The Parkinson Wellness Recovery (PWR!) Gym: A Model for Delivering Early and Continuous Access to Neuroplasticity-principled Exercise Programming for Individuals with Parkinson Disease (PD).

Theory Report
Population: Adult

Emily Elizabeth Borchers, PT, DPT, Physical Therapist, Parkinson Wellness Recovery

Becky Farley, PT, MS, PhD, Physical Therapist, Parkinson Wellness Recovery

Tara McIssac, PT, PhD, Associate Professor, AT Still University

Amy Casady, PT, DPT, Physical Therapist, Parkinson Wellness Recovery

Jennifer Bazan Wiggle, PT, DPT, Physical Therapist, Parkinson Wellness Recovery

Keywords: Plasticity

People with Parkinson Disease (PWP) can get better with exercise, yet traditional rehab is not implemented in a way that adheres to principles of practice shown in research to optimize brain function. Early intervention programs for PWP are not available despite research suggesting proactive exercise may slow the degenerative process or slow motor deterioration. Referrals to rehab are typically made after functional impairments have progressed to the point of disability. Even when short-term intensive therapy is available, the benefits of exercise quickly degrade unless adequate levels of continuous practice are maintained post-rehab. PWR!Gym specializes in proactive PD-specific wellness and neuroplasticity-principled group and 1:1 exercise programming for life. Care begins with an initial consultation with a PD-specialized therapist for assessment, education, 1:1 rehab, and practice of an individualized home exercise program as needed to get better. Members are then enrolled in an exercise class with a PD-specialized fitness instructor, three times per week for one hour consistent with their level of ability. Every 6 months, members meet with their PD-specialized therapist for a reassessment to capture changes in function and to address additional client goals with intensive practice. This ongoing cycle of personalized care from rehab to the community and back to rehab provides structure for ongoing monitoring to allow individuals to use their full potential to stay better. The techniques utilized at PWR!Gym are founded upon research in the fields of exercise science, motor control and motor learning. All group and 1:1 programming includes progressive aerobic training and PD-specific skill acquisition through amplitude-focused functional training. These movements (PWR!Moves®) can be performed in any position and directly target skills that interfere with everyday activities. They may be combined and progressed into a standalone exercise program or integrated into other research-based exercise approaches such as dance, tai chi, boxing, agility, pole walking, or task-specific training routines for gait, agility, strength, ADL, freezing, and dexterity. Therapists and instructors incorporate exercise for brain change principles when coaching participants through cognitive engagement, attentional focus, emotional engagement, and high physical effort. Preliminary data is available on PWR!Gym members at baseline and 6 months with ongoing data collection. We recently completed a pilot study from two rounds of group exercise programming exploring short-term effects of progressive aerobic training when paired with PWR!Moves®. Results suggest improvements in endurance, functional mobility, executive function, and non-motor symptoms associated with PD. We are continuing to explore novel therapy and group neuroplasticity programming opportunities based on recent research. The PWR!Gym community model provides a neuroplasticity-principled framework that is consistent with current European Guidelines and represents a paradigm shift necessary to truly slow disease progression.

Borchers, Emily Elizabeth, PT, DPT; Farley, Becky , PT, MS, PhD; McIssac, Tara , PT, PhD; Casady, Amy , PT, DPT; Bazan Wiggle, Jennifer , PT, DPT. The Parkinson Wellness Recovery (PWR!) Gym: A Model for Delivering Early and Continuous Access to Neuroplasticity-principled Exercise Programming for Individuals with Parkinson Disease (PD).. Poster Presentation. IV STEP Conference, American Physical Therapy Association, Columbus, OH, July 17, 2016. Online.