September: Weight Shifting

Fall is coming and it is time to move onto a new focus. September at Ignite Classes is all focused on weight shifting. Us physical therapists LOVE weight shifting, but let us share a little about why it is so important to us and critical to maintain for people with Parkinson’s.

First we should start with a definition. Weight shifting: moving the body's center of pressure back and forth over a fixed base. Imagine standing with your feet shoulder width and needing to reach for an object towards the right on a high shelf. In order to reach it you would need to move almost all your weight towards your right foot as you reach. Sounds easy and maybe a little boring, but it is actual critical for initiation of movement, changing directions, reaching, turning, and so much more. More importantly, impairments in ability to shift your weight have been shown to be one of the main factors leading to freezing of gait.

So now let’s define Freezing of Gait: the sudden inability to move while or with initiation of walking. This is usually characterized by a feeling of feet being stuck to the floor or the feeling of the rest of the body moving forwards while the feet remain behind. Freezing of gait most commonly happens to people when trying to first start walking, turing 180 or 360 degree turns, walking through narrow areas like a doorway, and stepping up a curb or step. It can also be worsened when you are feeling more stressed or during mutli tasking. As you can imagine this could make life very inefficient, but more critcally it can make you more likely to fall. This phenomenom does not happen to all people with Parkinson’s, but those of you who have dealt with it know how concerning and challenging it can be to overcome.

What most people do not realize is all the above activities require a weight shift in order to successfully complete them. For example, let’s break down starting to walk. Imagine you are standing there with 2 feet on the ground and you want to start walking forwards. In order to start walking forwards you will first need to subtly shift most of your weight onto one foot into order to take a step forwards with the other foot and start walking. Most of us never think about this as it is an automatic part of movement thanks to our elaborate neurologic system. Unfortunately with Parkinson’s a lot of those automatic movements are effected and the weight shift does not happen…i.e. you cannot start walking. And now you are frozen!

So what are we going to do about this and can it be prevented? As always, awareness helps! Conscious movement, ie conscious weight shifting can make it less likely to happen or at the least limit the effect of freezing on your function. Let’s take a scan through the evidence to see what is most effective to maintain that weight shift and prevent freezing episodes:

Let’s focus our attention on a current review:

Gilat, M., Ginis, P., Zoetewei, D. et al. A systematic review on exercise and training-based interventions for freezing of gait in Parkinson’s disease. npj Parkinsons Dis. 7, 81 (2021). https://doi.org/10.1038/s41531-021-00224-4

I’ll review the article consensus. Here is the good news, this systematic review found that all types of exercise/training that were studied to help with freezing had a statistically significant improvement in this issue. This included many different training options from generic exercise to more specific training strategies for freezing of gait. Exercise shown to help include: Tango dancing, nordic walking, swimming, Tai Chi, yoga, etc. The bad news is that none of these strategies showed long term retention. Meaning, if you stop doing it, you are more likely to start freezing again. Let’s use this as motivation though to keep exercising and practicing skills as preventative medicine!

This review found that up front, hopefully before the freezing episodes begin, you need to participate in regular moderate to vigorous exercise and maintain this as long as possible. This will not only maintain your physical fitness, sleep and mental health, and slow down motor symptoms, but it is also shown to delay the onset of freezing of gait. Once these episodes start to happen then you will want to get training that is specifically related to Freezing of gait, which includes balance/specific gait training and multi-task training that challenges the cognitive loops and the motor loops in your brain concurrently. If this problem becomes severe then the you will want to the start learn Freezing of gait specific strategies which are compensatory and behavioral modifications to prevent a freezing episode. To sum it up, they are proposing that with up front intense exercise followed by some balance/walking training we can shift the onset of this issue. And this is why we need to weight shift!

There is strong evidence also showing that people with Parkinson’s who exhibit freezing of gait do tend to have worse postural control, or balance, than people who do not have freezing episodes. There is additional research showing more specifically that people who freeze have issues with voluntary weight shifting, but other types of balance are still fairly intact. This further strengthens the importance of completing a well rounded exercise program that includes balance training in your weekly schedule. More specifically it should include what we therapists call “dynamic balance training” as most of the issue are happening with movement or attempting to initiate movement. I cannot count how many times I have given just simple weight shifting movements as a home exercise program to my patients and there is a reason it is a main part of the PWR Moves!

So in summary, keep up that intense exercise and make sure you are attending to your balance training as well. If you even feel stuck take a movement to reassess your balance and then purposefully shift that weight one direction and try to move again.

As always, please feel free to reach out to us with any additional questions or comments you have about this topic. If this information sounds helpful to someone else you know, please feel free to share the newsletter.

The more you know, the further you can shift,

Laura

Additional References:

Cosentino, C., Baccini, M., Putzolu, M., Ristori, D., Avanzino, L. and Pelosin, E. (2020), Effectiveness of Physiotherapy on Freezing of Gait in Parkinson's Disease: A Systematic Review and Meta-Analyses. Mov Disord, 35: 523-536. https://doi.org/10.1002/mds.27936

Bekkers EMJ, Dijkstra BW, Dockx K, Heremans E, Verschueren SMP, Nieuwboer A. Clinical balance scales indicate worse postural control in people with Parkinson's disease who exhibit freezing of gait compared to those who do not: A meta-analysis. Gait Posture. 2017 Jul;56:134-140. doi: 10.1016/j.gaitpost.2017.05.009. Epub 2017 May 11. PMID: 28544951.

Vervoort, Griet, Nackaerts, Evelien, Mohammadi, Farshid, Heremans, Elke, Verschueren, Sabine, Nieuwboer, Alice, Vercruysse, Sarah, Which Aspects of Postural Control Differentiate between Patients with Parkinson’s Disease with and without Freezing of Gait?, Parkinson’s Disease, 2013, 971480, 8 pages, 2013. https://doi.org/10.1155/2013/971480