Reviewed by Jon Glass, MD

Because Parkinson's disease affects your ability to move, exercise helps to keep muscles strong and improve flexibility and mobility. Exercise will not stop Parkinson's disease from progressing;but, it will improve your balance and it can prevent joint stiffening.

You should check with your doctor before beginning any exercise program. Your doctor may make recommendations about:

• The types of exercise best suited to you and those which you should avoid
• The intensity of the workout (how hard you should be working)
• The duration of your workout and any physical limitations
• Referrals to other professionals, such as a physical therapist who can help you create your own personal exercise program

The type of exercise that works best for you depends on your symptoms, fitness level, and overall health. Generally, exercises that stretch the limbs through thefull range of motion are encouraged.

Here are some tips to keep in mind when exercising.

• Always warm-up before beginning your exercise routine and cool down at the end.
• If you plan to workout for 30 minutes, start with 10-minute sessions and work your way up.
• Exercise your facial muscles, jaw, and voice when possible: Sing or read aloud, exaggerating your lip movements. Make faces in the mirror. Chew food vigorously.
• Try water exercise, such as water aerobics or swimming laps. These are often easier on the joints and require less balance.
• Work out in a safe environment; avoid slippery floors, poor lighting, throw rugs, and other potential dangers.
• If you have difficulty balancing, exercise within reach of a grab bar or rail. If you have trouble standing or getting up, try exercising in bed rather than on the floor or an exercise mat.
• If at any time you feel sick or you begin to hurt, stop.
• Select a hobby or activity you enjoy and stick with it. Some suggestions include: gardening; walking; swimming; water aerobics; yoga; tai chi.

By John Gaudiosi

RALEIGH, North Carolina (Reuters Life!) Ever since Nintendo launched the Wii, gamers have been interacting with characters and working out with virtual trainers in titles like Electronic Arts EA Sports Active or Ubisofts Your Shape.

Nintendo is even encouraging families to exercise together with Wii Games: Summer 2010, a national tour that kicks off in Jersey City, New Jersey on July 16 with Olympic gymnast Shawn Johnson serving as an ambassador for the competition.

Now researchers, scientists and game developers are using Nintendos console for many other health-oriented applications, and in some cases are getting millions of dollars in grants to dream up new technologies.

A recent gathering of over 400 top minds at the sixth annual Games for Health Conference in Boston found innovative new ways that video games with motion-sensor controllers are being used to help doctors and patients.

Through a grant from the National Institute of Health, Red Hill Games and the School of Nursing at the University of California San Francisco are using Wii technology to create games that help people with Parkinsons disease improve their balance. One called Rail Runner requires patients to stand up and sit down to operate an old-fashioned railroad hand cart.

Most of these patients are in their 70s and 80s, and they really love these games, said Bob Hone, creative director at Red Hill Studios. They really want something thats going to address their disease, and whats different is these games are designed specifically for them.

Red Hill is incorporating similar Wii technology into games to help improve gait and balance in kids with Cerebral Palsy.

These kids sometimes have physical challenges, so weve taken that into account to make games where they feel like theyre walking and they get to the finish line successfully, said Hone.

GROWING BUSINESS

This fall, Sony Computer Entertainment America will launch PlayStation Move for PlayStation 3 and Microsoft will introduce Kinect for Xbox 360. These new devices are expected to not only open up gaming to a new mainstream audience, but also offer pioneers in the burgeoning Games for Health arena the ability to dream up new technology.

The impact of these new technologies is going to be as seismic as Nintendo was when it originally came out with the Wii and the Wii balance board, because its going to extend across more platforms, said Stephen Yang, a researcher and assistant professor at New Yorks College of Courtland.

There are a lot of great game designers out there who will be able to tap into these new physical interactions with games and bring new experiences that will be both fun and beneficial for patients, Yang said.

John Lumpkin, MD, senior vice president of the Robert Wood Johnson Foundation, has seen first-hand the advances that motion-sensor controllers and physical games have had on both his patients and his own children.

These games promote motion, which increases the heart rate and burns more calories, said Lumpkin. Even a game with the simplest motion like playing drums on Rock Band can have a gamer burning twice as many calories per hour as he or she would just sitting around, while a more vigorous game like Dance Dance Revolution can burn as many as six times the amount of calories, said Lumpkin.

Lumpkin said what really excites him, and many in his field, is that fact that today researchers are using a Wii balance board game to help stroke victims regain their balance just as effectively as an $18,000 piece of equipment.

Thats one reason why the Games for Health sector has been growing exponentially over the past six years with no slowdown in sight.

When you look at the economic activity associated with Health Care in the U.S. its approximately 16 percent of gross domestic product, even in countries that spend less on health care, its still double-digit GDPs, said Ben Sawyer, co-founder, Games for Health.

Small games for health developers are receiving grants in the tens of millions to the low hundreds of millions of dollars, said Sawyer. When you combine those numbers with game sales of titles like Konamis Dance Dance Revolution, Ubisofts Your Shape, Nintendos Wii Fit and Electronic Arts EA Sports Active, the Games for Health sector is well over $1 billion annually.

by Jeremy Parker

Many sufferers of Parkinson's disease quickly find that various aspects of their life are no longer controllable in the way that they used to be however by exercising regularly Parkinson sufferers can continue to control their gross movements i.e. walking,holding objects etc. for longer which adds a mental and emotional boost to their well being. Research has shown that exercise may also improve the synthesis of dopamine in the brain and increase the levels of neurotrophic factors which are beneficial compounds.

Exercise for people diagnosed with Parkinson's disease incorporates muscle strengthening, flexibility and toning activities so that muscles and joints stay flexible and strong. It is normal for a physiotherapist to implement an exercise schedule for the patient that includes a range o factivities to work all muscles of the body over a two or three day period. So for example, day one of the cycle may include walking and strengthening exercises for the arms and hands whereas day two might be a yoga class where flexibility of the joints is the main focus.

It is essential to monitor the patients progress, not only so that any improvements and decreases in function are recorded but also as a stimulus for the patient; when people see improvement and can visualise the effort that they put in they are much more positive about continuing the regime.

In general exercise should test the entire body and not just the limbs so that posture and movement is maintained for a slong as possible. Good posture is essential in the later stages of Parkinsons disease because stooping can hamper breathing and swallowing. Exercises for posture include callisthenics, yoga, Pilates,tai chi, and swimming however not every sufferer will enjoy these types of activities. Simply sitting upright while reading a book or watchingTV and walking with a straight back will also help though, thus walking the dog or playing with the children or grandchildren are great ways to work the body muscles and to enjoy daily exercising.

Regular exercise for the Parkinson's sufferer will reduce the incidence of muscle cramps, rigidity of the joints and the aches and pains associated with staying still for long periods of time. Also, because exercise helps the sufferer to maintain control over many of their gross movements (although maybe not the tremors) it gives them a heightened sense of achievement and so stress and anxiety levels remain low.Keeping a positive mental attitude is incredibly important in conditions like Parkinson's disease where sufferer can very easily become frustrated and discouraged with their predicament.

As with all exercise routines, the patient should start with a good warm up followed by the exercise activity of their choice or which has been scheduled for that day, and then they should finish with a positive cool down so that the chances of developing muscle cramps and injuries are greatly reduced. An exercise session should ideally last around 15-20 minutes and should not by any means exhaust the patient. Overexertion can be equally as damaging to a Parkinson's sufferer as no exercise at all.

In order to make daily exercise more appealing and less of a chore it maybe worth trying to find a friend or relative that is willing to exercise with the patient. Also, a bit of variety in the type of exercise will not only mean that the exercise stays interesting but it will also ensure that all muscles and joints of the body are used to a satisfactory level.

J Neurol Neurosurg Psychiatry.

Authors: Mller T, Muhlack S

BackgroundFollowing cued levodopa (LD) intake, endurance exercise showed abeneficial effect on scored motor performance in patients withParkinsons disease (PD) in comparison with rest. This may result froman exercise induced increase in endogenous dopamine synthesis. As aresult, beneficial effects on movement and reactivity may occur.Objectives To measure reactivity and motor performance in a repeatedfashion with instrumental tasks after cued administration of soluble 200mg of LD/50 mg of benserazide. Design PD patients consecutivelyperformed paradigms, which assess reactivity and movement performance,after a standardised period of rest or of age-related, heart rateadapted endurance exercise on two consecutive days in a random order.Results Reactivity and execution of simple and complex motion serieswere significantly better following exercise than after rest. DiscussionEndurance exercise has a beneficial effect on reactivity and movementbehaviour in PD patients following cued application of LD probably dueto an augmented synthesis and release of dopamine and othercatecholamines and release in the prefrontal cortex, the nucleusaccumbens and the basal ganglia. Small changes in catecholaminemodulation of prefrontal cortex cells can have profound effects on theability of the prefrontal cortex to guide behaviour. Previous exercisemay also improve pedunculopontine nucleus function, which is involved inmotor-related attention processes.

By Michael Hutch PhD

Various forms of yoga have beenscientifically shown to handle and perhaps even remedy variouspersistent diseases. Listed below are various medical issues that havebeen proved scientifically to be improved by yoga.

Asthma: Yogabreathing exercises possibly could assist sufferers of mild asthma andmay help decrease their use of low-dose drug inhalers in wheezingattacks. Researchers from the Respiratory Medicine Unit, CityUniversity, Nottingham, call for added studies of ways of improvingbreathing mastery which they say have been largely unheeded by Westernmedicine. while yoga practitioners have long believed in the benefits ofpranayama breathing exercises for asthmatics, this has been difficultto examine formally. But, using a Pink City lung a device that imposesslow breathing on the user and can mimic pranayama breathing exercises it was possible to measure the effects of controlled breathing in ahospital test. Two simulated pranayama exercises were tested: slow deepbreathing and breathing out for twice as long as breathing in. Inasthma, the airways become restricted making breathing difficult. It isincreasing in the UK, with more than three million children and adultsaffected, and are responsible for 2,000 deaths annually. The doctorsused standard clinical tests to measure the volume of air patients wereable to blow out in a second and to test the irritability of theirairways. After yoga, their airways were two times less irritable.

Parkinsonsdisease: Yoga has a key purpose in management of Parkinsons as it hasemerged as a helpful alternate therapy and an ideal mode of exercise forParkinsons patients because of its gradual movements. Following thesteps mentioned below could successfully help individuals withParkinsons: 1. Concentrate on controlling your breath (Pranayama) asthis brand of yoga helps in moments of panic such as feet sticking tothe flooring when walking. In this form of yoga, the mind is alwayswatchful. 2. Few yoga exercises like back strengthening postures, lotsof shoulder movements, breathing practices and some meditationpositively helps. 3. One of the most useful forms of yoga used forParkinsons is Ashtanga Yoga. It works to strengthen the body andperform increases blood circulation. 4. day-to-day practice of yoga isall-important since Parkinsons itself does not inevitably weaken themuscles. Weakening of muscles is ordinarily caused by lack of motion.Daily exercise should be encouraged, but not enough to generatetiredness. 5. Parkinsons also result in the loss of motility of thefacial muscles. Pranayama and supplementary yoga movements could aid inrelaxing those muscles and bring a smile on the face of the patient.

Diabetes:Diabetes in a lot of forms affects up to 5percent of the worldpopulation with 12 million diabetics in Western Europe alone. Of theunique ways in which diabetes presents, noninsulin-dependent diabetesmellitus (NIDDM) is probably the most usually encountered geneticcondition. NIDDM or Type II diabetes is multifactorial, depending alsoon environmental factors including obesity, sedentary lifestyles andnutritional imbalances. One of the studies conducted to cure diabeteswas the one set up by the Yoga Biomedical Trust, founded in 1982 bybiochemist Dr Robin Monro, and an Indian yoga research foundation whichdiscovered that practicing yoga for 30 minutes a day for one monthhelped reduce blood glucose levels in some diabetics.The yoga patientstook part in one or two 90-minute sessions a week and were asked topractise at home. The classes included the particular yoga exercises ofthe spinal twist, the bow and abdominal breathing. At the conclusion ofthe 12 weeks blood sugar levels fell significantly in all patients inthe group and were slightly raised in a control group which had notjoined in the yoga sessions. Three yoga students managed to cutbacktheir medication, including one man who had not altered his drug regimenfor 20 years. It is not necessarily the exercise element of the yogatherapy package which is most significant, as there is not adequatephysical exercise to account for the changes, but stress decrease has alot to do with it. Stress hormones increase sugar levels in the blood.individuals also benefit from the stabilisation of their moods whichyoga brings, an increased perception of well-being and a belief of beingmore in mastery, which may assist with their diet control andconsequently their diabetes.