York, PA - While sitting in his wheelchair, Dale McCoy faced his son Craig in the family's Hellam Township living room.
"Hands out," Craig McCoy said while demonstrating the movements. "Down to the floor."
With wide, concentrated eyes and slow stiff movements, Dale McCoy, 81, extended his arms in front of his body, bent at his waist and lowered his hands to the floor. While still in his wheelchair, he returned his torso to an upright position.
Craig McCoy asked his dad to do it again.
Dale McCoy has Parkinson's disease, a progressive nervous system disorder that affects movement. The stretching exercise is one of many he does to help retain his mobility. In recent years, experts have started encouraging Parkinson's patients to move more because studies have shown that regular physical activity can improve their quality of life.
Jennifer Harlacher, senior therapist for HealthSouth Rehabilitation Hospital in West Manchester Township, said fear of falling, embarrassment and depression sometimes prevent people from staying active after they've been diagnosed.
"People stop doing what they enjoy," she said. Health care providers have become more adamant about recommending physical activity, along with medication and rehabilitation, as part of a patient's treatment.
"Generally, it's only been the last few years that it's become much more standard-of-care," said Dr. Anthony May of WellSpan Health Neurology.
When in training and early in his practice, May said, the health care industry focused on medication when treating people with Parkinson's. Although medicine works, he said, it has side effects and it often becomes less effective after five years.
May said Parkinson's disease affects the speed, size and rhythm of movements, which are a combination of many individual movements. If the individual movements don't happen in the right sequence or in a rhythmic way, he said, the sequence deteriorates, and it becomes harder to move.
"The normal functioning person takes for granted the automatic way in which we make very complicated movements to get up and go walking or reach for something," he said.
May said such movements are behaviors learned over a lifetime, and that therapy and exercise could help patients retrain their brains to execute movements and function longer. And although exercise helps most patients, he said, it hasn't been proven to slow the progression of the disease. "It could be hard to distinguish whether it stalls the disease or improves the symptoms," May said.
Cindy Capresecco, program coordinator for WellSpan Neurology, said Parkinson's care has evolved in the last 10 years because of research.
She said exercise can suppress a patient's symptoms for four to six hours and that physical activity helps people sleep better. Also, exercise classes provide patients with a place to socialize. WellSpan offers free exercise, tai chi and dance classes weekly for people who have Parkinson's, and HealthSouth holds an exercise class once a month.
"There's so much they can do other than swallowing a pill," she said. Craig McCoy tries to get his dad to exercise every day. If Dale is having a good day, Craig might instruct him on exercises for an hour. Dale also attends a monthly exercise class for Parkinson's patients at HealthSouth. If Dale is tired, Craig doesn't force it, because he knows it might be more frustrating for his dad.
Dale, who formerly worked as a mason and woodcarver, lived an active life before he was diagnosed. He often went hiking and boating. His wife, Gladys, said she and his family started to notice problems with his walking. He shuffled his feet when he walked, and his gait had become shorter.
"The worse I felt, the more I tried to fight it," Dale said. One late-summer evening about 10 years ago, after taking his dog for a walk at Rocky Ridge County Park, he fell. About a month later, a neurologist diagnosed him with Parkinson's.
Dale said he had known something was wrong for a while. Craig said he saw the importance of exercise when his dad first worked with a therapist after he was diagnosed. "I hadn't seen him walking that good in years," he said.
Craig said when Dale isn't as active, such as after recovering from an illness or during the winter, his symptoms usually worsen.
Donald Neiman, 72, of York Township, had to learn to incorporate physical activity into his routines after he was diagnosed with Parkinson's about eight years ago. Neiman, who didn't exercise earlier in life, has attended classes up to three times a week.
Before he was diagnosed, he said, he needed a cane to walk. Now, he keeps the cane rested on a chair in his kitchen as a reminder to stay active. Neiman said he has seen some people with Parkinson's who haven't kept moving after being diagnosed.
"I've watched them decline," Neiman said. "I think their inability to face it reduced their life span."
However, May said, it can be difficult for patients to become active. Many patients might not have transportation or access to a safe exercise facility. Also, a patient who's skeptical of its benefits might not get as much out of it.
May said it's human nature to go through lulls in exercise, but for someone with Parkinson's, those breaks can cause problems. "The point is to maintain that walking," he said. "There's no better way to do that than to actually walk."
About Parkinson's disease
--April marks Parkinson's Awareness Month.
--About 50,000 to 60,000 Americans are diagnosed with Parkinson's disease every year. The progressive nervous system disorder affects movement.
--Parkinson's disease typically affects people who are 50 and older. Men are more likely than women to develop the disease.
--The main symptoms include shaking or tremors, slowness of movement -- bradykinesia-- stiffness or rigidity of the arms, legs or trunk, and trouble with balance.
--Secondary symptoms include cramped handwriting, reduced arm swing, slight foot drag that creates shuffled walking, freezing when attempting to walk, loss of facial expression, low voice or muffled speech, and a decrease of ability in automatic reflexes such as blinking and swallowing.
--People who have Parkinson's are typically treated with medication that enhances dopamine production in the brain. Some patients who are in the advanced stages may undergo deep brain stimulation, a procedure during which surgeons implant electrodes into the brain.
--There is no cure.
-- National Parkinson Foundation, The Mayo Clinic