October: Don't Let Parkinson's Keep you down

The secret of moving from sitting to standing

Author

Ignite Neuro Fitness
October 22, 2024

Happy October everyone! This month at Ignite is all about getting up from sitting. Such a simple activity that we have to do possibly dozens of times a day. Despite the normalcy of this activity it actually requires much more strength, power, and anticipatory control than almost any other daily activity. As many of you may have already felt, it can become more difficult to move from sitting to standing when you have Parkinson’s.

I think first it is beneficial to break down the task. When you decide you are going to stand up your brain has to pull up that motor plan and it is a fairly complex one. It requires a well coordinated movement of the trunk and hips bending forwards while simultaneously keeping feet planted under body and knees bent.Then it requires your brain to switch instantly from everything bending to powerfully straigthening upwards again in a coordinated unfolding working against your body weight. Note that much of this task is all about coordination of movement and most critically shifting your weight forwards off your bottom (the heaviest part of your body!) and then propelling yourself against gravity up to full standing. Not an easy feat!

So why does this become difficult for some people with Parkinson’s? Well of course the reasons are multi factorial, but luckily have been studied! Let’s check out this systematic review to understanding what is happening to make this task less successful.

This group looked at all the relevant articles out there assessing sitting to standing and found a few patterns. I think one important consensus point from the article is that all the same muscles were activated in the same pattern as with people without Parkinson’s. This is great news! All the same muscles are coming on and can still be trained and utilized.

The reasons they found people with Parkinson’s were having difficulty getting up to standing really go back to some of the same issues that effect other movements

  1. Bradykinesia: Each step of the movement was not “big” or “fast” enough. They found that the “peak torques” or amount of rotational movement were reduced in more than one stage of the movement. This did not allow for enough of a forwards lean and weight shift to get off your rump and enough power to straighten yourself up to full standing. There was also reduced speed found initiating movement and during the movement. Speed is critical to produce power in your muscles and we require a fair amount of power to push our body weight up against gravity.

  2. Coordination issues: It was found that there was difficulty switching between the two main phases of sitting to standing: The bending/lift off phase vs the straightening/standing up phase. In Parkinson’s there can be some difficulty switching between 2 different tasks that require different patterns of muscle activation. First everything bends, then everything straightens. This moment between the two phases can take too long or not switch the pattern appropriately leading to falling back into the chair or not making it up to standing.

  3. Balance Control: Being off balance is a common issue for people with Parkinson’s and this loss of control can lead to more sense of instability rising from a chair. People with Parkinson’s were found to have reduced speed shifting their weight forwards (from their bottom to their feet) and then upwards. This effects where your body is centered over your feet. People were also found to compensate by bending forwards at their back (think stooped posture) instead of their hips which can lead to a feeling of being pulled back or falling back into your chair when you try to stand up.

This article looked specifically at the role of muscle strength in people with Parkinson’s and how this effects success with rising from a chair. Muscle weakness can be an issue not because the actual muscles are affected with Parkinson’s, but more so because there can more difficulty activating them fully and with power which can secondarily lead to weakness. The good news is this study only found one muscle group that did actual test as weaker for the participants with Parkinson’s that correlated with reduced ability to stand up: The gluts, i.e. you buttock muscles.

So what are we going to do about these potential issues? The first thing we suggest is to test yourself. There are a couple of standardized sit to stand tests we use regularly in physical therapy that can assess for your lower body functional strength, sit to stand success, and even be predictive of fall risk. You can try these both at home very easily from your standard dining room chair:

  1. The Five times sit to stand Test: Sit in a chair. The test does ask you to try this with your arms crossed over your chest. If you are unable to stand without pushing off with your hands then complete it with arm push off. Stand all the way up and sit back down 5 times and time yourself. Thats it!

    Cut off score: >16 seconds = increased risk of falls in Parkinson’s

  1. The 30 second Chair stand Test: Stand up and sit down as many times as possible within 30 seconds. This is looking more at endurance, but scoring below the age matched norms can be indicative of a fall risk.

Now let’s talk about best options to prevent issues with this critical daily skill or even how to restore function if you are finding it challenging. As most of you might guess, one of the best options is exercise!

We know that maintaining a regular and yes INTENSE exercise routine keeps your brain healthy and maintains your dopamine levels. We also know this has been shown to improve almost all motor and even some non motor symptoms with Parkinson’s. If you are already exercising, here a little something extra to do specifically to improve your sitting to standing.

First we can simply start with strengthening, and specifically of the gluts. There are many ways to strengthen this large but often underused muscle group. If you are working with a trainer then feel free to ask them, but below are a couple simple options that could be done at your home. All of these (except the top one) can be done with weight added to promote muscle growth and increase power.

These are 2 different ways to add weight to the same exercise

Second let’s think about creating speed and power with functional task training. Many studies with people with Parkinson’s have shown that one of the best ways to improve a difficult task is to practice that exact task with focus over and over again. The same goes for rising from a chair. Set yourself up on a higher than normal surface (your bed, a stool, a chair with extra cushions) and first practice sitting up tall and doing a large forwards lean at your hips. This should get you to the lift off stage and shift your weight forwards to your feet. Once you feel that lift off you want to think POWER to get up to standing. Power = Speed x Force (a little physics review for everyone). So move quickly but with a high level of muscle contraction. The higher chair should make the task easier and practicing as an exercise (maybe even with some music to help you keep a rhythm) will help you focus on the task to improve the skill over all.

There is also evidence that using what we call external cues (cues that help you move with a focus outside of your self) can be helpful to improve the task. We use these to facilitate movement daily in physical therapy! This could be a visual cue: “Lean until your eyes are looking at a spot between your feet and then stand up.” This could be a focus on an external physical challenge: “ Imagine standing up like you have tape over your shoes and you don’t want to rip it off. “ There has also been research showing that modeling, or trying to mirror what someone else is doing during the task is the most successful. If you have a partner or caregiver around then sit across from each other and match what they are doing with focused sit to stand training.

If you want to exercise, have a little fun, and also apply these skills please come join us at Ignite for our Ignite Intervals Class. We integrate these important concepts and functional training into all our classes. As always, if you think anyone would benefit from reading this newsletter please feel free to share!

The more you know, The better you can stand up.

Laura

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