrains and surfaces, and maintain balance when obstacles obstruct your path during your walk. Walk with an intention, but walk safely.
One question that often arises regarding walking as exercise is whether or not it is vigorous enough to be considered exercise. In order to get the benefits mentioned above, your walking needs to be at a pace where you feel some exertion. Two ways you can measure exertion are by monitoring your heart rate and using the Borg Rating of Perceived Exertion scale, or RPE scale.5 The latter method is thinking of a 0 to 10 scale where 0 means you are resting and 10 means you are giving your maximal effort, like you are running the hardest race of your life. The ideal place to be in order to benefit from the exercise is in the 4 to 5 range, or “somewhat hard” to “hard” range. If it feels “really, really hard” you are probably overdoing it. If it feels “moderate” or “easy,” then you are probably under-doing it. Another way to think of it is if you are walking with someone and having a difficult time talking to them because you are winded, then you are most likely at least at a 5 on the RPE scale.
If you prefer a more objective measure of your exertion, then monitoring your heart rate is another great way to see if you are walking vigorously enough. A simple method to do this is to calculate 220 minus your age: this is your maximum heart rate. So, if you are 60 years young, your max heart rate limit is 160 beats per minute. A good target heart rate zone for exercise is 50-80% of your max heart rate. So for our 60 year young person, she would want to be somewhere between 80 and 128 beats per minute. To calculate your heart rate, simply find your pulse (preferably on your wrist) and count how many pulses you feel in 30 seconds and multiply by two. Please bear in mind that heart medications can affect your heart rate, so if you are on heart medication, the RPE method would be much better for you.
Now that you have two excellent methods for seeing how vigorously you are walking, you may be wondering how long or far you should be walking. Again, this certainly depends on your health, and how active you currently are right now. The general recommendations from the American College of Sports Medicine is to get at least 150 minutes of moderate intensity exercise per week. 4 The nice thing about this recommendation, is that you can get the same benefits, no matter how you break this time up. If you are able to, I would suggest walking for 20-30 minutes per day for at least 5 days per week. If you have problems with fatigue, it would be better to do shorter durations like 5 minutes at a time, multiple times per day. Also, if you are currently not physically active, you may need to scale the amount of walking you do initially and slowly increase your time after you have been walking regularly for several weeks.
Other things to consider:
- If you take medication for Parkinson’s, wait until about one hour after you have taken a dose before you go out for a walk.
- If you use an assistive device at home like a cane or a walker, please use it on your walk for balance support.
- Be sure to wear good footwear with good traction and support. No flip-flops!
- Bring a cell phone. It is always a good idea to have one available in case you need to call someone for assistance. Also, many smart phones have built in pedometers: you can track your steps and distance, and compare it week to week!
For more information, check out the Parkinson’s Disease Foundations website for recommendations on walking.
- Goodwin, V., Richards, S., Taylor, R., Taylor, A., & Campbell, J. (2008). The effectiveness of exercise interventions for people with Parkinson’s disease: A systematic review and meta-analysis. Mov. Disord. Movement Disorders, 631-640.
- Vina, J., Sanchis-Gomar, F., Martinez-Bello, V., & Gomez-Cabrera, M. (2012). Exercise acts as a drug; the pharmacological benefits of exercise. British Journal of Pharmacology, 1-12.
- Franklin, B., Brinks, J., Sacks, R., Trivax, J., & Friedman, H. (n.d.). Reduced Walking Speed and Distance as Harbingers of the Approaching Grim Reaper. The American Journal of Cardiology, 313-317.
- Physical Activity and Public Health: Updated Recommendation for Adults From the American College of Sports Medicine and the American Heart Association. (2007). Circulation, 1081-1093.
- Borg Scale. (n.d.). Retrieved October 4, 2015, from http://crosscoaching.e-monsite.com/en/pages/downloads/borg-scale.html