Written by Tiana Corovic

Among its many known benefits, exercise may also be used as a rehabilitative treatment for the reduction and control of Essential (ET) and Parkinsonian tremors (PT). Performing every day tasks requires some degree of physical ability, such as strength, dexterity, and steadiness. Gaining control of movements does not have to come at the expense of a needle or a surgical procedure. Improvements in movement control and severity of tremors may occur after only six weeks of diligently applying to an exercise routine. This doesn’t have to take form of the huffy puffy weightlifting challenges aired on ESPN. Targeted strength training, tai chi, and yoga may bring about the desired increases in physical ability.

Strength Training

Strength training may range from kettle bell movements, speed lifting to body weight exercises, all of which require muscle groups to work against a force. Besides the obvious benefits for overall health, numerous studies point to strength training as a rehabilitative program for ET and PT. Resistance training is believed to induce neuromuscular adaptions that may benefit patients with ET by reducing the variability in motor firing rate (Sequeira, Keogh, & Kavanagh, 2012). When trained on heavy versus light resistance loads, patients were more likely to have increased steadiness, overall reduced tremor amplitude, and improved dexterity, noticeably in their most affected limb (Bilodeau et al., 2000; Sequeira et al., 2012).

Furthermore, even an untrained limb may begin to see improvements in muscle contractions by about 8.2% due to the cross-over effect of resistance training (Lee, Gandevia, & Carroll, 2009).  This is further reflected in the increased activity of the sensorimotor region in the brain, associated with the untrained limb during exercise (Farthing et al., 2007).

Tai Chi

Tai Chi is an exercise involving fluid movements that occur in a sequence while body weight shifts from one leg to the other. Studies demonstrate that patients with Parkinson’s Disease (PD) benefit in terms of balance and well being from practicing tai chi (Li et al., 2012). Since impaired balance is a common issue associated with PD and is known to reduce patients’ functional abilities, tai chi may act as a beneficial tool for reducing falls and its associated injuries. The improvements in physical function are thought to occur due to the reduction of dyskinesia (i.e., impaired voluntary movement) and bradykinetic movement (i.e., slow movement).  One study demonstrates that after tai chi practice twice a week for 24 weeks, participants had an average of 10.3cm increased stride length, increased walking speed, and greater knee extensions when compared to a stretching program (Li et al., 2012). While there are varying results in gait (ability to walk at a normal pace), mobility, aerobic endurance, and flexibility among studies, there’s a common consensus that tai chi improves physical function and well being among persons with PD (Ćwiękała-Lewis, K.,J., Gallek, M., & Taylor-Piliae, R, 2017). Tai chi’s many beneficial effects for physical ability make it a promising candidate as a behavioral intervention in patients with PD.

Yoga

Yoga is another tool that may be used to improve the severity of tremors. Due to its relaxing effects and the fact that tremors are frequently aggravated by stress, yoga may serve as a noninvasive relief method for patients with ET and PD. When individuals experience tremors, their default mechanism tends to be to tighten their muscles, often producing the opposite of the desired effect (Reeva & Cambell). Learning to relax can help overcome these maladaptive techniques to prevent worsening of tremors.   Stress may increase tremor amplitudes by activating various neural projections in the brain (Helmich & Dirkx, 2017).  A characteristic that separates PD from ET is that tremors frequently occur at rest during the former and during activity performance in the latter.

Tremors in PD increase markedly during cognitive stress to the point where they may even surpass effects of drugs, such as Levodopa, used for muscle control (Zach et al., 2017). Because of yoga’s common relaxing effect, it may be used as a form of behavioral therapy to reduce stress and its adverse effects.   Yoga’s benefits may further surpass the realm of stress reduction to improve patients’ physical abilities. After three months of yoga twice a week, there’s a significant reduction in bradykinesia, rigidity, and increased muscle strength in patients with PD (Ni, Mooney & Signorile, 2016). Another study demonstrated Bikram yoga’s ability to increase maximum voluntary force by 14% as well as reduce knee extension force fluctuations in patients that had the greatest difficulty prior to training (Hart & Tracy, 2008).  Exercise in multiple forms may be used as an additional treatment option for patients with ET and PD to improve physical well being.

Health does not need to come at the expense of high cost treatment options, negative side effects or invasive procedures. Improving one’s well being and capacity to perform activities in everyday life may be attained in the comfort of one’s home. Emerging evidence is indicating that strength training, tai chi, and yoga may benefit patients with ET and PD, helping patients to regain control of their movements and, by association, daily living activities.

References

Bilodeau, M., Keen, D. A., Sweeney, P. J., Shields, R. W., & Enoka, R. M. (2000).
Strength training can improve steadiness in persons with essential tremor. Muscle & Nerve, 23(5), 771-778.

Ćwiękała-Lewis, K.,J., Gallek, M., & Taylor-Piliae, R. (2017). The effects of tai  chi on physical function and well-being among persons with parkinson’s disease: A systematic review. Journal of Bodywork and Movement Therapies, 21(2), 414-421.
doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1016/j.jbmt.2016.06.007

Farthing, J. P., Borowsky, R., Chilibeck, P. D., Binsted, G., & Sarty, G. E. (2007). Neuro- physiological adaptations associated with cross-education of strength. Brain Topography, 20(2), 77-88. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1007/s10548-007-0033-2

Hart, C. E. F., & Tracy, B. L. (2008). YOGA AS STEADINESS TRAINING: EFFECTS ON  MOTOR VARIABILITY IN YOUNG ADULTS. Journal of Strength and Conditioning Research, 22(5), 1659-69.

Helmich, R.C., & Dirkx, M.F. (2017). Pathophysiology and Management of  Parkinsonian Tremor. Seminars in Neurology, 37, 127-134.

Kavanagh, J. J., Wedderburn-Bisshop, J., & Keogh, J. W. L. (2016). Resistance  training reduces force tremor and improves manual dexterity in older individuals with essential tremor. Journal of Motor Behavior, 48(1), 20-30. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1080/00222895.2015.1028583

Kidgell, D., & Pearce, A. (2010). Neural adaptations following cross-education  strength training: A pilot study. Journal of Science and Medicine in Sport, 12, 1. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1016/j.jsams.2009.10.107

Lee, M., Gandevia, S. C., & Carroll, T. J. (2009). Unilateral strength training increases  voluntary activation of the opposite untrained limb. Clinical Neurophysiology, 120(4), 802-808. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1016/j.clinph.2009.01.002

Li, F., PhD., Harmer, Peter,PhD., M.P.H., Fitzgerald, K., M.D., Eckstrom, Elizabeth,M.D.,  M.P.H., Stock, R., M.D., Galver, J., P.T., . . . Batya, S. S., M.D. (2012). Tai chi and postural stability in patients with parkinson’s disease. The New England Journal of Medicine, 366(6), 511-9.

Ni, M., Mooney, K., & Signorile, J. F. (2016). Controlled pilot study of the effects of  power yoga in parkinson’s disease. Complementary Therapies in Medicine, 25, 126-131. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1016/j.ctim.2016.01.007

Pal, P. K. (2011). Guidelines for management of essential tremor. Annals of  Indian Academy of Neurology, 14(Suppl1), S25–S28. http://doi.org/10.4103/0972-2327.83097

Reeva, M., & Campbell, D. Exercise for relaxation & improve life’s quality

Sequeira, G., Keogh., J.W., & Kavanagh, J.J. (2012). Can resistance training  improve fine manual dexterity in Essential Tremor patients? Archives of Physical Medicine and Rehabilitation, 93, 1466-8.

Yang, Y., Li, X., Gong, L., Zhu, Y., & Hao, Y. (2014). Tai chi for improvement of motor  function, balance and gait in parkinson’s disease: A systematic review and meta-analysis. PLoS One, 9(7), e102942. doi:http://dx.doi.org.myaccess.library.utoronto.ca/10.1371/journal.pone.0102942

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