Let’s have FUN with Function – "Make Function Exercise"
Why we do what we do!
Ever since my NIH funded research established the importance of intensive whole-body amplitude training as a rehabilitation protocol (LSVT BIG ®) for improving function in persons with Parkinson disease1, I wanted to do more to get at the heart of the mobility and functionality problems in persons with Parkinson disease (PWP)2-4. I knew an approach with a singular attentional focus on amplitude (for the symptom of bradykinesia) was not comprehensive enough4-7. General whole-body movement training was not specific enough6,8, blocked, high effort practice was not complex enough6,9-13! And repetition of the same exact protocol, every 6 months, or every year with the same person was not consistent with my training as a physical therapist . I felt that adhering to this type of fixed protocol:
- did not make use of my clinical reasoning skills for patient management as a physical therapist14
- was not adaptable enough to keep people optimally challenged physically and cognitively across fitness levels and disease severity6-8,10,12,13
- was not consistent with motor learning research principles or theories that contribute to behavioral and brain change7,10-11,13,15
Dr. Farley, Founder PWR!
If you feel like I did, if you want a more comprehensive, adaptable, personalized and learning-principled approach to treating PWP, if you want to be able to integrate other new research techniques into your interventions, if you want to target all the motor and cognitive symptoms of PD that contribute to the loss of functional mobility1-7, 16,17 (see the definition in Figure 1 below), then take our PWR!Moves Therapist Certification workshop and implement the PWR!Moves curriculum with all your clients with PD, and others with functional mobility deficits as well!
To learn how to “train PWP like functional athletes” then take our PWR!Moves Instructor Certification workshop. As a PWR!Moves Instructor your functional fitness classes can help PWP sustain the benefits of rehabilitation and reap the additional benefits of group programming8,18-21! That is why we developed separate workshops for therapists and exercise professionals so that rehab and group exercise professionals share a common goal to collaborate and “preserve functional mobility” (see that section below for more details)!
"Train Persons with Parkinson's Like an Athlete"
Read more from Dr. Farley about how to Go train functional mobility as an “open sport”
Functional Mobility Defined
The ability to move freely (mobility) and to perform all your activities of daily living (ADL’s) (functionality) independently and safely in complex and changing environments at home, work and in the community (functional mobility in the real world)17.
Why retraining and sustaining functional mobility is the “heart” of what we do.
The loss of functional mobility is a global disease-related feature of Parkinson disease (PD) and a major cause of disability4,6,14-15. In Figure 1, the pyramid at the bottom highlights the motor control skills that deteriorate in PD and contribute to the loss of functional mobility (i.e., antigravity extension, weight shifting, axial mobility, transitions)4. These building blocks are initially learned in development and are necessary for ALL physical activity. Once they are learned, none of us ever think about them again. They just occur spontaneously when needed7. If they deteriorate, so will all types of physical activity, including functional mobility, fitness (endurance, strength, balance, agility, and flexibility) and participation in life. That is why the building blocks are the heart of what we do (i.e., PWR!Moves). When these skills deteriorate in PWP they need to be re-trained and sustained to put off the motor and cognitive decline of PD – and to help PWP increase fitness and participation so they can continue doing the things they love to do!
"Our rehab and group exercise programs have shared goals to “preserve functional mobility.”
Whether you are instructing rehabilitation or group exercise, PWR! professionals are taught to use different methods of instruction to target different motor and nonmotor symptoms. Both therapists and exercise professionals start by rehearsing the basic PWR!Moves with high quality, attentional focus and vigor while connecting them to salient movements. They learn to progress the physical and cognitive challenge of the PWR!Moves to target skilled “task specific” or “fitness-specific” practice, respectively. As a physical therapist, you will focus on a personalized plan of care to target specific mobility functional or fitness goals. As a community group exercise instructor or personal trainer, you will integrate the PWR!Moves into fitness programming (strength, agility, balance, flexibility) and make function exercise! In collaboration, as part of the healthcare team, we expect PWR! professionals to work together to eliminate barriers to exercise and to keep people exercising and participating in physical activities for as long as possible. This requires bi-directional referrals for life, ongoing assessments, therapy bouts and communication, and referrals to other wellness and healthcare resources19. This cycling back and forth from rehab to community exercise and back is necessary to keep people optimally challenged physically and cognitively, address health changes proactively and to prevent attrition, injury and isolation.
We walk the walk - we have been doing this at our PWR!Gym in Tucson, AZ for 10 years!
This function-first rehab/fitness approach is consistent with the American College of Sports Medicine (ACSM) recommendations for people living with chronic diseases and disabilities22 and a recent perspective article on treating persons with PD as athletes8. These consensus statements and expert perspectives suggest that the goals of exercise are different in people living with chronic health conditions. Instead of general fitness goals focused on improving strength, balance or flexibility; there needs to be a more focused approach on improving the foundational skills that deteriorate and contribute to a loss of physical activity, fitness and functional mobility.
I couldn’t agree more! That is why we do what we teach and do!
We hope you will join us by increasing access for People with Parkinson's to this type of comprehensive ongoing programming!
Dr. Becky Farley About the Author
If you ask her, Dr. Becky Farley will tell you that working with her first client with Parkinson’s almost 20 years ago changed her life and her career, and since then she hasn't stopped changing lives of those living with Parkinson's, in Arizona and the rest of the world. In 2010, she established the PWR!Gym in Tucson and has been offering people with Parkinson disease the PD-specific physical therapy, group exercise, and social engagement they need to get better and stay better. Globally, Dr. Farley supports PWR!’s mission of making cutting-edge PD-specific "exercise as medicine” available to the 10 million people living with PD worldwide, by training healthcare and fitness professionals in the PWR!Moves and the PWR!4Life model (and she’s trained over 6000 professionals since she started in 2010!).
When she’s home in Arizona, you’ll find Becky working on Parkinson Disease-specific exercise at the PWR!Gym as well as leading our annual exercise intensive PWR! Retreats. When she’s on the road, she’s either teaching our PWR!Moves workshops or giving talks at conferences, community organizations, and healthcare networks across the US and world.
- Farley BG, Koshland GF. Training BIG to move faster: the application of the speed-amplitude relation as a rehabilitation strategy for people with Parkinson’s disease. Exp Brain Res. 2005;167(3):462-467. doi:10.1007/s00221-005-0179-7
- Perry SIB, Nelissen PM, Siemonsma P, Lucas C. The effect of functional-task training on activities of daily living for people with Parkinson`s disease, a systematic review with meta-analysis. Complement Ther Med. 2019;42:312-321. doi:10.1016/j.ctim.2018.12.008
- Radder DLM, Lígia Silva de Lima A, Domingos J, et al. Physiotherapy in Parkinson’s Disease: A Meta-Analysis of Present Treatment Modalities. Neurorehabil Neural Repair. 2020;34(10):871-880. doi:10.1177/1545968320952799
- King LA, Horak FB. Delaying Mobility Disability in People With Parkinson Disease Using a Sensorimotor Agility Exercise Program. Phys Ther. 2009;89(4):384-393. doi:10.2522/ptj.20080214
- Farley BG, Fox CM, Ramig LO, McFarland DH. Intensive amplitude-specific therapeutic approaches for Parkinson’s disease: Toward a neuroplasticity-principled rehabilitation model. Top Geriatr Rehabil. 2008;24(2):99-114. doi:10.1097/01.TGR.0000318898.87690.0d
- Ferrazzoli D, Ortelli P, Madeo G, Giladi N, Petzinger GM, Frazzitta G. Basal ganglia and beyond: The interplay between motor and cognitive aspects in Parkinson’s disease rehabilitation. Neurosci Biobehav Rev. 2018;90:294-308. doi:10.1016/j.neubiorev.2018.05.007
- Marinelli L, Quartarone A, Hallett M, Frazzitta G, Ghilardi MF. The many facets of motor learning and their relevance for Parkinson's disease. Clin Neurophysiol. 2017;128(7):1127-1141. doi:10.1016/j.clinph.2017.03.042
- Bouça-Machado R, Venturelli M, Tinazzi M, Schena F, Ferreira JJ. Treating Patients Like Athletes: Sports Science Applied to Parkinson’s Disease. Front Neurol. 2020;11:228. doi:10.3389/fneur.2020.00228
- Hondzinski JM. Specificity of Training, Not the Only Therapy Option for Parkinson’s Patients. J Nov Physiother. 2012;02(06):10-11. doi:10.4172/2165-7025.1000e119
- Petzinger GM, Fisher BE, McEwen S, Beeler JA, Walsh JP, Jakowec MW. Exercise-enhanced neuroplasticity targeting motor and cognitive circuitry in Parkinson’s disease. Lancet Neurol. 2013;12(7):716-726. doi:10.1016/S1474-4422(13)70123-6
- Kleim JA, Jones TA. Principles of Experience-Dependent Neural Plasticity: Implications for Rehabilitation After Brain Damage. J Speech Lang Hear Res. 2008;51(1):S225. doi:10.1044/1092-4388(2008/018)
- Wulf G, Lewthwaite R. Optimizing performance through intrinsic motivation and attention for learning: The OPTIMAL theory of motor learning. Psychon Bull Rev. 2016;23(5):1382-1414. doi:10.3758/s13423-015-0999-9
- Onla-Or S, Winstein CJ. Determining the optimal challenge point for motor skill learning in adults with moderately severe Parkinson’s disease. Neurorehabil Neural Repair. 2008;22(4):385-395. doi:10.1177/1545968307313508
- Patel R, Spreng RN, Turner GR. Functional Brain Changes Following Cognitive and Motor Skills Training. Neurorehabil Neural Repair. 2013;27(3):187-199, doi:10.1177/1545968312461718
- Vojciechowski AS, Gianello T, Zotz G, Paula A, Loureiro C, Israel VL. The International Classification of Functioning , Disability and Health as Applied to Parkinson ’ s Disease : A Literature Review. 2016;(May):29-40. doi:10.4236/apd.2016.52005
- Bouça-Machado R, Maetzler W, Ferreira JJ. What is Functional Mobility Applied to Parkinson’s Disease? J Parkinsons Dis. 2018;8(1):121-130. doi:10.3233/JPD-171233
- Mak MK, Wong-Yu IS, Shen X, Chung CL. Long-term effects of exercise and physical therapy in people with Parkinson disease. Nat Rev Neurol. 2017;13(11):689-703. doi:10.1038/nrneurol.2017.128
- Borchers EE, McIsaac TL, Bazan-Wigle JK, Elkins AJ, Bay RC, Farley BG. A physical therapy decision-making tool for stratifying persons with Parkinson’s disease into community exercise classes. Neurodegener Dis Manag. 2019;9(6):nmt-2019-0019. doi:10.2217/nmt-2019-0019
- Prodoehl J, Rafferty MR, David FJ, et al. Two-year exercise program improves physical function in Parkinson’s disease: The PRET-PD randomized clinical trial. Neurorehabil Neural Repair. 2015;29(2):112-122. doi:10.1177/1545968314539732
- Hao Z, Zhang X, Chen P. Effects of Ten Different Exercise Interventions on Motor Function in Parkinson’s Disease Patients—A Network Meta-Analysis of Randomized Controlled Trials. Brain Sci. 2022;12(6):698. doi:10.3390/brainsci12060698
- Durstine, J L, Geoffrey E. Moore, and Patricia L. Painter (eds). ACSM’s Exercise Management for Persons with Chronic Diseases and Disabilities 4th Edition Print. Human Kinetics, Champaign, IL, 2016.