1. Maintaining and improving mobility PDS Conference 2006 – New Horizons Bhanu Ramaswamy MCSP 21/09/06

2. Why is mobility so important? • It provides us a way to maximise physical potential • Allows us to remain fit (and possibly healthy) • Limits dependence • Gives us freedom • Essential for QoL and well-being • Sex and fun! B Ramaswamy; PDS Conference 21.09.06

3. Ask yourself this – how would you cope if you had your mobility taken away? B Ramaswamy; PDS Conference 21.09.06

4. The main things that adversely affect mobility in Parkinson’s. • Brady –, hypokinesia and rigidity • Mood • Fatigue • Falls • Co-morbidity or injures • Medication cycle • Responses from other people • Availability of appropriate activities B Ramaswamy; PDS Conference 21.09.06

5. Result in ……………… • Slowness of movement with loss of amplitude • Decreased joint flexibility • Altered response to balance threats • Decreased confidence to go out an do things • Stigma of other people misunderstanding the effects of PD / staring • Tired or lacking in motivation to initiate or continue activity • Pain B Ramaswamy; PDS Conference 21.09.06

6. Benefits of exercise • Known physiological, psychological and social benefits • Emerging benefits • PD specific benefits. • Benefits far outweigh the hazards B Ramaswamy; PDS Conference 21.09.06

7. Components of activity that can improve mobility • Musculo-skeletal strength and power • Flexibility and posture • Balance • Endurance And for people with Parkinson’s, • Relaxation B Ramaswamy; PDS Conference 21.09.06

8. Tests 2. Flexibility 3. Posture 1. Strength and power 5. Endurance 4. Balance B Ramaswamy; PDS Conference 21.09.06

9. Perspectives of people with PD about mobility 1. About this talk, what would you like to hear? Clarity of ‘mobility’ as it is a health term 2. What is the Government target for a fit and healthy nation? Poor awareness of 30mins at least 5 x week moderate exercise 3. Do you do this amount? 90% (majority) did not do this amount B Ramaswamy; PDS Conference 21.09.06

10. Perspectives continued………… 4. Why not? Already active; bored with what is offered; cannot do the ones I once enjoyed; response of others 5. Why? My wife nags me; I like the feeling of being fit; limits my stiffness 6. What things would help you to maintain activity? To find a routine that fits my lifestyle; a like-group; adapted gyms; trained staff; more fun activities and exercise; more sunshine B Ramaswamy; PDS Conference 21.09.06

11. Perspectives from exercise trainers • We only learn about normal physiology • Our equipment is not appropriate for people in wheelchairs • I didn’t know people with Parkinson’s could walk • I would like to learn, but don’t know how • What if they fall and injure themselves? B Ramaswamy; PDS Conference 21.09.06

12. Proven benefits of exercise • Increased functional independence • Improves participation and activity in QoL scales and can decrease reports of fatigue • Increases socialisation and feeling of well-being • Can allow medication doses to remain unchanged for a prolonged period • Improvement of step and stride length plus ground clearance (with cueing and compensatory strategies) • Improved safety – or no increase in falls B Ramaswamy; PDS Conference 21.09.06

13. Take home messages: • All people with Parkinson’s must be provided with the chance to improve, maintain and minimise the rate of deterioration of mobility • To ensure this happens, referral to the appropriately trained person is essential following (acceptance of) diagnosis • We must educate service providers about the condition so that they can best enable people with Parkinson’s to remain mobile for as long as possible B Ramaswamy; PDS Conference 21.09.06

14. Any questions about mobility and PD? Ask Karen and Fiona at the back! B Ramaswamy; PDS Conference 21.09.06