Exercise, whether mild, moderate, or vigorous, has been shown
to have a positive effect on many major systems of the body.
Regular exercise enhances blood circulation, increases
respiration, strengthens muscle tone, improves the heart's
ability to pump blood and promotes feelings of well being.
Exercise programs should be individualized for therapeutic value
and satisfaction, as well as monitored for effect and overall
outcome.
Physical exercise can play a major role in slowing the
progress of any muscle debilitating illness, including PSP.
Regular exercise improves balance and coordination, and enhances
mobility. All of the activities of daily living, including
dressing, eating, bathing, and walking involve the use of various
muscles. Improving muscle tone and strength can allow the
individual to maintain his or her independence longer. Remember
that exercise should always be performed regularly, starting at a
mild level and gradually increased.
When first starting an exercise program, the individual should
try several short exercise periods at different times of the day.
Over a period of time, the goal of an uninterrupted exercise
program lasting 10-20 minutes should be achieved. This should
include a variety of exercises using many of the muscle groups of
the body.
If the patient cannot manage independent exercise, daily
passive exercises may be substituted. As the patient is assisted
to bathe or dress, the joints and muscles of the body can be
gently moved in all directions to enhance mobility and prevent
contractions. However, if possible, active exercises performed
independently are preferred.
The exercise program should involve the following joints: jaw
and facial muscles, neck, shoulders, wrist, fingers, legs, and
low back. All of these exercises should be performed slowly and
gently, never straining. None of the exercises should cause pain.
If any pain occurs, reduce the intensity of the exercise. If the
exercise continues to cause pain, stop until you have consulted
your physician or physical therapist. A slight pulling feeling is
usually expected to occur, however.
These exercises came from an article written for those with
Progressive Supranuclear Palsy (PSP). They are meant to be
typical only. Of course those with other neurological conditions
may find them helpful also. Likewise those with PSP should look
at exercise articles written for other diseases that may be found
on this and other websites.
Jaw and facial muscle exercises:
Muscles of the jaw and face are important for speech, chewing
and preparation for swallowing, and for facial expression.
Gradual weakening of muscles with rigidity results in a mask-like
facial expression. However, the weakening process may be slowed
by exercise. Start at the brow and draw muscles of brow upward
and then forward. Progress to muscles of eyes, nose, lips,
checks, contracting and relaxing each set. For jaw, clinch jaw
without gnashing teeth. Repeat each set of muscles 5-10 times in
a session in front of a mirror, or another person, until the
pattern appears easy to follow.
Neck exercises:
Neck exercises can be done while sitting in a chair. Try to
hold the stretched position for a count of five. Gradually
increase each of these exercises up to a performance of 5-10
times in a session.
Lower your chin to your chest. Hold this position, then
return to the center position.
Turn your head to the fight, looking over your shoulder; hold
and return to the center position. Repeat to the left.
Looking straight ahead, lower your fight ear toward your
right shoulder; hold and then return your head to a position
looking straight ahead. Repeat to the left.
Drop your chin forward so that it rests on your chest. Gently
roll your head to the right to the point where your right ear is
closest to your right shoulder. Hold this position ,and then roll
back to the contcr. Repeat to the left side.
Support yourself with your hands behind you on the floor or
in the bed. Jut your lower jaw forward. Gently allow your head to
drop backward; hold, then return to center. This exercise may be
performed before you get out of bed in the morning or later in
the daily exercise program when you are already on a mat or quilt
on the floor.
Shoulder exercises:
Shoulder exercises can be performed while sitting in a chair
or standing. Gradually increase each exercise until all are
repeated 10-15 times.
Raise your shoulders as high as you are able toward your
head, then let go suddenly, allowing gravity to drop your
shoulders and arms. Inhale when you raise your shoulders and
exhale when you allow them to drop. (This exercise relieves
tension in the neck, shoulders, and upper back.)
Raise your shoulders as high as you can and roll them back,
down, front, and back up to the original position in a continuous
circular motion. You can do one shoulder at a time or both
together. Reverse the direction.
Stand or sit with your left foot about 12 inches in front of
your right foot. Swing the fight arm in a circle front to back as
if you were winding up to pitch a softball. Try to keep the elbow
straight but not locked. Reverse your leg position and perform
this exercise with your left arm. If a caregiver is assisting you
in performing this exercise, he or she should rotate each
shoulder in a large circle, first clockwise and then
counter-clockwise.
Stand or sit with our feet parallel, about two feet apart,
with your knees slightly bent (if you are standing). Trying not
to lean backward, rotate both arms in a baseball pitching motion,
alternating in one continuous movement. Reverse the
direction.
Fold both arms across your chest with your feet flat on the
floor. Bend forward so that your elbows are over your knees. Lean
forward, twisting to your left elbow to try to touch your right
knee. Return to an upright position. Next, reverse the exercise,
twisting at the waist and trying to touch your right elbow to
your left knee. (This exercise will stretch your shoulder and
waist.)
Wrist and finger exercises:
Wrist and finger exercises can be performed while sitting in a
chair. Try to work up to a repetition of 5-10 times.
Hold your arms out in front of you. Keeping your elbows
straight, make circles. As you progress you can increase the arc
of motion of the circles. Then reverse the direction.
Hold your arms in front with your elbows bent. Bend your
wrist so that it is raised above your arm, then bend your wrist
so that it is below your arm. Next bend your wrist outward so
that it is pointing toward your elbow. Reverse this motion and
bend your wrist so that it is pointing inward.
Position your arms as in the previous exercise. Bend the
fingers of both hands to make a fist, then open your hands so
that your fingers are straight.
Leg and lower back exercises:
Sit in a chair with another chair placed in front of you.
Place one foot on the seat of the chair. Lean forward and place
both of your hands on your right knee. Gently press downward to
straighten your knee. Work up to holding this position for a
count of 20. Release the pressure, allow your hands to relax and
repeat 3 times. Then perform this exercise with your left knee
raised on the chair.
While sitting in a chair, have both feet flat on the floor in
front of you. Raise your fight leg so that your knee is straight.
Repeat 5 times and then raise your left leg.
While sitting in a chair, rest both feet flat on the floor in
front of you. Raise each foot so you are resting on your toes,
then roll your foot back so that you are only resting on your
heels. Repeat this exercise as rapidly as possible for a count of
20.
Exercises while lying flat:
The following exercises must be performed while lying flat,
either on the bed or on a floor mat. Try to work up to repeating
these exercises 5 times.
While lying flat on your back with your legs straight, place
both arms over your head. Stretch and hold for a count of 5 and
then relax.
While lying flat on your back with your legs straight on the
floor, pull your right knee toward your left shoulder. Hold for a
count of 5-10. Return to the starting position with your legs
straight. Repeat this exercise pulling your left leg toward your
right shoulder.
While lying flat on your back with both legs straight, pull
both knees toward your chest, hold for a count of 5 and return to
the starting position. Begin this exercise with your head flat on
the floor. You may progress to raising your head off the floor as
you raise your knees toward your chest.
While lying flat on your back, keep both shoulders flat on
the floor and straighten your left arm until it is level with
your shoulders. Bend your right knee. Turn your head to look
toward the hand of the arm that is straight. Use your left hand
to pull your bent, right knee over your left leg and attempt to
touch the floor beyond your left leg. Remember to keep both
shoulders touching the floor. Hold for a count of 5 and return to
your starting position, flat on your back with your legs
straight. Repeat this exercise, bending your left knee over your
right leg.
Turn over and lie on your abdomen with your legs straight.
With your arms at your sides, lift your right leg, return to the
floor and lift your left leg. As you progress, hold each leg
raised for a count of 1-2.
Help in Getting Around
Suggestions for Maintaining Balance
You may have noticed that you easily lose your balance when
attempting to walk, sit or stand. We have previously discussed
the reasons for this. If you continue to have problems with
balance, you may want to consult your physician and a physical
therapist. Also, remember that walking promotes bone as well as
muscle strength. Make a habit of wearing low heeled shoes with
"easy ties" or velcro fasteners, instead of light
weight slippers, for foot and lower leg support and to prevent
falling.
Hints to use when walking:
Before attempting to walk, spread your feet wide apart, about
10 inches. This will improve your overall balance and help
prevent your body from leaning in any direction. You may want to
check your balance in a minor before you begin to walk and again
while walking.
Exaggerate lifting your feet and toes when walking, as if you
are marching.
Exaggerate your arm swing, both forward and backward to
improve the cadence of walking.
Look straight ahead and lean slightly forward while you walk.
Try not to look at the floor as you walk, but note the presence
of any hazards beforehand in order to have them removed or
avoided. This posture will lessen the likelihood of a backward
fall.
Walking to music or counting while you walk also keeps the
slow, deliberate cadence.
Turn in a wide arc, always looking forward. Plan your turn to
have enough room for a wide arc. Never pivot in one spot.
Pivoting may offset the center of your body and cause you to lose
your balance.
If you find that using a walking cane or a walker steadies
your gait, ask a physical therapist or a nurse how to use
it.
Try to anticipate rapid steps backward so that you can stop
yourself before you lose your balance. If you are using a walker,
release it before falling because it may fall on you! Once you
have regained your balance, start again, taking high, long
deliberate steps. You may feel safer if you have a caregiver walk
to the side and a step back of you. Sometimes the use of a long
sturdy leather or web belt fastened around the patient's
waist with the "tail" extended for the caregiver to
grasp firmly will increase security.
Avoid talking when you walk. Talking may interfere with
concentration and ability to maintain your balance. If you need
to say something while you are walking, stop and talk, and then
resume walking.
Suggestions for sitting in a chair:
Select a heavy, straight chair with arms. You may want to
raise the height of the seat with a few firm pillows so you
won't have to lower yourself too far.
Stand with the back of your legs against the front of the
chair.
Place both hands on the arms of the chair.
Lean forward as far as possible.
Ease yourself into the chair slowly.
Suggestions for standing from a chair:
Place your hands on the arms of the chair.
Move forward in the chair to the edge, placing your feet
about 10 inches apart.
Rock forward slowly to gain some momentum.
On the count of 3, push down on the armrests quickly to raise
yourself from the chair.
Keep a moderate-weight walker nearby to assist with balance
after arising from a chair.
