The Power of HIIT to Combat Parkinson’s Symptoms

By Leisl Hymes, PT, DPT, NCS

Physical Therapist

In my time working with people with Parkinson’s disease (PD), both as a PT and at the specialized boxing gym I opened with a partner, I have seen and heard that with PD, “the little things get a lot harder.” This means that when physical therapists propose high-intensity interval training (HIIT), it can be a hard sell to people with PD -and their families.

Getting through daily routines is already difficult, and you want me to learn to box/dance/insert-complex-activity-here?

Educating patients about the research supporting HIIT and (as possible) connecting them to communities of people reaping HIIT’s benefits can get them on board. The results have been remarkable for large numbers of people with PD, so it’s worth knowing about how it works for them and some of the options for HIIT activities.

Meet Your Patient Where They Are

Doing HIIT with people with Parkinson’s means adapting to where they are and building on it.

Patients who have not been exercisers may be reluctant or argue that they “keep busy, isn’t that enough?” By accessibly teaching the research (150 minutes of exercise per week at greater than or equal to 80% of max heart rate), then monitoring HR to show what the recommended level of exercise intensity feels like, you can demonstrate to patients that simply “keeping busy” isn’t enough to reduce motor symptoms associated with PD. Also, starting with short intervals (“you can do anything for 30 seconds”) followed by rest breaks can show the patient that you’re receptive to their vital signs and subjective feedback about the intensity.

For a lifetime exerciser, this leap will be easier. They understand the concept of working at a high intensity and have experienced the psychological benefits of decreasing stress, anxiety, depression, and other mood disorders which are commonly non-motor symptoms of Parkinson’s. They also have experienced the physical benefits of exercise.

Education for these patients should focus on the importance of symptom-specific, challenging exercises. We all understand that if you are training to run a marathon, you will see greater improvements if your training is primarily running as opposed to biking or swimming. Likewise, if a patient with Parkinson’s is struggling with balance or trunk control and weakness, they will benefit more from exercises that emphasize these weaknesses. If a patient takes daily walks in the neighborhood, this is great — but it is not likely to achieve the level of intensity or challenge necessary to reduce symptoms. Their walk route is likely the same every day, they are accustomed to it, and they do not have to adjust or accommodate new challenges on this walk.

Patients with Parkinson’s Disease Benefit From a Wide Array of Different HIIT Activities

HIIT comes in many flavors. It can be implemented one on one. Many patients will also benefit from the community and encouragement of a group program. Crucially, if a patient enjoys the particular kind of exercise and its setting, they are much more likely to persist and to, therefore, see better results.

Boxing

Boxing-style workouts lend themselves to high-intensity intervals and specifically address many motor symptoms of PD. Many of the skills that boxers train to improve line up with symptoms of Parkinson’s.

• Tremors: Boxers train for improved hand-eye coordination.
• Bradykinesia: Boxers train for speed of movement.
• Rigidity: Boxers train for improved flexibility.
• Postural instability: Boxers train for optimal balance.
• Stooped posture: Boxers train to improve core strength.
• Shuffling gait and freezing: Boxers train for agility and rapid muscle fire.

Boxing is likely something new for a lot of people with PD, so it is important to emphasize that you are promoting non-contact, boxing-style training. The novelty may inspire more interest than the same exercises that they have always done in therapy. Also, boxing can be fun, and it provides an opportunity to release stress and anger that they might have about their diagnosis.

Dancing

Many forms of dance also fit well into the challenging and specific, high-intensity workout frame. Like boxing, dancing focuses on coordination, flexibility, balance, core strength, and agility.

Another benefit of dancing is the cognitive challenge. While certain dances have specific steps that are learned by rote, when actually dancing one must think on one’s feet, so to speak. Depending on the room, the partner, obstacles, density of people, the dancer is forced to make adjustments. This helps with preparing strategies for new or crowded environments.

Taiko Drumming

Taiko drumming is another modality that is being studied for its benefits on symptoms associated with PD. The large, vigorous, theatrical movements of Taiko are good for core strength, posture and balance. They establish a strong internal rhythm which can help with symptoms like bradykinesia and freezing.

How to Modify HIIT Exercises for Seated Positions

Yes, you can dance sitting down! Options for HIIT can all be adapted for a seated position if necessary. They can be tweaked to ensure that each person is working at a high intensity specifically appropriate for them based on their HR max. And each of these fun and engaging activities can provide ongoing variety and challenge rather than drudgery and repetition.

While it may sound as though specialized space and equipment are needed, all these activities can be easily adapted to a clinic or home setting. You can use a pair of boxing gloves and focus mitts, have the patient punch a balance pad that you hold, or even just utilize some shadow boxing in front of a mirror. Taiko style drumming can be done with a PVC pipe and a therapy ball.

With the right match of patient and HIIT modality – and some persistence – both the little things and the big things might even get easier.