Exercise framework for professionals

The purpose of the exercise framework is to promote exercise that is suitable for everyone with Parkinson's. The exercise framework also considers aspects of movement challenges to help people with Parkinson's manage daily activities.

Parkinson's is a progressive neurological condition that affects everyone differently. The main symptoms are slowness with smallness of movement (bradykinesia), rigidity and tremor. These are examples of motor symptoms, which can create mobility difficulties. Non-motor symptoms are wide ranging and can include fatigue, bladder problems, changes to mood and motivation. The variety of symptoms can make daily life unpredictable and routine tasks more difficult.

When exercise is done correctly and safely, with a personal goal, it can improve these daily challenges. No exercise done in this way has shown to be harmful.

With these things in mind, the exercise framework has been developed to provide structured guidance to professionals to help people with Parkinson's do exercise that is right for them and their condition.

• Health professionals including GPs, consultants, Parkinson’s nurses, physiotherapists, and other health professionals who recommend exercise as part of their work.

  GPs and nurses in particular can help people with Parkinson’s understand the importance of doing exercise from diagnosis onwards.

• Exercise professionals such as personal trainers and fitness instructors.

  Local leisure centres and gyms are an ideal place to encourage people with Parkinson’s to use exercise to help them manage their condition.

Many people with Parkinson's are not achieving the Department of Health’s recommendation of 2.5 hours of exercise per week.

The exercise framework provides structured support so that people with Parkinson's can increase exercise to this level.

Being active for 2.5 hours a week can help manage Parkinson’s symptoms, and has a positive impact both physically and mentally.

Parkinson's is a long term condition with symptoms and other daily challenges that can create barriers to exercise.

The physical symptoms of Parkinson's including rigidity, fatigue or pain, may make certain exercise more difficult or off-putting for people.

Also symptoms such as slowness of movement and thought, which some people experience, can affect daily routines. For example, this could include difficulty travelling or access to exercise classes, making symptoms harder to manage. Because of this it is important that any exercise is sensitive to these symptoms and challenges, but also intensive enough to help relieve them.

Non-physical symptoms, such as mental health issues like low mood and anxiety may also make someone less motivated to exercise.

The exercise framework should support staff to help motivate people with Parkinson's to continue healthy behaviour. The main benefits of overcoming the barriers to exercise are the enjoyment of doing something that is good for health, and doing it with others.  

To help overcome any barriers to exercise, it is important to understand someone’s individual needs with Parkinson's. Discussions on suitable exercise should include the effects of medication, fitness levels and social circumstances.

Exercise can be as important as medication and can be prescribed as a daily dose in a similar way. Because of this you can use the exercise framework to promote exercise as an important part of everyday life for people with Parkinson's.

It is designed to be flexible and to work with the changing, individual nature of the condition. This will help people understand what exercise, method or style might be beneficial at different times and what outcome they can achieve.

It will be especially helpful in using the effect of exercise to help people with Parkinson's carry out everyday movements and activities.

With these things in mind the exercise framework is divided in the following ways:

Initially, it considers the focus of the exercise, depending on symptoms at, and since diagnosis. For example:

• if someone should be investing in (more) exercise to help slow the progression of their symptoms
• if they should be keeping active to stay mobile
• if they are at a stage where movement has become more challenging and they have to adapt to this

The exercise framework then provides an idea of the evidence at each of these phases.

Finally, there are examples of the sort of exercise someone might try to deal with their Parkinson's.

The columns of the exercise framework do not represent a progression of symptoms. People with Parkinson's reported key issues around exercise and each column has advice to deal with them.

 Advice can be taken from one column and mixed with a suggestion from another column if this helps a person with Parkinson's at that time.

The best type of exercise should help people with Parkinson's to feel as fit and well as possible to manage everyday life.

The exercise framework suggests a blend of styles and intensity that will help people with Parkinson's do what they can at different times over the course of the condition.

There is no ideal solution or exercise for everyone. No one type of exercise can provide the ‘best’ benefits all the time because our needs change with daily life.

Because of this the focus should be on motivation and engagement. This should consider that many people with Parkinson's find exercising with other people helps them reach and maintain their goals, to help them deal with the challenges of everyday life with Parkinson's.