their boss or coworkers, fearing the disclosure will adversely affect their job security. PD support groups are available in most areas of the country and provide a helpful forum for discussing Physical therapy Research has shown that regular exercise benefits those with PD. 6 It improves mobility, balance and gait, and may also reduce depression. A physical therapist may design an individualized exercise program for an individuals with Parkinson’s. It is best for people with PD to exercise when they feel most mobile, which is often about an hour after a dose of medication. Exercises that promote upright posture and that require balance are recommended as the first priority for individuals with PD. Such exercise includes walking, dancing, and most sports and aerobics classes. Alternatives that strengthen muscles are modified squats, pushing onto toes and wall pushups. Light weights may be used. Exercises that provide a good cardiopulmonary workout but do not promote or require balance, such as swimming or riding a stationary bicycle, are beneficial but are considered a “second Safety concerns Because it can lead to fractures or head injuries, falling is one of the most dangerous complications of PD. Individuals with PD are aware of the risk of falling and have usually been educated in ways to sit, stand and walk to reduce the risk. Dyskinesia may add to the risk of falling. References 1. CDC. Prevalence of doctor-diagnosed arthritis and arthritis-attributable activity limitation— United States, 2003–2005. MMWR 2006;55(40):1089–92. 2. CDC. Prevalence of self-reported arthritis or chronic joint symptoms among adults—United States, 2001 MMWR 2002;51(42):948–50. 3. CDC. Prevalence of disabilities and associated health conditions among adults—United States, 1999. MMWR 2001;50:120–25. 4. Nevitt MC. Obesity outcomes in disease management: clinical outcomes for osteoarthritis. Obes Res 2002;10:33S–37S. 5. Hurley MV. The role of muscle weakness in the pathogenesis of osteoarthritis. Rheum Dis Clin North Am 1999;25:283–98. 6. The best way to prevent osteoarthritis. (April 16, 2006). Johns Hopkins Health Alerts. http:// www.johnshopkinshealthalerts.com/alerts/arthritis/JohnsHopkinsArthritisHealthAlert_180-1. html. Accessed April 25, 2007. 7. Arthritis Foundation Self-Help Program. http://www.arthritis.org/events/getinvolved/ ProgramsServices/ArthritisSelfHelp.asp. Accessed April 26, 2007. 8. Christensen R, Astrup A, Bliddal H. Weight loss: the treatment of choice for knee osteoarthritis? A randomized trial. Osteoarthritis Cartilage 2005;13(1):20–27. 9. Altman RD, Hochberg MC, Moskowitcz RW, et al. Recommendations for the medical management of osteoarthritis of the hip and knee: 2000 update. American College of Rheumatology Subcommittee on Osteoarthritis Guidelines. Arthritis Rheum. 2000;43:1905– 15. 10. National Center for Complementary and Alternative Medicine. Questions and answers: NIH glucosamine/chondroitin arthritis intervention trial (GAIT). (February 2006). http://nccam.nih. gov/research/results/gait/qa.htm. Accessed April 25, 2007. 11. National Center for Complementary and Alternative Medicine. Massage therapy as CAM. (September 2006). http://nccam.nih.gov/health/massage/ Accessed April 26, 2007. 12. Which alternative treatments work? (August 2005). http://www.consumerreports.org/cro/ health-fitness/drugs-supplements/alternative-medicine-805/overview/index.htm. Accessed April 26, 2007. 13. Cherin DC, Sherman KJ, Deya RA, et al. A review of the evidence for the effectiveness, safety, and coast of acupuncture, massage therapy, and spinal manipulation for back pain. Ann Intern Med. 2003;138(11):898–906. 14. Perlman AI, Sabina A, Williams AL, et al. Massage therapy for osteoarthritis of the knee. Arch Intern Med 2006;166:2533–38. 15. Engebretson J. Massage found effective for chronic hand arthritis. Massage Today 2006;6(12). Available at http://www.massagetoday.com/mpacms/mt/article.php?id=13519. Accessed April 26, 2007. 16. Stitik, T. P., et al. (2011). Rehabilitation for osteoarthritis overview of osteoarthritis rehabilitation. Retrieved June 21, 2012 from http://emedicine.medscape.com/ article/305145-overview 17. Anderson, B. D. (2012). Patient information: Shoulder osteoarthritis treatment (Beyond the basics). Retrieved June 21, 2012 from www.uptodate.com/contents/shoulder-osteoarthritis- treatment-beyond-the-basics 18. Casley-Smith JR. Alternations of untreated lymphedema and its grades over time. Lymphology 28(4):174–85. 19. Deo SV, Ray S, Rath GK, et al. Prevalence and risk factors for development of lymphedema following breast cancer treatment. Indian J Cancer. 2004;41(1):8–12. 20. Revis DR, Jr. Lymphedema (October 25, 2005). http://www.emedicine.com/med/topic2722. htm Accessed April 10, 2007. 21. Brennan JF. Lymphedema following the surgical treatment of breast cancer: a review of pathophysiology and treatment. J Pain Symptom Manage 1992;7(2):110–16. 22. Kelly DG. A Primer on Lymphedema. Upper Saddle River, NJ: Pearson Education, Inc.: 2002. 23. Heyloer LK. Obesity is a risk factor for developing lymphedema in breast cancer patients. Poster 2-6, presented at the 2006 Annual Symposium of the American Society of Breast Disease. 24. Jeanne AP, Ruby TS, Peters M, et al. Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer 2001;92(6):1368–77. 25. Thiadens SRJ. 18 steps to prevention revised: lymphedema risk-reduction practices. (July 2005). http://www.lymphnet.org/lymphedemaFAQs/riskReduction/riskReduction.htm. Accessed April 15, 2007. 26. The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. Lymphology 2003;36:84–91. 27. Chapman C. Lymphedema 101: what every therapist should know. Massage Therapy Journal 2001:39(4): 86–90. 28. Fowler, G. R. (2010). Physical therapy management of primary lymphedema in the lower extremities: A case report. Physiotherapy: Theory and Practice, 26(1), 62-68.
issues such as these. Psychologists and social workers can provide additional guidance and support for individuals with PD.
tier” choice of exercise. Exercises that help maintain muscle mass are also suggested, but these should not include weight lifting. The American Parkinson Disease Association advises individuals with PD to structure adequate rest periods into their exercise program, wear shoes with good support, maintain normal breathing and move slowly through each exercise, avoiding bouncing motions. Strengthening exercises may help to maintain muscle mass. Muscle mass and strength help patients to maintain balance. Strengthening postural muscles may help the patient to maintain a more upright posture. Ultimately, a good fitness and exercise program helps to maintain proper posture and balance, and improve symmetry in flexibility and strength. 9 A common side effect of levodopa is dizziness upon rising, caused by orthostatic hypotension, or a drop of blood pressure when getting up. Be alert to this when the patient rises from a reclining position or gets up from a chair, and provide assistance as needed to help him or her avoid a fall. 29. Cruz, R. (2009). Lymphedema program. Beyond Basics, Newsletter, Fall, 2009. Retrieved June 21, 2012 from www.beyondbasicsphysicaltherapy.com 30. Bennett, RM. Fibromyalgia and the disability dilemma. A new era in understanding a complex, multidimensional pain syndrome. Arthritis Rheum 1996;39:1627–34. 31. Bennett RM. Principles of treating fibromyalgia (n.d.). http://www.myhalgia.com/treatment/ treatment percent20overview.htm. Accessed April 27, 2007. 32. Bazzichi L, Giannaccini G, Betti L, et al. Alteration of serotonin transporter density and activity in fibromyalgia. Arthritis Res Ther 2006;8(4):R99. 33. Russell I, Orr MD, Littman B, et al., Elevated cerebrospinal fluid levels of substance P in patients with the fibromyalgia syndrome. Arthritis Rheum 1994;37(11):1593–601. 34. Bennett RM. Disordered growth hormone secretion in fibromyalgia: a review of recent findings and a hypothesized etiology. Z Rheumatol 1998;57 Suppl 2:72–76. 35. Paiva ES, Deodhar A, Jones KD, et al. Impaired growth hormone secretion in fibromyalgia patients: evidence for augmented hypothalamic somatostatin tone. Arthritis Rheum 2002;46(5)1344–50. 36. McLean SA, Williams DA, Harris RE, et al. Momentary relationship between cortisol secretion and symptoms in patients with fibromyalgia. Arthritis Rheum 2005;52:3660–69. 37. Goldenberg DL, Simms RW, Geiger A, et al. High frequency of fibromyalgia in patients with chronic fatigue seen in a primary care practice. Arthritis Rheum 1990;33(3): 381–87. 38. Wolfe F, Smythe HA, Yunus MB, et al. The American College of Rheumatology 1990 criteria for the classification of f: report of the multicenter criteria committee. Arthritis Rheum 1990;33(2):160–72. 39. Goldenberg DL, Burckhardt C, Crofford L. Management of fibromyalgia syndrome JAMA. 2004;292:2388–95. 40. O’Malley PG, Balden E, Tomkins G, et al. Treatment of fibromyalgia with antidepressants: a meta-analysis. J Gen Intern Med. 2000 (9):659–66. 41. Arnold LM, Lu Y, Crofford LJ, et al, for the Duloxetine Fibromyalgia Trial Group. A double- blind, multicenter trial comparing duloxetine with placebo in the treatment of fibromyalgia patients with or without major depressive disorder. Arthritis Rheum 2004;50(9):2974–84. 42. American College of Rheumatology. Fibromyalgia. (June 2006) http://www.rheumatology. org/public/factsheets/fibromya_new.asp. Accessed April 27, 2007. 43. Field T J, Diego M, Cullen C, et al. Fibromyalgia pain and substance P decrease and sleep improves after massage therapy. Clin Rheumatol. 2002 8(2):72–76 44. Sunshine W, Field T, Schanberg S, et al. Fibromyalgia benefits from massage therapy and transcutaneous electrical stimulation. J Clin Rheumatol 1996;2:18–22. 45. WebMD. (2012). Fibromyalgia health center. Fibromyalgia and physical therapy. Retrieved June 22, 2012 from www.webmd.com/fibromyalgia/guide/fibromyalgia-and-physical- therapy 46. Everyday Health. (2011). How physical therapy eases fibromyalgia pain. Retrieved June 22, 2012 from http://www.everydayhealth.com/fibromyalgia/ease-fibromyalgia-pain-with- physical-therapy.aspx 47. Di Minno M, Aminoff JF. Overview of Parkinson Disease (n.d.). National Parkinson Foundation. http://www.parkinson.org/NETCOMMUNITY/Page.aspx?&pid=226&srcid=201. Accessed April 16, 2007. 48. University of California, San Francisco, Parkinson’s Disease Clinic and Research Center. Introduction to Parkinson’s Disease (n.d.). http://www.ucsf.edu/brain/pdcenter/intropdmod1. htm Accessed April 24, 2007. 49. Shobha SR, Hofmann LA, Shakil A. Parkinson’s disease: diagnosis and treatment. Am Fam Physician 2006;74(12):2056-56. 50. TA Zesiewicz, M Gold, G Chari, RA Hauser. Current issues in depression in Parkinson’s disease. Am J Geriatr Psychiatry 1999;7:110–18. 51. Parkinson’s Disease Foundation. Medications and Treatments (n.d.). http://www.pdf.org/ AboutPD/med_treatment.cfm. Accessed April 24, 2007. 52. Fisher B, Yip J. Physical therapy for individuals with Parkinson’s disease: a paradigm shift (n.d.). http://www.parkinson.org/NETCOMMUNITY/Page.aspx?&pid=402&srcid=198. Accessed April 24, 2007. 53. Harnandez-Reif M, Field T, Largie S, et al. Parkinson’s disease symptoms are differentially affected by massage therapy vs. progressive muscle relaxation: a pilot study Journal of Bodywork and Movement Therapies 2002;6(3)177–82. 54. Duval C, Lafontaine D, Hebert J, et al. The effect of Trager therapy on the level of evoked stretch responses in patients with Parkinson’s disease and rigidity. J Manipulative Physiol Ther 2002;25:7 455–64. 55. University of California. (2010). Exercise and physical therapy for Parkinson’s Disease. San Francisco: University of California.
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