How to Create a Daily Routine for Brain Health & Mobility with Parkinson’s

Episode Transcript
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SPEAKER_00 (00:11):
Welcome to Live Parkinson's Live an Exceptional
Life.
I'm your host, ChrisKestenbotter, and I've been
living an exceptional life withParkinsons for the past 15
years.
The mission of this podcast isto help as many people as
possible living with Parkinson'sto lead a great quality of life.
Today we're talking about how tobuild a simple daily routine
that supports both brain healthand mobility when you have

(00:33):
Parkinson's.
So if you want practical stepsthat you can actually follow,
not just theory, then you're inthe right place.
Now imagine having a routine soconsistent it becomes automatic.
A set of short practices thatkeep you moving, thinking
clearly, and helps you reducethe chance of falls.
That's what we're going to bebuilding today.

(00:53):
Short, doable habits backed byscience so you can feel more
confident starting each day.
As a disclaimer, please ensurethat before you start anything
new, that you get approval fromyour healthcare professional to
ensure it's appropriate for yourspecific health needs.
Alright, so let's talk about whyroutines and exercise can help
you on your Parkinson's journey.

(01:15):
Research shows that moderate tohigh intensity exercise combined
with regular strength andbalance training helps improve
motor symptoms, functionaloutcomes, and overall quality of
life for people withParkinson's.
Now you've probably heard me sayit a million times.
All right, maybe not a million,maybe just a hundred times, that
exercise is a key cornerstone inhelping you stay active, mobile,

(01:39):
and engaged on your Parkinson'sjourney.
Now it's definitely helped me onmy 15-year Parkinson's journey.
I'm still able to teach apeddling for Parkinson's class
through the Davis FinneyFoundation, and I teach a boxing
class for people withParkinson's.
But to provide you withadditional support so that you
don't have to believe what I'mtelling you with blind faith,
there is an article published inthe Journal of the American

(02:01):
Physical Therapy Associationfrom December of 2021 titled
Physical Therapist Management ofParkinson's, a clinical practice
guideline from the AmericanPhysical Therapy Association.
The American Physical TherapyAssociation developed a clinical
practice guidelines that arebased on systematic reviews of

(02:22):
published studies involvingphysical therapist management of
individuals with Parkinson's.
The article provides a summaryof both recommendations which
should be used.
Now they broke therecommendations down into a
table with the followingheadings type of intervention,
quality of evidence, strength ofrecommendation, and the actual

(02:42):
recommendation itself.
So let's take a look at whatthey include in their
recommendations, starting offwith aerobic exercise.
They say the quality of evidenceis high, and their
recommendation is physicaltherapists should implement
moderate to high intensityaerobic activity to improve
cardiovascular fitness, reducemotor disease severity, and

(03:05):
improve functional outcomes.
Alright, next up, resistancetraining.
The quality of evidence is high,and they recommend including
resistance training to reducemotor disease severity, improve
your strength, power, andnon-motor symptoms, and improve
functional outcomes as well.

(03:25):
Number three on our list,balance training.
The evidence for balancetraining is high, and physical
therapists should implementbalance training intervention to
help reduce postural controlimpairments and improve balance
and gait outcomes.
Also, mobility and balanceconfidence will be improved.

(03:46):
Finally, flexibility exercises.
Now they indicate that theevidence is low, but can be
included to help with the rangeof motion.
Now, while there are morerecommendations, these are some
of the key ones that we aregoing to focus on today.
Now, if you haven't worked witha physical therapist and are
having balance, gait or otherproblems in your daily life, I

(04:08):
highly recommend seeing aphysical therapist.
Now I've gone at least threetimes for balance and gait
issues, and they really help meimprove.
Now, I wanted to cover thisbecause it reinforces what I've
been stressing about exerciseand the skills and tools that I
learned in physical therapyreally helped me on my daily
journey.
All right, now we've looked athow exercise can help with our

(04:30):
overall fitness, strength, andbalance, but beyond muscles and
balance, did you know thatexercise also affects the brain?
Yes, you heard that right.
Exercise can also help ourbrain.
And I know mine needs plenty ofhelp, that's for sure.
Clinical studies andmeta-analysis show that exercise
raises the level ofbrain-derived neurotropic

(04:52):
factor, or BDNF.
I say that 10 times fast.
A key neurotropin associatedwith neuroplasticity, and we've
talked about this before, butneuroplasticity is the brain's
ability to form new neuralconnections.
A lot of times when you'relearning a new skill or a new
hobby, you're buildingneuroplasticity, maybe like

(05:12):
guitar or you're playingsomething else.
Now, why is this important?
Because BDNF helps the brainadapt and form new connections,
which is part of how exercisesupports thinking and movement.
In fact, there's a studypublished in the journal
Neuroplasticity from Septemberof 2017 titled The Effect of

(05:33):
Aerobic Exercise on BrainDerived Neurotropic Factor in
People with NeurologicalDisorders, a systematic review
and meta-analysis.
And the authors concluded thatthis review provides evidence
that aerobic exercise has apositive impact on levels of
BDNF in neurological populationsas measured by peripheral blood.

(05:55):
And to wrap up why routine andexercise matters,
community-based andtask-specific activities such as
dance programs like Tango havebeen shown to improve your gait,
your balance, and yourconfidence.
Now, behavioral programs likethe LSVT Big program, which I
have personally participated in,they show functional benefits

(06:18):
for movement retraining.
So if you're having trouble withyour balance or you're having
trouble with your gait, checkinto the LSVT Big program.
I know some of the physicaltherapists use it, and it's uh
it's a good program that you canactually do at home as well.
You can do the exercises to helpyou with your balance.
Others include Tai Chi, Dance,Yoga.

(06:39):
They're all great options to mixinto your routine.
All right, now let's switchgears and turn our attention to
the actual routine, which is apractical research-based
blueprint that we're going to betalking about.
Now, before we dive intospecifics, let's talk about some
guiding principles for ourroutine.
So if you have some paper, feelfree to jot these down for

(07:00):
future reference.
If not, try to remember them ifyou can.
First, aim for consistency overintensity at first.
Why?
Because if you try to go all outat the beginning, you're going
to wear yourself out, you'regoing to be so sore and tired
that you won't be able tocontinue.
So when you're first startingout, always start out slow and
build on your wins andsuccesses.

(07:23):
And also, one of the reasons youdo this as well is you want it
helps you stay consistent and sothat you'll continue on with
your program.
So it's always better to startsmall and build gradually.
Next up is combine aerobicstrength, balance, and
flexibility exercises across theweek.
So don't try to do them all atthe same time in the same day.

(07:45):
Spread them across the week, andthat's going to help you.
So this helps ensure that youhave all your bases covered and
you're getting a complete bodyworkout and that you don't get
burned out doing the sameexercises over and over again.
Now, from a personalperspective, I like to spend 10
minutes a day on balanceexercises and then 10 minutes on
stretching and flexibilitybecause both of those are what I

(08:07):
use in my daily life.
So the balance exercises havereally helped me improve my
balance and the flexibility andstretching keeps me mobile and
helps me to feel like I can getaround a lot better.
Then I usually do four days ofaerobic exercise, like cycling,
like a spin class, walking,swimming, uh, elliptical.

(08:29):
And then to round out myexercise program, I also do
strength training three times aweek.
Now I typically do lightweightsand more reps.
And then I try to includebodyweight exercises in there as
well, like squats and lunges andmarches and those types of
things as well.
So that I actually work on notjust my arms and back and chest,

(08:52):
but I also work on my core andmy legs because that's what's
going to give you help you withyour balance.
So it's important to do strengthtraining.
Now you don't have to be afraidand say, Oh, I can't go to the
gym and lift weights.
You can use lightweights at homeand do more repetitions.
They help to increase yourflexibility, but also you want

(09:13):
to do strength training to helpmaintain your muscle mass, which
we begin to lose as we age.
So I typically do these threetimes a week, and there that
does help me in in terms ofstrength and flexibility.
Plus, again, it helps you withyour core, which is going to
help you with your balance andyour gait.
So remember, try to have a goodbalance of different types of

(09:35):
exercises.
So next up on our guidingprinciples is use habit cues.
Like the time of day, for me, Ipersonally like to exercise in
the morning when I have the mostenergy.
And then you can also have apairing activity.
Like some people like toexercise and then have morning
coffee.
I know the the one spin classthat I take, they do the spin

(09:56):
class and then we all gettogether afterwards for some
coffee and conversation.
And you can also time it to yourmedication schedule as well.
So if you do best right afteryou take your medication, maybe
that's the best time to for youto exercise.
So use habit cues like that.
So build a habit and it's goingto help you in the long run.

(10:16):
And then finally, and last butnot least, is safety first.
Now, this one's very importantbecause you can't be consistent
if you hurt yourself.
So before you exercise, again,you want to get clearance from
your doctor.
And then once you're you'recleared from your doctor, you
want to make sure that you clearany trip hazards.
If you need to, use a chair forsupport or a wall or a spotter.

(10:40):
And also if you need it, consulta physical therapist or your
doctor before you start anythingnew.
But they could uh physicaltherapists can help you work
through some of these exercisesas well.
All right, now we have all ourguiding principles and let's use
those to help us develop a dailymicro routine.
10 to 20 minutes that we can doevery day.

(11:00):
Now, what I'm about to share isan example, and it's for
informational purposes only.
Now, if you like it, review itwith your doctor to make sure
it's right for you.
And let's get started.
And we'll begin with afive-minute warm-up, which we
can do marching in place,shoulder rolls, neck mobility,
where you can look left, center,right, and then lift up and

(11:26):
down.
So you want to make sure thatyou stretch your neck out as
well, and then some nice anklecircles in both directions.
This is gonna help loosen up andget the blood flowing.
Now the next move into is amobility circuit, and you can
try to do it twice if you can.
So from a chair, you can do sitto stand.
So try to do those eight totwelve times because this is

(11:48):
gonna provide strength andfunctional training.
And again, you can use supportif needed.
Use the chair, use a wall or usea spotter.
Heel raises, try to do 10 ofthese.
This builds ankle strength andbalance.
So again, I would highlyrecommend that you start out
using a wall or stable counter.

(12:09):
And then marching with high kneelifts for 30 to 60 seconds, and
this is good for cardio and gatecueing.
And then finally, two to fiveminutes of mindful breathing.
And you can do three to fourslow deep inhales and exhales.
This is going to help you managestress, and it can be used to

(12:30):
initiate your walking if youhave freezing issues.
Alright, so there you have it.
A daily micro schedule to helpyou on your Parkinson's exercise
journey.
Alright, now let's look at whata weekly schedule might look
like.
And let's start with aerobicexercise.
You want to try to target threeto five sessions per week, 20 to
40 minutes each, at a moderateor vigorous pace when you're

(12:54):
cleared by your doctor.
Start by gradually building bothtime and intensity.
Now, some examples of aerobicexercise would include
treadmill, walking, cycling,brisk walking outside with a
friend, or dance classes.
Swimming is another greatexample.
Aerobic training is linked tobetter motor and non-motor

(13:16):
outcomes and is the focus of thephysical therapy recommendations
that we discussed earlier.
Alright, next up is strength andresistance.
Try to do at least two sessionsper week, ideally 30 to 45
minutes.
And you want to focus on yourlegs, your hips, your core, and
your arms because they're allimportant for our balance.

(13:37):
And then progressive resistancetraining improves your strength
and functional performance.
Alright, next up is balance andtask specific training.
And you want to try to targetthis two to three times per
week.
And they can be short, 10 to 15minute sessions.
Use exercises that challengeyour stability for balance
exercises.

(13:58):
And you can go toliveparkinsons.com and get your
free copy of the nine balanceexercises to help improve your
balance.
And then you can also include uhdance-based classes like Tango
or Zumba.
They're going to help you withyour balance and flexibility and
movement as well.
Now, flexibility and mobility isthe next daily or every other

(14:19):
day exercise that you want totry to include.
And then finally, mindfulnessand cognitive health.
Try to do 10 to 15 minutes, andthis can include mindfulness and
meditation, or one of mypersonal favorites is dual task
exercises, like walking orstrength training, where you're
counting by threes or oddnumbers, or you're spelling

(14:41):
words forward and backwardduring an exercise, because this
is going to challenge you bothphysically and mentally at the
same time.
So I like to do like squatswhere I'll say the months of the
year backwards, or lunges whereI spell new words.
So all those are going to helpyou while you're exercising to

(15:02):
build both your physical andyour cognitive skills.
Size, intensity, and volume mayhelp to increase brain-derived
neurotropic factors and otherbrain health markers.
And then this information isfrom the study, The Effect of
Aerobic Exercise on BrainDerived Neurotropic Factor that
was published inNeuroplasticity.
If you project your voice whileyou're doing these dual task

(15:24):
exercises as well, you can helpand improve your speech volume
as well, because we all knowthat our speech tends to get
quieter as our diseaseprogresses.
All right, now let's look atsome real-world tips to stay
consistent.
First off, short and frequentbeats, long sessions.
So if you do 30 to 40 minutes istoo much for you now, split them

(15:44):
into two 15 to 20 minutesessions.
Do one in the morning and theother in the afternoon.
Use community, group classes,online sessions, or a walking or
workout buddy.
They're going to help youincrease your compliance to your
exercise routine, and they'regoing to help keep you
accountable and make sure thatyou're able to continue with

(16:05):
your program.
And then plus, you can alsocompare results.
So when you work out with abuddy.
And then track small wins.
Write down your progress.
Extra steps, improvesit-to-stand repetitions, fewer
freezing episodes.
When you celebrate small wins,it's going to help keep us
motivated and pushing forward.
And that's the whole key.

(16:26):
We want to stay motivated and wewant to make sure we're pushing
forward.
All right, now let's look atsome practical modifications and
safety.
And then give you an exampleweek for exercising for brain
and body health.
And let's start with somepractical modifications.
So if you have freezing of gait,what you can do is use external
cues like rhythm, rhythmicmusic, stepped counting, or

(16:48):
visual targets.
So for instance, rhythmic music,a lot of times if I have
freezing and I listen to music,if you follow the beat, some
that helps to get you started.

Sometimes you can count as well: one, two, three, and then (16:58):
undefined
initiate your movement.
So those are some things thatyou can do to help with.
And according to the physicaltherapist management of
Parkinson's, a clinical practiceguideline from the American
Physical Therapy Association, ifyour balance is limited, do
balance work next to a sturdysurface and consider a

(17:20):
supervised class or physicaltherapy.
And then finally, alwayscoordinate exercise timing with
your medication for bestperformance windows.
Alright, so now let's give you asample week what it might look
like.
So Monday, you might start offwith 30 minutes of aerobic
exercise and 10 minutes ofstretching and flexibility.

(17:40):
Tuesday, 35 minutes of strengthtraining and 10 minutes of
balance exercises.
Wednesday, dance or Tai Chiclasses for balance.
Thursday, 30 minute aerobicintervals plus 10 minutes of
strength and flexibilitytraining.
Friday, strength training, whereyou might do 30 minutes of that

(18:02):
plus 10 minutes of balanceexercises.
And then maybe Saturday, you doa community walk, you do a yoga
class, you do swimming.
And then Sunday, rest or justgeneral mobility and mindfulness
exercises.
Now before we close out thisepisode, I want to address two
common myths that I hear and Iread about from people with

(18:23):
Parkinson's.
And the first myth is exercisewill make my tremors worse.
Well, the reality is appropriateexercise programs are safe and
often help to improve your motorsymptoms and function when done
correctly, under the guidanceaccording to the physical
therapy guidelines that wetalked about earlier.
The second myth is you're tooold to start.

(18:45):
The reality is that people atdifferent stages of disease
benefit from tailored exerciseprograms based on their needs.
Now remember, even modest gainsmatter.
And remember to always reviewthis with your physician before
you start any new exerciseprogram.
Alright, as we close this out,if you take one thing from this

(19:07):
episode, it's this move daily.
Even a short, structuredmobility block combined with
regular aerobic strength andbalance work can make a
meaningful difference in yourmobility and your brain health.
Now, to learn more about this,visit my website,
liveparkinsons.com, andsubscribe to the free monthly
newsletter, which is packed withinformation to help you live a

(19:29):
great quality of life withParkinsons, and you can become
part of the community.
You can also get the ninebalance exercises to help you
improve your balance, as well asother informational articles
there as well.
Now, if you want to support theshow and my mission to help
people live an exceptional lifewith Parkinsons, consider
clicking on the support the showlink in the podcast description

(19:49):
or visit my Kofi page atKofi.comslash Live Parkinsons.
Your support helps keep theseepisodes free and helps me
create more resources to helpthe Parkinsons community.
Now thank you so much forlistening.
If you found the episodehelpful, please subscribe or
follow the podcast and sharewith someone who can benefit.
Until next time, stay healthy,stay strong, and live your best

(20:13):
life with Parkinson's.
Thanks again for listening andsee you all soon.

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