Physio, Exercise and The Joys of Dual Tasking

As a physio working with people with PD my task is to listen intently, observe posture, movement, and the intent to move. I feel the body’s response to movement, I question, and I try to imagine a world of being that I have only limited insight into. I take my cues from the person I’m working with, from their carers and families. My clinical encounters are an exchange of ideas – we’re working it out together.

It’s an exciting time to be a physio in the world of PD. Over the past decade we’ve learnt a lot about the relationship between movement and cognition, which is critical to understanding motor deficit in PD. We know that both are influenced by pathology, and that dopamine deficiency is only one of the culprits – other neurotransmitters such as cholinesterase and serotonin are keen to be in on the act of degradation. They all influence cognition and therefore motor performance. As physios we test the impact of cognition on motor performance. Have you ever been asked to perform two tasks at once, such as walking and subtracting serial 7 numbers backwards from a given number? If not, I’m sure your turn will come. It’s hard to do without slowing down or stopping altogether. Sometimes during assessment we ramp up task difficulty even further, to help identify where the problem lies. We may introduce an unexpected task and then observe the motor response. The most concerning threats to balance are unseen or unanticipated, and actions are not always sufficient to prevent a slip or a fall. The challenge is to find ways to improve these responses, which is harder than improving anticipatory balance responses such as reaching or stepping.

We’re also riding a global wave that speaks to the virtue of exercise and physical activity, and as physios we get fairly excited by this. But we’re realistic and understand the need to find activities to suit each person. Exercise may be training for a vigorous event, it may be a 30 minute walk each day, a gym class, Tai Chi, yoga, dance, it may be walking short distances to interrupt long periods of sitting. Evidence for the benefits of exercise in PD is strong  and there is some evidence in animal models to suggest it may also be neuroprotective. Even if exercise does not modify the pathology itself, it certainly has an effect on the secondary consequences of PD such as reduced strength, aerobic deconditioning, loss of general dexterity. Exercise can enhance the uptake of medication. It fires up our endorphins and makes us feel good. Getting started is hard, and finding the resources to commit long term is challenging, especially in PD. Motivation is a slippery eel.

It’s a privilege to work with the PD community, all as we move towards a brighter future, and WPC is integral to that future. You have been warned – at the next congress there may be someone lurking about who says to you ‘Oh –  would you mind - can you subtract 7 from 181 and keep subtracting backwards, whilst you walk towards that chair at your usual pace?’


Sue Lord, PhD served on the Program Committee of and presented at the Fourth World Parkinson Congress in Portland, Oregon. She currently serves as a Senior Research Fellow at School of Clinical Sciences, Auckland University of Technology, New Zealand

Ideas and opinions expressed in this post reflect that of the author(s) solely. They do not necessarily reflect the opinions of the World Parkinson Coalition®