New Study Examines Impulse Control, REM sleep and Dopamine

Impulse control behaviors (ICBs) affect between 14% and 40% of people with Parkinson’s disease (PD). Examples of ICB’s include compulsive gambling or shopping, hoarding and hypersexuality. ICBs become impulse control disorders (ICD) when they impair one’s ability to function at work, home and navigate day-to-day life. Only 2% of people have ICBs in the general population.

Why the dramatic disparity? It has to do with the gold standard medication for PD: Dopamine replacement therapy, such as L-dopa, as well as dopamine agonists, such as Requip (ropinirole), Mirapex (pramipexole) and Neupro (rotigotine), are all strongly linked to experiencing ICBs. This is because dopamine, in addition to relaying messages that plan and control body movement, also plays a primary role in the reward pathway in our brains ― in other words, it makes us feel good, even elated.

Since ICBs are commonly experienced as highly pleasurable ― and even anxiety-relieving ― people with ICBs may go to great lengths to hide their compulsions from friends, family and their healthcare professionals. Unfortunately, all too often, this concealment results in detrimental personal and financial consequences. There is a need to better understand the Parkinson’s-ICB connection.

A large, three-year, prospective, multi-center study published in Neurology titled, “Impulse control disorders in Parkinson disease and RBD: A longitudinal study of severity” (Baig et al., 2019) sought to address four key questions:

  1. What is the distribution and severity of PD-ICBs?
  2. How does this vary over time?
  3. How common are Parkinson’s ICBs?
  4. Which clinical factors are associated with PD-ICBs?

In this study, otherwise healthy people with ICBs were compared with those who had PD and a REM sleep behavior disorder (RBD). Why was REM chosen? Previous studies have suggested that the presence of RBDs may infer a higher risk of developing PD-ICD. However, it is not known whether RBD itself, or whether a particular RBD-PD subtype, increases that risk.

There were 932 PD participants in the study. Due to factors such as withdrawal and deaths, 531 completed the study. Those with RBD (and the control arm) were clinically screened for ICBs using the Questionnaire for Impulsivity in Parkinson’s Disease. Those who were ICB-positive were then invited to participate in a semi-structured interview, that was repeated every 18 months. Clinical assessments were performed with a variety of tools to assess a broad range of motor and non-motor symptoms at each visit. The severity of the ICB was assessed with the Parkinson’s Impulse Control Scale, and ICB prevalence and associations were mathematically calculated.

Results

  • Impulse control behaviors were common in the early stages of PD (19.1% prevalence).
  • There were no increased risks for having ICBs associated age, sex, cognition, sleep disorders or marital status.
  • The incidence of depression was higher among participants with PD with ICD than those without.
  • There was significant variation in the severity (both the impact and intensity) of PD-ICB – fluctuating within a relatively short period of time.
  • Internal factors (mood and coping mechanisms) impacted the severity of PD-related Impulse control behaviors.
  • External factors (major life events and social support) also impacted the severity of the PD-ICBs.

What Does This Mean?

This study found that ICBs are common in the early stages of PD, with a larger proportion of this population having symptoms of ICD, but not enough for the behavior to be designated a disorder. While scientists have known for over a decade that dopamine-related drugs could be linked to ICDs in some people with PD, it wasn’t until 2004 that people living with Parkinson’s began to learn that ICDs could be a rare side effect of dopamine agonists.

Thus, dopamine dosage changes may need to be considered, when ICB or ICD behaviors appear to be present. Lastly, people with PD, and their care partners, need to be aware that internal (mood and coping mechanisms) and external factors (major life events and social support) were found to be contributing causes for progressing from an impulse-control behavior problem to a disorder.

Learn More

Learn more about Parkinson’s and impulse control issues in the following Parkinson’s Foundation resources or by calling our free Helpline at 1-800-4PD-INFO (473-4636):

References

Baig, F., Kelly, M. J., Lawton, M. A., Ruffmann, C., Rolinski, M., Klein, J. C., . . . Hu, M. T. (2019). Impulse control disorders in Parkinson disease and RBD: A longitudinal study of severity. Neurology, 93(7), e675-e687. doi:10.1212/WNL.0000000000007942

Barone, D. A., & Henchcliffe, C. (2018). Rapid eye movement sleep behavior disorder and the link to alpha-synucleinopathies. Clin Neurophysiol, 129(8), 1551-1564. doi:10.1016/j.clinph.2018.05.003

Fantini, M. L., Figorilli, M., Arnulf, I., Zibetti, M., Pereira, B., Beudin, P., . . . Durif, F. (2018). Sleep and REM sleep behaviour disorder in Parkinson’s disease with impulse control disorder. J Neurol Neurosurg Psychiatry, 89(3), 305-310. doi:10.1136/jnnp-2017-316576

Figorilli, M., Congiu, P., Lecca, R., Gioi, G., Frau, R., & Puligheddu, M. (2018). Sleep in Parkinson’s Disease with Impulse Control Disorder. Curr Neurol Neurosci Rep, 18(10), 68. doi:10.1007/s11910-018-0875-x

For more insights on this topic, listen to our podcast episode “Clinical Issues Behind Impulse Control Disorders.”

Why Physical Therapy Should Be Your Top Priority: At Least For the Moment.

Ensuring you have an accessible, customized, and engaging physical therapy experience from start to finish will get you on your road to recovery.  However, we also need you to make physical therapy a priority for a short period of time (in most cases).

Before Your Visit

Avoid Roadblocks. Once you are prescribed physical therapy, it’s important that you don’t run into any roadblocks during the appointment-making process because your physical therapy will be a series of visits.  So decide what’s important right now, and say no to extra obligations.

Make a list of any questions you have and want to ask your physical therapist.

Write down any symptoms you’ve been having and for how long. If you have more than one area of symptoms, begin with the one that bothers you the most. Describe whether your pain or symptoms are:

  • Better or worse with specific movements, activities, or positions such as sitting or standing.
  • More noticeable at certain times of the day.
  • Relieved or made worse by resting or a specific task or activity.

Write down key information about your medical history, even if it seems unrelated. For example:

  • List all prescribed and over-the-counter medicines you take or have taken within the last month. Don’t forget to include any vitamins and supplements you take.
  • Make a note of any relevant personal information. Include things that you believe might be linked to your condition, such as:
    • Recent stressful events.
    • Injuries.
    • Incidents or accidents.
    • Your home or work environment.
    • List any medical conditions of your parents or siblings.

Ask a family member or trusted friend to go with you to your appointment. They can help you remember details from your health history and take notes to help you remember what was discussed during your visit.

If you wear glasses or use a hearing aid, take them with you. Tell your physical therapist and clinic staff if you have a hard time seeing or hearing.

Take any lab, imaging, or reports from other health care providers with you that are related to your medical history or current condition.

Bring a list of your doctors and other health care providers. Your physical therapist can discuss their findings and your progress with them. Physical therapists partner with other health care providers to ensure you get the best possible care.

When you make your appointment, ask whether you should wear or bring a certain type of clothing for your first visit. Don’t wear clothing that doesn’t stretch. Your physical therapist may have you take part in treatment activities during your first session.

Financial Considerations

  • Carefully review the clinic’s financial policy. If you do not receive it at your first appointment, ask for a copy. If anything is unclear, ask questions or ask for someone to explain the policy to you before starting treatment.
  • The physical therapy clinic will ask you to sign the financial agreement. Read it carefully and ask questions if anything is unclear.
  • The clinic staff will request payment of any deductibles and copayments before or after each visit. Paying these at the time of service will help you better manage health care costs and avoid a large bill after treatment ends.
  • If you need to change how often you have physical therapy for financial reasons, discuss this with your physical therapist. They can explore options and develop a workable plan to help you get the care you need.
  • If you change or lose your insurance coverage, be sure to inform your physical therapist and the clinic’s front office staff.

What To Expect During Your First Visit

Your physical therapist will begin by asking you lots of questions about your health. These will include specific questions about your condition and any symptoms that led you to see them. The details you give will help your physical therapist assess whether you are likely to benefit from physical therapy. It also will help them choose the treatments that are most likely to help you.

Your physical therapist also will ask you specific questions about your home or work setting, your health habits and activity level, and your leisure and sports interests. Their goal is to help you become as active and independent as possible and return to the activities you enjoy.

Your physical therapist will perform a detailed exam. Depending on your symptoms and condition, your physical therapist may evaluate your:

  • Strength.
  • Flexibility.
  • Balance.
  • Coordination.
  • Posture.
  • Blood pressure.
  • Heart and respiration rates.

A physical therapist using manual therapy on a patient's leg.

Your physical therapist may use their hands to examine or feel on or around the area of concern. They also will assess the motion and function of your joints, muscles, and other tissues.

Your physical therapist also may check:

  • How you walk (your gait).
  • How you get up from a lying position or get in and out of a chair (functional activities).
  • How you use your body for certain activities, such as bending and lifting (body mechanics).

Your physical therapist will work with you to determine your goals for physical therapy. Then, they will create a treatment plan for your specific condition and goals. In many cases, the physical therapist will diagnose your condition and begin treatment right away.

A main goal of treatment is to improve or maintain your ability to do daily tasks and activities. Your physical therapist may address pain, swelling, weakness, and limited motion to help you reach this goal. They will check your response to each treatment and make changes as often as needed. Physical therapy treatment also may speed your recovery.

Education is an important aspect of your physical therapy treatment. Your physical therapist may teach you special exercises to do at home. They also may show you different ways to do your work and home activities. The goal is to lessen or get rid of the problem believed to be the reason for your pain, strain, or injury and show you ways to stay healthy.

Your physical therapist will assess your need for special equipment. For example, they may suggest special footwear, splints, or crutches. They also may advise that you use special devices to help make your home a safer place for you, especially if they find that you are at an increased risk of falling. They will determine what equipment you need based on your situation. They may either provide it for you or tell you where you can find it. If you do need special equipment, your physical therapist can show you how to use it properly.

Your physical therapist will share important information with your doctor and other health care providers at your request.

Your physical therapist will recheck your progress often throughout your plan of care. They will work with you to plan for your discharge from physical therapy when you are ready. Make sure to talk with your physical therapist about what to do if you have questions after discharge or if your symptoms or condition worsens.

Your physical therapy visit may include working with a physical therapist assistant on exercises prescribed by your physical therapist. Physical therapists and PTAs work together and with other health care providers to make sure you get the care you need.

Get the Most Out of Physical Therapy

You will get out of your physical therapy sessions what you put into them. It will take a certain amount of effort on your part, as agreed between you and your physical therapist, to get the most benefit from each session. Here are four tips to help you get the most out of physical therapy:

1. Keep Your Appointments

  • Arrive for your sessions on time or a few minutes early. Being late may reduce your one-on-one time with your physical therapist and affect other patients.
  • Engage in the discussion to decide how often you will see your physical therapist and determine your treatment goals. Then, work with your physical therapist to meet your goals.
  • Attend your appointments. Missing appointments can delay your recovery. Failing to show without canceling in advance may result in a fee and disrupts the physical therapist’s schedule. If an emergency keeps you from going, try to give notice as soon as possible. Review the facility’s financial and cancellation policy before you begin treatment.
  • If you plan to stop therapy or change how often you receive treatment for personal or financial reasons, discuss this with your physical therapist.

2. Follow Your Physical Therapist’s Instructions

It is essential to follow your physical therapist’s guidance. They may recommend that you:

  • Modify an activity.
  • Limit or restrict the use of a specific body part (such as reducing weight on one leg while walking).
  • Avoid certain movements.

Ignoring these precautions may lead to injury or delay your recovery.

If your physical therapist provides special devices (splints, walkers, canes, or braces) for home use, follow the exact usage instructions they give you. Be sure to ask questions if you are unclear. Incorrect use may be harmful.

Your physical therapist also may recommend making changes in your home for your safety, such as:

  • Removing throw rugs.
  • Rearranging furniture.
  • Setting up safety rails.

3. Do Your Home Exercise Program

Doing your home program as often as prescribed by your physical therapist is essential to your recovery. If the instructions are unclear, ask your physical therapist to explain them to you. Only do exercises that your physical therapist prescribed. Follow their instructions for:

  • How often (times per week).
  • How many times (repetitions).
  • The specific resistance (weight in pounds or band color).

More is not always better and may cause injury!

 

Parkinson’s: The Shaking Palsy

Read Time: 4 minutes

Parkinson’s disease is the second most common degenerative brain disorder affecting adults. (Alzheimer’s disease is the most common.) People of all ethnic groups can develop PD, but it occurs less among African American and Asian populations. James Parkinson’s Essay about Parkinson’s Disease was first defined as only a “motor” (movement) disease, but research has shown that it also causes “nonmotor” symptoms (such as lightheadedness when standing up) in other systems of the body. People with PD are at risk of falling and sustaining other injuries due to their movement and balance challenges.

What Is Parkinson’s Disease?

Parkinson disease is related to a loss of nerve cells in the brain that produce a chemical called dopamine. Dopamine and other brain chemicals are normally in balance and are important for the control of body movements, thought processes, decision-making, moods, and other behaviors.

The exact cause of PD is not yet known. Family history, aging, or exposure to certain environmental toxins may contribute to the onset of PD. It is a chronic degenerative disease, which means that it gets worse over time; however, people usually do not die from it.

The severity and symptoms of PD can vary widely. Some people have the disease for 20 to 30 years and experience a slower decline in mobility and thinking over a longer period of time. Others may experience difficulty with physical movements and thought processes within 5 to 10 years, as the disease progresses more rapidly.

Signs and Symptoms

Nonmotor symptoms of PD, such as a decreased sense of smell, sleep problems, and lightheadedness when first standing up, can begin many years before motor (movement) symptoms develop. Motor symptoms of PD, which typically include muscle and joint stiffness (rigidity), shaking (tremors) in the hands and limbs, slowed movement, and balance problems, most often begin at or around age 60. However, early-onset PD can affect people at a younger age.

The motor symptoms of PD can be very mild at first. A common early symptom is a tremor in 1 hand, most often when you are at rest. It might look like you are rolling a pill between your thumb and forefinger. Tremors also can occur in your legs or jaw when you are at rest. Since the tremors are most apparent during rest, they usually go away when moving and typically don’t interfere substantially with daily functions.

As the condition progresses, people with PD may notice other motor symptoms, such as:

  • Movements that become smaller, possibly resulting in:
    • Shuffling when walking.
    • The arms swinging less when walking.
    • The voice becoming quieter.
  • Muscle stiffness or rigidity, causing discomfort in the neck, trunk, or shoulders.
  • Pain due to muscle stiffness.
  • Postural instability, resulting in poor balance and a greater risk of falling.
  • Movements that become slower during daily activities such as dressing, showering, or moving in bed.
  • A feeling of the feet being “frozen” to the floor, making it hard to take a first step, or to turn around when walking.
  • Stooped posture.
  • Difficulty speaking at a normal voice level.
  • Difficulty swallowing.
  • Difficulty performing tasks that were once easy to do, such as gardening or swinging a tennis racquet or golf club.
  • Difficulty making facial expressions.
  • Difficulty holding and releasing urine (bladder urgency and incontinence).

Nonmotor symptoms might include:

  • Difficulty paying attention to a task for a long period of time or dividing attention between 2 or more tasks.
  • Fatigue.
  • Lack of motivation.
  • Lightheadedness.
  • Depression.
  • Anxiety.
  • Disturbed sleep.

How Is It Diagnosed?

Because there is not one definitive test for PD, it can be difficult to diagnose. A diagnosis is usually made based on a person’s medical history and a neurological examination. If your physical therapist suspects that you have symptoms of PD, you may be referred to a neurologist for further examination.

A diagnosis of PD may be made if a person is found to have:

  • Slowing of motion and tremor when resting, or muscle rigidity
  • A significant improvement in symptoms when taking a medication to treat PD.
  • Initial symptoms on 1 side of the body only.

How Can a Physical Therapist Help?

Because PD affects each person differently, your physical therapist will partner with you to manage your specific situation—now and as your condition changes. You are not alone!

Following a diagnosis of PD, your physical therapist will conduct a comprehensive evaluation, including tests to examine your posture, strength, flexibility, walking, endurance, balance, coordination, and attention with movement. Based on your test results, your physical therapist will develop an individualized treatment plan to help you stay as active and as independent as possible. Your program will include exercises and techniques to combat the symptoms of PD.

Depending on the nature and severity of your condition, your treatment program may focus on activities and education to help you:

  • Improve your fitness level, strength, and flexibility.
  • Develop more effective strategies to get in and out of bed, chairs, and cars.
  • Turn over in bed more easily.
  • Stand and turn to change directions more efficiently.
  • Improve the smoothness and coordination of your walking.
  • Improve your ability to perform hand movements.
  • Decrease your risk of falling.
  • Improve your ability to climb and descend stairs and curbs.
  • Perform more than 1 task at a time more efficiently.
  • Participate in activities that are important to you.

A physical therapist working with a patient on movement and balance skills

Some of the medications designed to manage PD symptoms may have an immediate positive effect. For example, movement is typically much easier shortly after you begin taking certain PD medications. Your physical therapist will know how to time treatments, exercise, and activity based on both the schedule and the effects of your medications to get the best results.

Parkinson’s disease can make daily activities seem frustrating and time-consuming. Your physical therapist will become a partner with you and your family to help you combat and manage the symptoms of PD. As your condition changes, your treatment program will be adjusted to help you be as independent and as active as possible.

Some people with PD benefit from using a cane or a walker. Your physical therapist can work with you to determine if any of these devices may be helpful to you. If you need physical assistance to help you with moving in bed or getting out of a chair, your physical therapist can team with you and your family to develop strategies to make moving easier and help prevent injury. In addition, your physical therapist can make suggestions on changes to your home environment to optimize safe and efficient daily function at home.

Go Big, LSVT BIG!

Because LSVT BIG treatment is customized to each person’s specific needs and goals, it can help regardless of the stage or severity of your condition. That said, the treatment may be most effective in the early or middle stages of your condition when you can both improve function and potentially slow further symptom progression. Beginning your work with LSVT BIG before you’ve noticed significant problems with balance, mobility or posture will often lead to the best results, but it’s never too late to start. LSVT BIG can produce significant improvements even for people facing considerable physical difficulties.

Can This Injury or Condition Be Prevented?

To date, there is no known way to prevent PD. Studies have shown improved walking, balance, strength, flexibility, and fitness in people with PD, who participate in a regular exercise program. However, these studies also indicate that people with PD gradually lose the gains they make when their supervised exercise program ends. It’s important to work with your physical therapist to help develop good long-term exercise habits.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat patients with PD. You may want to consider:

  • A physical therapist who is experienced in treating people with neurological disorders. Some physical therapists have a practice with a neurological focus.
  • A physical therapist who is a board-certified clinical specialist or who has completed a residency or fellowship in neurologic physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.

General tips when you are looking for a physical therapist (or any other health care provider):

  • Get recommendations from family, friends, or other health care providers.
  • When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with PD.

During your first visit with the physical therapist, be prepared to describe your concerns in as much detail as possible, and let the physical therapist know what you would like to accomplish by going to physical therapy.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. Treatment includes a combination of medication and physical therapy—and in some cases surgery. Physical therapists partner with people with PD and their families to manage their symptoms, maintain their fitness levels, and help them stay as active as possible.

You can contact our physical therapist’s directly for FREE CONSULTATION or evaluation.

 

Exercise for Parkinson’s Disease is More Than Healthy; It’s a Vital Component.

Exercise is an important part of healthy living for everyone. For people with Parkinson’s disease (PD), exercise is more than healthy — it is a vital component to maintaining balance, mobility, and activities of daily living (i.e. bathing, toileting, cooking, and dressing). Exercise and physical activity can improve many PD symptoms. These benefits are supported by research.

The Parkinson’s Outcomes Project shows that people with PD who start exercising earlier and a minimum of 2.5 hours a week, experience a slowed decline in quality of life compared to those who start later. Establishing early exercise habits is essential to overall disease management.

What Type of Exercise Should I Do?

To help manage the symptoms of PD, be sure your exercise program includes a few key ingredients:

  • Aerobic activity
  • Strength training
  • Balance, agility, and multitasking
  • Flexibility

The Parkinson’s Foundation, in collaboration with the American College of Sports Medicine, created new Parkinson’s disease (PD) exercise recommendations to ensure that people with Parkinson’s are receiving safe and effective exercise programs and instruction.

The new exercise guidelines include recommended frequency, intensity, time, type, volume, and progression of exercises that are safe and effective for people with Parkinson’s across four domains: aerobic activity, strength training, balance, agility, multitasking, and stretching. Each recommendation is paired with specific types of activity and special safety considerations for people with PD.

Parkinson’s Exercise Recommendations (available in multiple languages)

These elements are included in many types of exercise. Biking, running, Tai chi, yoga, Pilates, dance, weight training, non-contact boxing, qi gong and more — all have positive effects on PD symptoms.

There is no “exercise prescription” that is right for every person with PD. The type of exercise you do depends on your symptoms and challenges. For sedentary people, just getting up and moving is beneficial. More active people can build up to regular, vigorous activity. Many approaches work well to help maintain and improve mobility, flexibility and balance to ease non-motor PD symptoms such as depression or constipation.

Researchers in the study did not distinguish between what type of exercise participants did and determined that all types of exercise are beneficial. The most important thing is to do the exercise regularly. We suggest finding an exercise you enjoy and stick with it.

Challenges to Exercising

  • People in the early stages of PD tend to be just as strong and physically fit as healthy individuals of the same age.
  • Disease progression can lead to the following physical change:
    • Loss of joint flexibility, which can affect balance.
    • Decreased muscle strength or deconditioning which can affect walking and the ability to stand up from sitting.
    • Decline in cardiovascular conditioning, which affects endurance.

Tips for Getting Started

  • First, be safe. Before starting an exercise program, we recommend you to see a physical therapist specializing in Parkinson’s for full functional evaluation and recommendations..
  • Use a pedometer (step-counter) and figure out how many steps you take on average each day, then build up from there. Many smartphones or smartwatches have a built-in pedometer feature or an application that can be downloaded.
  • Exercise indoors and outdoors. Change your routine to stay interested and motivated.
  • Again, most importantly pick an exercise you enjoy.

source: www.parkinson.org

Fitness for Every Age … and Stage

Like most people, you have probably heard that muscle strength, absent some weightlifting, starts to decline in middle age. And you probably expect things like your balance, coordination and flexibility to naturally take a bit of a downturn …. someday. But new research from Duke University shows that these fitness-related changes begin much earlier than many people expect — often when they’re still in their 50s.

To assess age-related changes in people’s fitness abilities, researchers at Duke’s Center for the Study of Aging and Human Development had 775 participants from their 30s to their 90s perform tests designed to measure things like strength, endurance, balance and walking speed.

At all ages, the men generally performed better than the women, but the age at which physical declines became truly apparent was consistent for both genders — the 50s. That’s when both sexes began to have trouble rising from and sitting in a chair repeatedly for 30 seconds (an indicator of declines in lower body strength) or standing on one leg for up to 60 seconds (a measure of balance).

Additionally, people in their 60s and 70s showed a marked slowing of gait speed (based on distance covered per second of a four-meter walk) and a drop in aerobic endurance (based on a six-minute walk test). By contrast, those in their 80s and 90s had dramatic declines in their balance, gait speed, lower body strength and aerobic endurance.

“People were very surprised by these changes because most of these tests aren’t typically done if you go to the doctor,” says study coauthor Katherine Hall, an assistant professor in medicine at Duke University School of Medicine’s Division of Geriatrics. “Some of this is inevitable — our bodies are machines, and if you put 60 or 70 years of wear on any machine, it’s going to show some decline.” Even so, the rate or severity of these declines varies significantly from one person to another based on how active — or sedentary — you are.

The benefits of banking fitness

“What’s really happening is many of these changes start to occur earlier in life but don’t manifest themselves and become problematic until later in age,” explains Cedric X. Bryant, chief science officer at the American Council on Exercise. There’s also a domino effect involved: Declines in muscle strength and bone mass start to occur in the 30s, he notes, and “losses of lower body strength and balance will eventually impact walking speed.”

It’s a mistake to wait until these declines in physical fitness set in. After all, these fitness factors affect not only your general level of functionality but also your overall health: In a practical sense, your gait speed, for example, may determine whether you can cross the street safely before the light turns red. But it’s more than that, too. “Gait speed is now being called the sixth vital sign,” Hall says. “It’s the strongest predictor of hospitalizations, as well as a person’s risk for developing chronic diseases, disabilities and cognitive decline.”

That’s why it’s smart to look at building and maintaining physical fitness in a way that’s similar to how you might amass savings for retirement. “You get the greatest returns on your investment the earlier you start,” Bryant says. “But the beauty is: It’s never too late to start. All these systems respond to the right dose of stress in the form of physical activity and exercise.”

Participating in regular physical activity can modify all of these age-related declines in muscle strength, balance, mobility, agility and endurance considerably. “As much as 50 percent of these age-related deficits can be attributed to our lifestyles,” Bryant says. That means you have the power to profoundly influence how or whether these fitness parameters change as you get older.

The power of a plan

To minimize or delay such declines, you’ll want to follow a well-rounded exercise program that targets endurance, strength, balance, and agility. In every decade, it’s important to start with aerobic exercise — whether it’s walking briskly, jogging, bicycling, swimming, dancing, using a cardio machine (like an elliptical trainer) — several times per week, for at least 150 minutes of moderate-intensity per week. (A good gauge of what’s moderate intensity, Bryant says, is being able to talk, but not sing, while you’re working out.)

Staying aerobically active is especially important, as you get older, because “losses in cardiovascular fitness occur more rapidly than losses in muscle strength,” notes Fabio Comana, a faculty instructor at the National Academy of Sports Medicine.

Beyond that aerobic baseline, here’s what to add in by age.

In your 50s

If you haven’t already, it’s critical to work on building and maintaining muscle strength, especially in your lower body because “you lose muscle strength faster in your lower extremities than in your upper body,” Comana says. Whether you choose to use your own bodyweight (by doing squats, lunges, pushups or triceps dips), weights or resistance bands is up to you. But it’s best to target all the major muscle groups including the glute muscles (in the buttocks), the quadriceps and hamstrings (in the thighs) and the calf muscles.

If you can do a whole-body strength-training regimen that also addresses the pectoral muscles (in the chest), the latissimus dorsi (in the back), the deltoid muscles (in the shoulders) and the biceps and triceps (in the upper arms), that’s even better, Bryant says. “Start with one set of eight to 15 repetitions and work up to two to three sets, twice a week.” Add plank exercises to build and maintain core strength and you will have covered all your bases.

In your 60s and 70s

Make an effort to walk more often and to vary your pace so that you’re alternating between bouts of faster walking and a more comfortable pace, Hall advises. You can work on protecting your balance by trying to stand on one foot for up to 60 seconds with your eyes open, sitting in a chair and lifting one foot from the floor with your eyes closed, or continuously going from a seated to a standing position without using your hands, Comana suggests, noting that these balance exercises can be “somewhat remedial.” To take extra precautions to protect your balance, you might try a mind-body form of exercise such as yoga, Pilates, or tai chi, which would “provide agility, mobility, flexibility and some muscular fitness benefits as well,” Bryant says.

In your 80s and beyond

As far as cardiovascular activities go, “find something you enjoy that provides social engagement and makes you feel energized,” Hall advises. This could involve taking a water aerobics class with friends or joining a walking group. An added perk: “Cardiorespiratory exercise is one of the best deterrents to developing cognitive decline,” Hall says. Continue working on your balance by alternately standing on one leg then the other with one hand on a counter to steady yourself and the other by your side. Or try standing with one foot behind the other, with the heel of the front foot against the toes of the back foot (maintain your balance for 10 seconds then switch placement of the feet). “Be sure to wear supportive shoes,” Hall says. If you find yourself really struggling with balance, consider working with a trainer in a supervised setting.

And don’t give up. As the Duke study found, “There are people in their 80s who are doing better than some people in their 60s are,” Hall says. “The body is a malleable machine that responds well to challenges, which means there’s a lot of room for being an active agent in your own health.”

source: https://www.aarp.org/health/healthy-living/info-2018/banking-fitness-any-age.html

Happiness: It’s All About the Ending

A happy ending makes (almost) anything more pleasurable

In many ways, living in the moment has its benefits. While you’re in the midst of an enjoyable experience, you’re most likely to be tuned into the pleasures signaled by your body’s senses. By contrast, an experience marked by pain, mishaps, and inconvenience is one you’d just as soon get out of as soon as possible. Even so, after it’s over, many of us forget how badly we felt while it was going on. When pain outweights pleasure, living in the moment isn’t all that it’s cracked up to be.

As it turns out, many of us are pretty likely to form biased memories of our experiences. The biases can go in both positive and negative directions. According to Nobel-prize winning psychologist Daniel Kahneman, the “peak-end rule” is just one of many errors of judgment that affects the accuracy of our cognitive apparatus. An event makes its mark in our memories more by what happens at its end than at any prior point. In his book, Thinking Fast and Slow, Kahneman points out many of the illogical features of our thought processes, including the contrast between our experiences in the moment and the way we remember them.

Studies of happiness in the moment use a method called “experience sampling” in which people provide an instantaneous reading of how they are feeling. New technologies allow researchers to “ping” participants, asking them questions about what they’re doing right now, instead of having them provide recollections at some later point. For example, German researcher Bettina Sonnenberg and her colleagues (2012) asked participants on their mobile phones to report the activities they were engaging in while pursuing their daily routines. The participants also completed standard survey questionnaires about their use of time. People’s reports through experience sampling were very consistent with surveys that they later completed regarding questions about the amount of time they spent at paid work. However, when participants were asked to estimate how much time they spent in less regular, predictable activities (such as errands or leisure), the survey reports diverged substantially from the moment-to-moment data they recorded through experience sampling.

It’s no surprise that people rate their happiness while having a previous experience higher than they did while going through the experience itself. While you’re in the moment, you are aware of more of the “objective” features of the situation. You may be having your favorite meal, trying to unwind after a stressful day, and although you love the music itself, your mind strays to some of the unpleasant things that happened to you earlier. If we “ping” you to rate your happiness, your rating may reflect not the food you’re trying to enjoy, but the recall of what caused you to feel stressed. How many times, for example, have you watched a movie or TV show, absorbed in the action, only to have that little glimmer of emotional discomfort penetrate your consciousness?

From this one brief example, let’s extrapolate to more significant experiences in your life. Perhaps it was a joyous family occasion that became marred, temporarily, by someone’s emotional outburst. You really wanted to enjoy the event, but it wasn’t going completely as planned due to this one unfortunate incident. Over time, your memory of that event, according to Kahneman, will smooth out the rough edges and you’ll be left with an overall recollection that most likely will be a happy one.

There are many advantages to remembering the past in a positive way. In my research on personality and aging, I’ve found that the older adults with higher levels of self-esteem and well-being are the ones who tend to focus on those positive events from their lives. Long-term happiness often depends on your forming a favorable narrative of your life. Those who ruminate over their failures, disappointments, and mistakes are not only less happy in the moment, but also risk experiencing chronic depression.

With this background in mind, let’s take a closer look at one of the most intriguing results that Kahneman describes about the foibles of human memory. The peak-end rule states that the way an experience ends determines the happiness we ascribe to it. There are two classic experiments demonstrating the peak-end rule. Kahneman and his associates showed, in 1993 that participants exposed to 30 seconds of 14 degree ice water (very cold!) rated the experience as more painful than participants exposed to 90 seconds of exposure to 60 seconds of 14 degree ice water plus 30 additional seconds of 15 degree ice water. In other words, participants found the 90 seconds of ice water exposure less painful than those exposed to 60 seconds of nearly equally cold water because the 90 seconds ended with exposure to a “warmer” stimulus. We will rate an experience as less painful, then, if it ends on a slightly less painful way. The “peak end” in this case was a one degree difference in water temperature.

Many studies support the peak-end rule. People will prefer and even choose exposing themselves to more pain (objectively determined) if the situation ends with them feeling less pain. Think about it this way. If you are having a tooth drilled, you’d find it was less painful if the dentist ends the procedure with some lightening of the drill’s intensity, even if the procedure is longer than it would otherwise be. Counterintuitive? Yes. Common? Definitely.

We approach not only our experiences of pleasure and pain in this way, but also our acquisition of objects that we’re given as gifts. As reported in a review article by Dartmouth psychologist Amy Do and collaborators (2008), participants given free DVD’s were more pleased with the gifts if they received the more popular ones after the less popular ones, then if they received the exact same DVD’s in the opposite order. When it comes to pleasure, it’s all about the ending.

In the happiness realm, we can come up with many similar analogies from everyday life. Think about the last time you took a trip that was hopelessly botched by a series of mishaps. While traveling somewhere on vacation or for the holidays, perhaps you were delayed by bad weather, traffic, or a combination of the two. While going through the moment, you could not have been any more miserable. An experience sample would have charted your unhappiness as off the charts. However, as bad as it was for a while, by the end you got where you were going and were even reasonably on time. All those bad memories during the moment now recede and you feel that you have no real reason to complain. Contrast that experience with a trip that starts out well but ends badly. You’ll rate that experience as one worthy of your most vociferous objections to anyone and everyone who will listen.

What can you learn from the peak-end rule to help you boost your own happiness quotient, both long-term, and in the moment? Here are three take-away messages:

1. Keep your mind focused on your goals during a negative experience. If things are going badly for you, try to find some redeeming aspect of the situation that will keep you motivated to get through it. If you are going through a painful procedure, medical or otherwise, look for ways to make it end on a better note than it began.

2. Don’t let minor discomforts ruin your pleasurable experiences. Those longed-for occasions don’t always go perfectly. However, if you can keep the occasional disruptions from invading your mood, you’ll find the pleasure-to-pain ratio wins out in favor of pleasure.

3. End your experiences on a “high note.” As Jerry Seinfeld so wisely pointed out many years ago, ending on a high note will always leave them “wanting more.” If you wait till the “bitter end” (to use another metaphor), the experience will be one you remember far more pleasantly.

As Shakespeare says, “All’s Well that Ends Well.” Let’s hope that your endings are just as happy!

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source: www.psychologytoday.com

Elevate Your Heart Rate With Physical Therapy

Heart disease is a leading cause of death and disability. This shouldn’t be a surprise – it’s been at the top of the list for years. You know that taking care of your heart is important. That means doing things like eating right, avoiding smoking, and exercising regularly. While all of those things can be difficult, today we’re going to focus on exercise.

HOW PHYSICAL THERAPY CAN HELP WITH YOUR HEART HEALTH

Cardiovascular exercise is anything that makes you breathe harder and your heart pumps faster. That could be walking, running, dancing, biking, swimming or hiking. It strengthens your heart and blood vessels. It can help control weight, lower blood pressure, reduce stress, and prevent heart disease.

If you’re regularly going for a run or swimming laps, you don’t need help from your PT. But 3 out of 4 adults aren’t exercising regularly. If you’d like to get started, your PT may be just the person to help you. It’s not uncommon to get injured, then never get back to your old routine. Your PT can help you deal with the old injury and design a plan to get you safely back to regular activity.

It’s also not uncommon to try to be more active on your own, only to stir up pain somewhere like your back, hip, knee or shoulder. Your PT can help with that too. They’ll figure out why you’re having pain, help you correct it, and get you a plan to reach your goals.

Physical therapists can also help you safely increase your activity levels after major medical issues like a heart attack, stroke, or even cancer. Recent research has shown improvements in cardiovascular fitness, fatigue levels, and even pain in cancer patients who participate in a personalized physical fitness plan from a PT.

Whatever your barriers to physical activity are, your PT can likely help you overcome them. As movement experts, physical therapists are trained to deal with a variety of conditions. They’ll help you work around whatever issues you have so you can safely elevate your heart rate and keep cardiovascular disease away.

Why Walking With a Buddy is a Great Idea! Plus, Six Bonus Tips!

Walking is a healthy, low-impact, and free activity that can be enjoyed every day. There are many advantages to walking daily. Not only is it beneficial for muscles and bones and cardiovascular and pulmonary health, but walking can serve as a weight-loss mechanism and mood booster. While it is totally feasible to walk solo, there are many great reasons to walk with a partner. Let’s explore a variety of reasons to have a “walking buddy.”

  • Walking buddies are a great source of encouragement. They can get you motivated, keep you on track, and cheer you on. And you can do the same for them.
  • A walking buddy can hold you accountable and vice versa. Thus, having a walking partner makes it more difficult for either party to skip the activity.
  • It is generally safer. In a worst-case scenario, should a partner trip or fall, the other is right there to assist. It also may be more secure to walk with a partner than to walk alone.
  • Walking together is fun. It provides a sense of purpose and creates a positive experience.
  • Staying active and engaged in a fun activity with a friend can reduce feelings of loneliness and even reduce depression in some individuals.
  • It builds relationships. Friends may share advice, stories, recipes, or engage in fun subjects such as sports or music.
  • It helps to pass the time more quickly.

These are some of the many great reasons to walk with a partner. Whether for exercise, walking the dogs, pushing babies in strollers, or simply spending time outdoors, togetherness can make the activity immensely more fun. No matter where you walk, whether on a sandy beach, a country trail, a suburban neighborhood, or a city block, the experience is generally more profound when enjoyed with a friend.

Six bonus tips:

1) Before engaging in exercise, talk to your doctor to decide what type of activities are right for you.

2) When walking for exercise, find a walking partner who shares similar goals with you. It’s important to keep a similar pace so that you each reach the maximum level of activity desired.

3) Wear appropriate walking shoes (no flip flops, heels, or ill-fit shoes) to minimize falls.

4) Be sure to stay hydrated and wear sunscreen as necessary.

5) Invest in a cell phone holder for walking so that you can safely carry your cell phone for emergencies.

6) When walking near high traffic areas, wear light clothing, stop, look, and listen before crossing the road, and cross at designated crosswalks.

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source: amac.us

 

Physical Therapy Guide to Chronic Obstructive Pulmonary Disease (COPD)

Chronic obstructive pulmonary disease causes breathing difficulty and leads to other systemic problems. COPD is the tenth most prevalent disease worldwide. It’s estimated that by 2050, COPD will be the fifth leading cause of death in the world. Although COPD used to be more common among men, it now affects women nearly as equally in developed countries.

Physical therapists can work with your pulmonary rehabilitation team or with you individually to help improve:

  • Your exercise capacity.
  • Your overall strength.
  • Your health.

What Is Chronic Obstructive Pulmonary Disease (COPD)?

In chronic obstructive pulmonary disease, the airways in your lung lose their normal shape and elasticity and can become inflamed. The result is that the airways are less efficient at moving air in and out of your lungs. Primary risk factors for developing COPD include:

  • Smoking.
  • Inhaling toxic substances.
  • Indoor and outdoor pollutants.
  • Genetic/environment interactions.
  • Respiratory insult to the developing lungs during prenatal or early childhood stages of life.

Current research indicates that COPD is no longer considered a “smoker’s” or “older person’s” disease.

The most common types of COPD are:

  • Chronic bronchitis—a chronic inflammation of the medium-size airways, or “bronchi” in the lungs, causing a persistent cough that produces sputum (phlegm) and mucus for at least 3 months per year, in 2 consecutive years.
  • Emphysema—a condition in which small air sacs in the lungs called “alveoli” are damaged. The body has difficulty getting all of the oxygen it needs, resulting in shortness of breath (“dyspnea”) and a chronic cough.

In addition to causing breathing difficulty, COPD results in cough, sputum production, and other symptoms. The disease can affect the whole body and lead to:

  • Weakness in the arms and legs.
  • Balance problems and increased risk of falls.
  • Nutritional problems (weight loss or gain).

People with COPD are likely to have other health problems that can occur at the same time or be related to COPD, such as:

  • Reduced blood supply to the heart (ischemic heart disease).
  • High blood pressure (hypertension).
  • Depression.
  • Lung cancer.
  • Osteoporosis.
  • Diabetes.
  • Congestive heart failure.
  • Coronary artery disease.
  • Atrial fibrillation.
  • Asthma.

Over time, COPD leads to a progressive decline in physical function because of increased shortness of breath (dyspnea) and loss of muscle strength. There are 4 stages of COPD — mild, moderate, severe, and very severe — based on measurements of the amount or flow of air as you inhale and exhale. People with COPD may need to take medications or may require supplemental oxygen.

How Can a Physical Therapist Help?

Your physical therapist will perform an evaluation that includes:

  • A review of your history, including smoking history, exposure to toxic chemicals or dust, your medical history, and any hospitalizations related to your breathing problems.
  • A review of your medications.
  • Assessment of what makes your symptoms worse, and what relieves them.
  • Review of lung function test results that may have been performed by your physician.
  • Muscle strength tests of your arms, legs, and core.
  • Walk tests to measure your exercise capacity.
  • Tests of your balance and your risk of falling.

Pulmonary rehabilitation, including exercise training for at least 4 weeks, has been shown to improve shortness of breath, quality of life, and strategies for coping with COPD. Your physical therapist will serve as an important member of your health care team, and will work closely with you to design a program that takes into account your goals for treatment. Your physical therapist’s overall goal is to help you continue to do your roles in the home, at work, and in the community.

Improve Your Ability to Be Physically Active

Your physical therapist will design special exercises that train the muscles you use in walking and the muscles of your arms, so you can increase your aerobic capacity and reduce your shortness of breath. You may also use equipment, such as a recumbent bike, treadmill, or recumbent stepper to improve cardiovascular endurance.

Research has shown that strength training in people with moderate to severe COPD increases muscle mass and overall strength. Your physical therapist will provide strengthening exercises for your arms and legs using resistance bands, weights, and weighted medicine balls

Improve Your Breathing During Activity

People with COPD often have shortness of breath and reduced strength in their “inspiratory muscles” (the muscles used to breathe in). Your physical therapist can help you with inspiratory muscle training, which has been shown to help reduce shortness of breath and increase exercise capacity. Your physical therapist can instruct you in pursed-lip and diaphragmatic breathing, which can help make each breath more efficient, and helps to reduce shortness of breath during your physical activities.

Improve Your Balance

The decrease in function and mobility that occurs with individuals who have COPD can cause balance problems and risk of falls. People who require supplemental oxygen can be at a greater risk for a fall. If balance testing indicates that you are at risk for falling, your physical therapist can help by designing exercises aimed at improving your balance, and helping you feel steadier on your feet.

Can This Injury or Condition Be Prevented?

One of the most important ways to prevent COPD is to stop smoking, which also can delay the onset of COPD, or delay the worsening of breathing difficulty. If you are a smoker who has a cough or shortness of breath but whose tests don’t yet show a decline in lung function, you may be able to avoid a diagnosis of COPD, if you stop smoking now! The American Lung Association offers an online Freedom From Smoking® program for adult smokers. Your physical therapist also can help you get in touch with local smoking cessation programs.

If you already have COPD, your physical therapist can guide you to help slow the progression. The therapist will show you how to continue an exercise program at home or at a fitness center after you’ve completed your physical therapy treatment. Regular exercise that is continued after pulmonary rehabilitation for COPD helps slow the decline in quality of life and shortness of breath during activities of daily living. It has been found that patients who continue exercising after completing a pulmonary rehabilitation program, maintained the gains that had been made, whereas those who stopped their exercise program had a major decline in their exercise endurance and physical functioning.

When COPD is accompanied by excessive body weight, breathing can be more difficult. Excessive weight can also inhibit the ability to exercise and decrease overall quality of life. Your physical therapist can help you manage your weight, or prevent unnecessary weight gain by designing an exercise program specifically targeted to your current abilities. Your physical therapist also can also refer you to a dietician for help with proper nutrition to support a healthy lifestyle.

source: choosept.com

PT vs. PTA; What is the Difference?

Most professionals have assistants, for example, a physician (MD) has a physician assistant (PA). Hence, a physical therapist (PT) has a physical therapist assistant (PTA). Each is incredibly educated requiring a graduate degree from an accredited physical therapist program for PTs, and an associate degree from an accredited PTA program for PTAs, followed by both taking the National Licensure Exam for the Commonwealth of Virginia; PTs (now required to have either a masters or clinical doctorate), and PTAs (who provide services under the direction of a licensed PT). Thus, creating a dynamic duo that has the most specialized education with an established theoretical and scientific base, widespread clinical applications in the restoration, maintenance, and promotion of optimal physical function. But, often it is misunderstood that, like physicians and physician assistants who work together as a team, PTs and PTAs are not considered equals in their profession. So what is the difference you wonder? The only difference is that PTAs cannot perform Initial Evaluations-a collection of patient history, conducting a systems review and the performance of tests and measures to identify potential and existing problems-in short the Diagnosis, Prognoses, Re-Evaluation of the Diagnosis, Plan of Care, or the development and implementation of Discharge plans.

So what is left for the PTAs to do for you? Well, that’s easy! PTAs can carry out the plan of care and goals established for you by your PT.

That’s right! Your PT carries out your treatment through their assistant. This is because Physical Therapy is different than a visit with your Physician. You have more visits because you are now in the treat and be treated phase. Your body is ready to have all anatomy systems relating to your condition treated such as muscle/brain re-education (teaching your brain to use your muscles properly), making sure you are doing your homework, (also called a Home Exercise Program or HEP), and performing Manual Therapy (which is when the PT/PTA physically performs stretches or manipulations to the affected, and surrounding, part(s) of the body.)

Of course, you do see your PT during your treatment, but this teamwork allows for the PTs to evaluate other patients coming in for their first visit, as you continue with your treatment. The saying goes that for everyone visit you have with your PT, you might have the next two visits with their PTA; that’s usually how we conduct our patient’s treatment series at Carousel. Meanwhile, there is constant communication, verbal and documented, between the dynamic duo allowing 2-sets of eyes that can differentiate between any possible hiccups during your treatment, such as strategies or plateaus. This allows for re-examination or modifications necessary to achieve the anticipated goals and expected outcomes to restore optimal quality of life as it relates to movement and health!