Pilates Programming for Parkinson’s and Other Neurological Conditions

By Shelia Cowart

Navigating life with neurological conditions like Parkinson’s Disease and Multiple Sclerosis (MS) can be a complex journey. As the automaticity of movement wanes, individuals often find themselves in a constant battle to maintain balance and perform even the simplest tasks. The challenge intensifies when daily activities demand multitasking, raising the risk of falls. Traditional exercise programs often fall short in addressing these intricate needs, leaving individuals with Parkinson’s and MS in search of a tailored solution to enhance their well-being. This was my inspiration to create a specialized  program to support people with neurological conditions – NeuroFIT. Our NeuroFIT program’s primary mission is to enhance the quality of life for individuals living with Parkinson’s disease and other neurological conditions.

Unique Challenges that Individuals with Parkinson’s Disease Face

The movements of Individuals with Parkinson’s Disease become less automatic, and they must think more about what they are doing to compensate. Because of this, it becomes more challenging to do two things at once such as walking while talking or thinking about something else. This has been shown to significantly increase someone’s risk for falls. The loss of automatic movements leads to an increase in dual-task costs. This means it takes more brain power to do two things at once. For these reasons, at Longevita we understand it is important to incorporate a cognitive challenge with exercise to help reduce the dual-task cost and reduce risk of falls. The Longevita NeuroFIT program involves balance, agility, and multi-task training.

Balance, Agility, and Multi-Task Training For Individuals with Parkinson’s Disease

Balance, agility, and dual-task training type of exercises involve activities such as multi-directional stepping, weight shifting, large amplitude movements, and balance on different surfaces such as foam, and doing multiple things at once such as walking or stepping while performing a cognitive task at the same time. Part of the NeuroFIT program that includes this time of exercise incorporates non-contact boxing and agility training. There are many benefits to doing this type of training such as:

• Improved balance
• Improved sensory integration.
• Reduced fall risk
• Improved quality of life
• Improved cognition

Balance systems are a vital aspect of the Longevita NeuroFIT program. We approach this with a compassionate understanding of the unique challenges individuals with Parkinson’s Disease face. Through our strong community and a customized approach, we utilize various techniques, including the Pilates reformer, Pilates Spring Wall, non-contact boxing, and agility training, to address these concerns.

Since the risk of falls is a high concern, it is important to understand three fundamental systems that play a crucial role in maintaining our balance:

• First and foremost is our vision. Many of us heavily rely on our vision to orient ourselves and maintain equilibrium. It’s the way we use visual cues to stay steady on our feet.
• The second system is somatosensory input, which involves our ability to feel and interpret sensory information sent up through our feet. This information helps us make the necessary adjustments to stay balanced.
• The third system, the vestibular system, is an inner ear equilibrium system. It plays a significant role in detecting motion, head position, and our orientation in space. These three systems work together harmoniously to keep us balanced and steady.

However, individuals with Parkinson’s Disease often struggle with integrating information from these three systems, leading to poor balance and an increased risk of falls. This can be especially challenging for those living with the condition.

Our NeuroFIT program underscores the necessity of training all three balance systems to work harmoniously. It reinforces why we emphasize practicing balance on various surfaces, including uneven ones like ramps, and using compliant surfaces like foam pads. Additionally, we introduce variations in visual conditions, such as head turns or closing the eyes, to challenge and enhance the integration of these systems.

At Longevita, we understand the benefits of performing balance and agility exercises with a cognitive challenge, below are some ways we implement this type of exercise. We recommend doing this type of exercise 2-3x per week (or daily if you can!) which the NeuroFIT classes are held 5 days per week and each class is 90 minutes. There are many ways to implement this type of exercise. We love to implement agility-based movements with an added cognitive challenge that is performed at the same time. There are so many ways to add a cognitive challenge to your exercises. Some examples of ways to add a cognitive challenge include:

• Naming a word, animal, or food that starts with each letter of the alphabet.
• Naming as many items as you can think of from certain categories (cities in Washington, sports, farm animals, etc.)
• Naming as many items as you can think of that are a certain color.
• Performing certain exercises in a sequence that you need to recall such as doing non-contact boxing.
• Counting back from 100 in various series, such as 7 for example.
• While performing boxing sequences, the coach will walk around with mathematical flashcards, such as 9X8=? and they must voice the answer.

Resistance Training for Individuals with Parkinsons’ Disease

Along with balance and agility training, Longevita NeuroFIT utilizes the Pilates reformer and the Pilates Spring Wall for resistance training which involves working on increasing the strength and force that muscles can produce. This program also includes body weight exercises such as sit to stands, as well as the use of dumbbells, resistance bands, etc.

Resistance Strength Training Improves Bradykinesia and Functional Performance:  Bradykinesia is the slowness of movement that can occur with Parkinson’s Disease due to the loss of dopamine (1).

Resistance Strength Training improves balance, strength, and motor symptoms:  Resistance training performed 2-3 days per week can significantly improve muscle strength, balance, and Parkinson’s motor symptoms in individuals with early to moderate Parkinson’s Disease. (2)

People with Parkinson’s can have difficulty with gait initiation. This means that when someone with Parkinson’s attempts to begin walking from a stationary position, they may have some trouble. The effects of resistance training on gait (walking) initiation in individuals with Parkinson’s Disease. Resistance training programs help individuals to improve their ability to shift their weight, take larger steps, and move faster.

Resistance Training Improves Bradykinesia and Functional Performance:  Resistance training improves bradykinesia improves walking speed and functional mobility.

Resistance training performed 2-3 days per week can help improve:

• Balance
• Motor symptoms on the UPDRS exam
• Strength
• Quality of life
• Bradykinesia
• Walking
• Functional performance (sit to stands, walking speed etc.)

Pilates Reformer Exercises for People with Parkinson’s

1. Footwork: 

This is a foundational exercise on the Pilates reformer that involves pushing the carriage back and forth using the legs while lying on your back. For individuals with Parkinson’s disease, it can help:

• Improve lower body strength, particularly in the legs.
• Enhance range of motion in the hips, knees, and ankles.
• Promote balance and stability as you control the carriage’s movement.

2. Feet in Straps: 

This exercise involves having both feet in the straps moving the legs in a circular motion. Leg circles on the reformer can assist with:

• Strengthening the hip flexors and abductors.
• Improving hip joint mobility and stability.
• Enhancing coordination as you control the leg’s movement.

3. Chest Expansion: 

Using the reformer’s straps or handles or can be done using the Spring Wall by standing or in a seated position, the chest expansion exercise helps with:

• Strengthening the muscles in the chest, shoulders, and upper back.
• Improving posture by opening the chest and encouraging proper alignment.
• Enhancing breathing by expanding the chest and improving lung capacity.

4. Long Stretch Series: 

This series involves a combination of plank-like positions and movements on the reformer, using straps and carriage. Long stretch exercises are beneficial for:

• Strengthening the entire body, including the core, shoulders, and legs.
• Enhancing overall body control and proprioception.
• Promoting better balance and stability as you engage in controlled movements.

Pilates Spring Wall Exercises for People with Parkinson’s

The Pilates Spring Wall is a versatile piece of equipment to improve posture by strengthening the muscles that support proper alignment. Here are some exercises on the Pilates Spring Wall that can help enhance posture:

1. Wall Angels: 

Wall Angels are excellent for opening the chest and improving upper body posture. Stand facing the Spring Wall with your arms bent at a 90-degree angle, forearms against the wall. Slowly slide your arms upward, maintaining contact with the wall, and then lower them back down. 

• To promote better posture and shoulder mobility.

2. Chest Expansion

Attach the Spring Wall handles to the springs, and stand facing away from the wall. Hold onto the handles with your arms extended out to the sides. Gradually pull the handles toward your front, keeping your shoulders down and back. 

• This exercise strengthens the upper back and opens the chest, helping to counteract rounded shoulders.

3. Rows on the Pilates Spring Wall:

This exercise targets the muscles of the upper back, shoulders, and arms, which are essential for everyday activities like lifting, carrying, and reaching. Increased upper body strength can enhance your overall functional fitness.

• Improved Posture: Rows help strengthen the muscles responsible for proper posture, particularly the muscles of the upper back. By regularly practicing this exercise, you can combat the negative effects of slouching and sitting for extended periods, leading to better posture.
• Scapular Stability: Rows emphasize scapular (shoulder blade) stability. Strong and stable shoulder blades are crucial for optimal shoulder function and injury prevention. This exercise helps to balance the muscles around the scapulae.
• Core Engagement: Maintaining a strong core during the Rows exercise is essential for stability and injury prevention. This exercise promotes core engagement as you resist the pull of the springs.
• Muscle Balance: Rows help balance the strength and development of the upper body muscles. Many people tend to have overdeveloped chest muscles and weaker upper back muscles, leading to muscle imbalances. Rows can help correct this imbalance.
• Flexibility and Mobility: This exercise also encourages flexibility and mobility in the shoulder joints, improving your range of motion over time.

4. Lat Pull Downs:

This exercise targets the muscles of the upper back and shoulders. Stand facing the Spring Wall, holding the handles overhead. As you pull the handles down toward your shoulders, focus on keeping your shoulders down and drawing your shoulder blades together. 

• This strengthens the upper back and helps maintain proper shoulder alignment.

Introducing NeuroFIT – the Unique and Holistic Pilates-Based Program for Neurological Conditions

Our NeuroFIT program’s primary mission is to enhance the quality of life for individuals living with Parkinson’s disease. We are proud to offer this specialized program at Longevita Pilates & Yoga Studio in Auburn, WA. Through NeuroFIT, we offer a comprehensive and compassionate approach to managing Parkinson’s. Our program is designed to empower people on their wellness journey, focusing on improving their physical and emotional well-being. With our team of dedicated coaches and a strong sense of community, our participants experience a holistic approach that addresses the unique challenges of Parkinson’s disease. We are committed to helping them build strength, flexibility, and confidence, all while fostering a sense of belonging in our vibrant community.

NeuroFIT is held 5 days a week with each class offering unique challenges for everyone, using different equipment.  This can include BOSU, obstacle course, Pilates reformer, weights, and many other things.  Along with physical challenges, we add cognitive exercises and utilize their voices.

All the exercise classes that are designed for NeuroFIT address common issues associated with Parkinson’s disease.  Some of these issues include, but are not limited to, balance, gait, soft voices, strength, and endurance.  lasses also build confidence, camaraderie, community, and friendship in a safe environment.

But NeuroFIT is not just about exercises; it’s about building a supportive community. Our participants become more than just attendees; they become a part of a family that understands their journey intimately. Through support groups, social events, and community outreach, they find camaraderie, friendship, and hope.

NeuroFIT is a beacon of optimism, a place where individuals with Parkinson’s can take control of their lives, rebuild their confidence, and embrace a brighter future. Our involvement in fundraising events like the APDA Optimism walk and the Northwest Parkinson walk amplifies our commitment to the larger Parkinson’s community. These help NeuroFIT connect to the Parkinson’s community on a larger scale resulting in doctors recommending our program to their patients.

Our mission at Longevita Pilates & Yoga Studio, through NeuroFIT, is to reach out and touch as many lives as we can. We believe in the power of knowledge, compassion, and understanding to make a meaningful difference. Together, we are not just building physical strength; we are cultivating resilience, courage, and a sense of belonging.

We believe in the power of sensorimotor integration training, working diligently to help you train all three of your essential balance systems. Our dedicated team is here to guide you through various techniques, including Pilates reformer, Pilates Spring Wall, non-contact boxing, and agility training. We encourage you to embrace the practice of balancing on uneven surfaces, compliant surfaces, and altering visual conditions to enhance the integration of these systems. If you or your loved one has been diagnosed with Parkinson’s Disease, don’t hesitate to reach out and start your transformative journey towards a healthier, more balanced life. Your better tomorrow begins today.

References:

• Progressive Resistance Training Improves Bradykinesia, Motor Symptoms and Functional Performance in Patients with Parkinson’s Disease. 2020. National Library of Medicine, ePub.
• Effects of Resistance Exercise on Balance Ability. 2020.  National Library of Medicine, ePub.