December: Arm Swing during Walking

We are almost at year’s end and I thought we could squeeze in one more newsletter before we ring in a new year. This month at Ignite we have been focusing on facilitating arm swing in our exercise classes. A change in the natural movement of your arms during walking is often one of the first motor signs that people or their family members note with Parkinson’s. This typically starts on one side of the body only and usually prior to noting changes in your walk in your lower body. The question that many of my patients often ask is why does this happen and why is this important to my walking function?

I say we start with learning a little bit more about normal arm movements with ambulation. Why do we swing our arms while we walk? Arm swing helps to counter balance our leg movements, maintain stability, and reduce energy expenditure with walking. It helps to reduce the amount of twisting movement at the trunk and pelvis which allows for a smoother walking pattern and less energy expenditure of the leg muscles. With reduced or absent arm swing you can have increased trunk movements leading to more imbalance. It can also cause quickness to fatigue of the lower body leading to worsening walking endurance and a sense of weakness in the legs with prolonged walking. So hopefully now you buy why arm swing can be very helpful and important for gait.

The next questions I want to address is the why this happens in Parkinson’s. Let’s see what the research has to tell us. This systematic review from 2023 reviewed all the articles related to arm swing during walking for people with Parkinson’s. They found that evidence does show that there is signifiant asymmetry of arm swing for PwP as well as a lower arm swing amplitude compared to people without Parkinson’s. They did report that change in arm swing can itself be an independent predictor of falls. Another interesting piece of evidence to note from this study is that they found across multiple studies that arm swing asymmetry was similar both ON and OFF dopamine medication. As they found that it truly is one of the earliest signs of changes in gait in Parkinson’s and it is not as responsive to medication as some other symptoms we need to find other ways to work on this function.

Another systematic review looked more into the details of the kinematics or science of the movement of arm swing to help explain the why. They found that EMG studies (analyzing muscle activity) have found arm swing is actively controlled which explains why it is affected for most people with Parkinson’s. They suggest that rigidity (stiffness), bradykinesia (slowness of movement), as well as incoordination all play a roll in the reduction of arm swing. Once the arm is not swinging there is less counterbalance of the opposite leg and then the body starts to twist and sway more leading to imbalance.

Let’s move onto how we can improve arm swing to improve and sustain walking function. I do not mean to sound like a broken record, but I want to start by stressing the importance of regular exercise. As I have discussed in previous newsletters we know that intense exercise, especially aerobic exercise, has significant improvement and can even recover function for all motor symptoms. I cannot stress this enough, but get your heart going.

Since we are discussing walking and more specifically arm swing with walking in this newsletter I did another evidence scan on best treatment for this topic. Looking at a systematic review regarding the effects of exercise on gait function they found that overall the most helpful type of exercise you can do to improve walking is walking specific exercise rather than general exercise. Sounds obvious right!? This does not necessarily mean just start walking more, but it means conscious and focused walking or walking related movements. The evidence shows that focusing your attention during your focused walking on arm swing specifically can help to improve walking ability overall.

Many other articles have found that use of external cueing is one of the best ways to facilitate improved walking. This could come in the form of a verbal cue from yourself or a partner, it could be using visual cues to step to lines on the floor, or it could be use of weight on your body to help you sense movement better. Music is a great external cue to help improve the natural rhythm of walking and coordination of arm swing. One study found significant improvement in the movements of the lower body with walking when they placed wrist weights on the participants to help them swing their arms more. There has also been arm sensors (vibration on wrist when arms are not swinging enough) developed to help remind you to move your arms to help you walk better. There is ample research on the benefits of nordic walking using walking poles and the benefits on improving walking function for people with Parkinson’s. Much of this occurs as the use of the walking poles facilitates a bigger and more powerful arm movement.

I think the last and most important take home from this section is that focused training and regular practice of conscious arm swing during walking will in turn help improve ALL aspects of walking.

I am sure before this newsletter you had not given your arm movements during walking this much thought, but I am hoping that I have brought awareness of the value of it now. I hope you start swinging your arms as a way to help initiate walking, increase speed of walking, increase step length, and overall improve your walking mechanics. Consider grabbing some walking poles or wrist weights to help facilitate this movement. Think about walking with a friend or partner and doing intervals of speed walking with exaggerated arm swing. Figure our what music helps you keep your rhythm. We are consistently working on gait challenges and coordination with arm swing in our ignite classes. We know that maintaining walking function is one of the primary goals of many people with Parkinson’s. Come join us if you are interested!

As always, if you know someone who may benefit from this newsletter please share and feel free to contact us with any questions. Also consider joining us January 15th for our first educational class about the science behind falls and how to reduce you fall risk. We will be offering it both in person and virtual and you can find more info on our website to sign up.

The more your know, the better your arms will swing.

Laura

Articles for your Reference:

Espinoza-Araneda J, Caparrós-Manosalva C, Caballero PM, da Cunha MJ, Marchese RR, Pagnussat AS. Arm swing asymmetry in people with Parkinson's disease and its relationship with gait: A systematic review and meta-analysis. Braz J Phys Ther. 2023 Nov-Dec;27(6):100559. doi: 10.1016/j.bjpt.2023.100559. Epub 2023 Nov 7. PMID: 37980716; PMCID: PMC10695845.

Priscila A. Rocha, Gustavo M. Porfírio, Henrique B. Ferraz, Virginia F.M. Trevisani, Effects of external cues on gait parameters of Parkinson's disease patients: A systematic review, Clinical Neurology and Neurosurgery, Volume 124, 2014, Pages 127-134,

Ni M, Hazzard JB, Signorile JF, Luca C. Exercise Guidelines for Gait Function in Parkinson’s Disease: A Systematic Review and Meta-analysis. Neurorehabilitation and Neural Repair. 2018;32(10):872-886. doi:10.1177/1545968318801558

Jiyeon Yoon, Jinse Park, Kunbo Park, Geunyeol Jo, Haeyu Kim, Wooyoung Jang, Ji Sun Kim, Jinyoung Youn, Eung Seok Oh, Hee-Tae Kim, Chang Hong Youm, The effects of additional arm weights on arm-swing magnitude and gait patterns in Parkinson’s disease, Clinical Neurophysiology, Volume 127, Issue 1, 2016, Pages 693-697,

Mainka, S., Schroll, A., Warmerdam, E., Gandor, F., Maetzler, W. and Ebersbach, G. (2021), The Power of Musification: Sensor-Based Music Feedback Improves Arm Swing in Parkinson's Disease. Mov Disord Clin Pract, 8: 1240-1247. https://doi.org/10.1002/mdc3.13352

Elizabeth Thompson, Peter Agada, W.Geoffrey Wright, Hendrik Reimann, John Jeka, Spatiotemporal gait changes with use of an arm swing cueing device in people with Parkinson’s disease, Gait & Posture, Volume 58, 2017, Pages 46-51, ISSN 0966-6362, https://doi.org/10.1016/j.gaitpost.2017.07.001.